{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:37:28Z","timestamp":1785800248743,"version":"3.56.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T00:00:00Z","timestamp":1662076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of adverse neonatal outcomes. Although twin pregnancies had a higher risk of developing HDP, it is not known whether HDP in twins will increase the risk of adverse neonatal outcomes. We aimed to assess whether this association differed in singleton and twin pregnancies in women who conceived with assisted reproductive technology (ART).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We finally included 193,590 live births born <jats:italic>via<\/jats:italic> ART from the National Vital Statistics System (NVSS) for the years 2015\u20132019. We used Log-binomial regression to evaluate the associations between HDP and the risk of adverse neonatal outcomes in ART mothers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 193,590 ART-treated mothers, there were 140,870 and 52,720 mothers who had singleton pregnancies and twin pregnancies, respectively. Those ART mothers with twin pregnancies had a higher rate of HDP than singleton pregnancies (20.5% vs. 11.0%). In singleton pregnancies, the risks of preterm birth [adjusted risk ratio (aRR)): 2.80, 95% CI 2.67\u20132.93], low birth weight (aRR: 2.80, 95% CI 2.67\u20132.93), small for gestational age (aRR: 1.41, 95% CI 1.34\u20131.49), 5 min Apgar &amp;lt;7 (aRR: 1.66, 95% CI 1.50\u20131.83) and cesarean section (aRR: 1.23, 95% CI 1.21\u20131.25) were significantly higher in HDP mothers than in non-HDP mothers respectively. However, in contrast to singleton pregnancies, these associations were weak or reversed in twin pregnancies, after adjusting for confounding factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In ART-treated women, although twin pregnancies had a higher HDP rate, the risk of adverse neonatal outcomes associated with HDP was lower than that of singletons.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2022.839882","type":"journal-article","created":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T07:37:56Z","timestamp":1662104276000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["Hypertensive disorders of pregnancy and neonatal outcomes in twin vs. singleton pregnancies after assisted reproductive technology"],"prefix":"10.3389","volume":"10","author":[{"given":"Ting","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hin Ching","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luyao","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binbin","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuhui","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoqun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.ejogrb.2010.10.012","article-title":"The impact of in vitro fertilization on health of the children: an update","volume":"154","author":"Fortunato","year":"2011","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1056\/NEJMoa0803072","article-title":"Cumulative live-birth rates after in vitro fertilization","volume":"360","author":"Malizia","year":"2009","journal-title":"N Engl J Med."},{"key":"B3","first-page":"1","article-title":"Infertility service use in the United States: data from the National Survey of Family Growth, 1982-2010","volume":"73","author":"Chandra","year":"2014","journal-title":"Natl Health Stat Report."},{"key":"B4","first-page":"1","article-title":"First births to older women continue to rise","volume":"152","author":"Matthews","year":"2014","journal-title":"NCHS Data Brief."},{"key":"B5","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.bpobgyn.2020.06.012","article-title":"Assisted conception in women of advanced maternal age","volume":"70","author":"Seshadri","year":"2021","journal-title":"Best Pract Res Clin Obstet Gynaecol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1001\/jama.2016.21311","article-title":"Contribution of assisted reproductive technology to overall births by maternal age in the United States, 2012-2014","volume":"317","author":"Levine","year":"2017","journal-title":"JAMA."},{"key":"B7","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1016\/j.ajog.2005.05.018","article-title":"results: optimize not maximize","volume":"194","author":"El-Toukhy","year":"2006","journal-title":"Am J Obstet Gynecol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/AOG.0000000000003021","article-title":"202 Summary: gestational hypertension and preeclampsia","volume":"133","year":"2019","journal-title":"Obstet Gynecol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1136\/bmj.38380.674340.E0","article-title":"Risk factors for preeclampsia at antenatal booking: systematic review of controlled studies","volume":"330","author":"Duckitt","year":"2005","journal-title":"BMJ."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1254","DOI":"10.1161\/CIRCULATIONAHA.113.003904","article-title":"Chronic hypertension in pregnancy","volume":"129","author":"Seely","year":"2014","journal-title":"Circulation."},{"key":"B11","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1002\/uog.17493","article-title":"Chronic hypertension and adverse pregnancy outcome: a cohort study","volume":"50","author":"Panaitescu","year":"2017","journal-title":"Ultrasound Obstet Gynecol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1186\/s13052-020-00926-0","article-title":"The impact of pregnancy induced hypertension on low birth weight in Ethiopia: systematic review and meta-analysis","volume":"46","author":"Getaneh","year":"2020","journal-title":"Ital J Pediatr."