{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T05:53:40Z","timestamp":1750312420759,"version":"3.28.0"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","issue":"05","funder":[{"name":"The National Institutes of Health's National Center for Advancing Translational Sciences","award":["UL1TR001422"],"award-info":[{"award-number":["UL1TR001422"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:p>\n            Objective\u2003Our objective was to investigate the association between maternal outcomes and twin chorionicity in a large, contemporary obstetric population.<\/jats:p><jats:p>\n            Study Design\u2003Retrospective cohort study was conducted at a single, large tertiary care center. Prenatal and inpatient records for all individuals with twin gestations were reviewed from 2000 to 2016. Patients with monoamniotic twins, higher-order multiples reduced to twins, multiple sets of twins in the study period, or undetermined chorionicity were excluded. Patients with monochorionic twins were compared with those with dichorionic twins. The co-primary outcomes were gestational diabetes mellitus and hypertensive disorders of pregnancy. Secondary outcomes included cesarean delivery, preterm delivery, postpartum hemorrhage, and other maternal outcomes. Bivariate and multivariate analyses were performed to assess associations of chorionicity with maternal outcomes.<\/jats:p><jats:p>\n            Results\u2003Of the 2,979 patients eligible for inclusion, 2,627 (88.2%) had dichorionic twin gestations and 352 (11.8%) had monochorionic twin gestations. Patients with monochorionic twins were less likely to self-identify as non-Hispanic White and to have conceived via assisted reproductive technology but were more likely to be publicly insured, multiparous and have prenatal care with a maternal\u2013fetal medicine provider. Neither gestational diabetes mellitus (6.8% monochorionic vs. 6.2% dichorionic, p\u2009=\u20090.74; adjusted odds ratio [OR] 1.06, 95% confidence interval (CI) 0.60\u20131.86) nor hypertensive disorders of pregnancy (21.9% monochorionic vs. 26.3% dichorionic, p\u2009=\u20090.09; adjusted OR 0.99, 95% CI, 0.71\u20131.38) differed by chorionicity. Of the secondary maternal outcomes, patients with monochorionic twins experienced a lower frequency of cesarean delivery (46.0 vs. 61.8%, p\u2009&lt;\u20090.001), which persisted after multivariate analyses (adjusted OR 0.60, 95% CI 0.46\u20130.80). There were no differences in preterm delivery, preterm premature rupture of membranes, hemorrhage, hysterectomy, or intrahepatic cholestasis of pregnancy.<\/jats:p><jats:p>\n            Conclusion\u2003The odds of gestational diabetes mellitus and hypertensive disorders of pregnancy do not appear to differ by twin chorionicity.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-1745-3118","type":"journal-article","created":{"date-parts":[[2022,1,19]],"date-time":"2022-01-19T23:37:46Z","timestamp":1642635466000},"page":"611-617","source":"Crossref","is-referenced-by-count":2,"title":["The Association of Twin Chorionicity with Maternal Outcomes"],"prefix":"10.1055","volume":"41","author":[{"given":"Rachael B.","family":"Cowherd","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"Department of Obstetrics and Gynecology, Division of Gynecology, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle T.","family":"Cipres","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"Division of Gynecology, Boston Children's Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liqi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia H.","family":"Barry","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha L.","family":"Estevez","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York City, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn M.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,2,21]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1097\/01.AOG.0000446856.51061.3e","article-title":"ACOG Practice Bulletin No. 144: Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies","volume":"123","author":"American College of Obstetricians and Gynecologists","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"09","key":"ref2","doi-asserted-by":"crossref","first-page":"2549","DOI":"10.1093\/humrep\/der213","article-title":"Stillbirth and neonatal mortality in monochorionic and dichorionic twins: a population-based study","volume":"26","author":"S V Glinianaia","year":"2011","journal-title":"Hum Reprod"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"578.e1","DOI":"10.1016\/j.ajog.2014.03.003","article-title":"Risk of late-preterm stillbirth and neonatal morbidity for monochorionic and dichorionic twins","volume":"210","author":"J L Burgess","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1002\/uog.6140","article-title":"Intrauterine growth in multiple pregnancies in relation to fetal number, chorionicity and gestational age","volume":"32","author":"A T Papageorghiou","year":"2008","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1016\/j.ajog.2005.04.007","article-title":"Persistance of adverse obstetric and neonatal outcomes in monochorionic twins after exclusion of disorders unique to monochorionic placentation","volume":"193","author":"L Leduc","year":"2005","journal-title":"Am J Obstet Gynecol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/AOG.0b013e318160d65d","article-title":"Twin chorionicity and the risk of stillbirth","volume":"111","author":"Y M Lee","year":"2008","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/S0002-9378(99)70324-8","article-title":"Gestational diabetes mellitus: metabolic and blood glucose parameters in singleton versus twin pregnancies","volume":"181","author":"D B Schwartz","year":"1999","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/S0002-9378(00)70350-4","article-title":"Hypertensive disorders in twin versus singleton gestations","volume":"182","author":"B M Sibai","year":"2000","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1080\/14767050802663194","article-title":"Risk for developing gestational diabetes in women with twin pregnancies","volume":"22","author":"J A Rauh-Hain","year":"2009","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"43","key":"ref10","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.15585\/mmwr.mm6743a2","article-title":"Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth\u2014United States 2012\u20132016","volume":"67","author":"N P 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Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy","volume":"122","author":"American College of Obstetricians and Gynecologists","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1017\/thg.2016.17","article-title":"Twin chorionicity and the risk of hypertensive disorders: gestational hypertension and preeclampsia","volume":"19","author":"P Bartnik","year":"2016","journal-title":"Twin Res Hum Genet"},{"issue":"05","key":"ref21","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1038\/s41581-019-0119-6","article-title":"Pre-eclampsia: pathogenesis, novel diagnostics and therapies","volume":"15","author":"E A Phipps","year":"2019","journal-title":"Nat Rev Nephrol"},{"issue":"03","key":"ref22","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1046\/j.0960-7692.2001.00470.x","article-title":"Twin chorionicity and pre-eclampsia","volume":"18","author":"M D Savvidou","year":"2001","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"01","key":"ref23","first-page":"100","article-title":"Pre-eclampsia and chorionicity in women with twin gestations","volume":"8","author":"A Singh","year":"2014","journal-title":"J Clin Diagn Res"},{"issue":"03","key":"ref24","doi-asserted-by":"crossref","first-page":"377.e1","DOI":"10.1016\/j.ajog.2014.10.029","article-title":"Mode of delivery preferences in a diverse population of pregnant women","volume":"212","author":"L M Yee","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref25","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/birt.12238","article-title":"Exploring women's preferences for the mode of delivery in twin gestations: results of the twin birth study","volume":"43","author":"B Murray-Davis","year":"2016","journal-title":"Birth"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1745-3118.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T14:34:15Z","timestamp":1730817255000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1745-3118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,19]]},"references-count":25,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2024,3,20]]},"published-print":{"date-parts":[[2024,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1745-3118","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"type":"print","value":"0735-1631"},{"type":"electronic","value":"1098-8785"}],"subject":[],"published-other":{"date-parts":[[2022,1,19]]},"published":{"date-parts":[[2022,1,19]]}}}