},{"key":"B13","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.ejogrb.2015.11.031","article-title":"Maternal clinical disease characteristics and maternal and neonatal outcomes in twin and singleton pregnancies with severe preeclampsia","volume":"201","author":"Connolly","year":"2016","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1038\/jp.2012.74","article-title":"Preterm severe preeclampsia in singleton and twin pregnancies","volume":"33","author":"Henry","year":"2013","journal-title":"J Perinatol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e20190076","DOI":"10.1542\/peds.2019-0076","article-title":"2017 US reference for singleton birth weight percentiles using obstetric estimates of gestation","volume":"144","author":"Aris","year":"2019","journal-title":"Pediatrics."},{"key":"B17","unstructured":"Guide to Completing the Facility Worksheet for the Certificate of Live Birth and Report of Fetal Death2003"},{"key":"B18","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1038\/hr.2016.126","article-title":"Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis","volume":"40","author":"Umesawa","year":"2017","journal-title":"Hypertens Res."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1093\/humrep\/dev090","article-title":"Risk of hypertensive disorders in pregnancies following assisted reproductive technology: a cohort study from the CoNARTaS group","volume":"30","author":"Opdahl","year":"2015","journal-title":"Hum Reprod."},{"key":"B20","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1016\/j.fertnstert.2015.12.024","article-title":"Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment","volume":"105","author":"Wang","year":"2016","journal-title":"Fertil Steril"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1414","DOI":"10.3390\/jcm9051414","article-title":"Racial disparity in pregnancy risks and complications in the US: temporal changes during 2007\u20132018","volume":"9","author":"Bornstein","year":"2020","journal-title":"J Clin Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1097\/HJH.0000000000001846","article-title":"Blood pressure changes during twin pregnancies: the Japan Environment and Children's Study","volume":"37","author":"Iwama","year":"2019","journal-title":"J Hypertens."},{"key":"B23","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1002\/uog.8936","article-title":"Maternal cardiac function in normal twin pregnancy: a longitudinal study","volume":"38","author":"Kuleva","year":"2011","journal-title":"Ultrasound Obstet Gynecol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1016\/j.ajog.2007.10.783","article-title":"Twin pregnancy and the risk of preeclampsia: bigger placenta or relative ischemia?","volume":"198","author":"Bdolah","year":"2008","journal-title":"Am J Obstet Gynecol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1161\/CIRCULATIONAHA.111.054361","article-title":"Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia","volume":"125","author":"Rana","year":"2012","journal-title":"Circulation."},{"key":"B26","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1016\/j.ajog.2014.11.035","article-title":"Maternal circulating angiogenic factors in twin and singleton pregnancies","volume":"212","author":"Faupel-Badger","year":"2015","journal-title":"Am J Obstet Gynecol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"g2301","DOI":"10.1136\/bmj.g2301","article-title":"Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis","volume":"348","author":"Bramham","year":"2014","journal-title":"BMJ."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1097\/01.AOG.0000238335.61452.89","article-title":"Effect on neonatal outcomes in gestational hypertension in twin compared with singleton pregnancies","volume":"108","author":"Luo","year":"2006","journal-title":"Obstet Gynecol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1038\/s41371-020-0312-x","article-title":"Hypertensive disorders of pregnancy and risks of adverse pregnancy outcomes: a retrospective cohort study of 2368 patients","volume":"35","author":"Li","year":"2021","journal-title":"J Hum Hypertens."},{"key":"B30","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1053\/sper.2002.34775","article-title":"Trends in the occurrence, determinants, and consequences of multiple births","volume":"26","author":"Blondel","year":"2002","journal-title":"Semin Perinatol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss6606a1","article-title":"Assisted Reproductive Technology Surveillance - United States, 2014","volume":"66","author":"Sunderam","year":"2017","journal-title":"MMWR Surveill Summ."},{"key":"B32","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1016\/S0002-9378(00)70350-4","article-title":"Hypertensive disorders in twin versus singleton gestations. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units","volume":"182","author":"Sibai","year":"2000","journal-title":"Am J Obstet Gynecol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.preghy.2015.01.003","article-title":"Is gestational hypertension beneficial in twin pregnancies?","volume":"5","author":"Ferrazzani","year":"2015","journal-title":"Pregnancy Hypertens."},{"key":"B34","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1111\/aogs.13774","article-title":"The maternal and perinatal implications of hypertensive disorders of pregnancy in a multiple pregnancy cohort","volume":"99","author":"Hayes-Ryan","year":"2020","journal-title":"Acta Obstet Gynecol Scand."},{"key":"B35","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1097\/AOG.0000000000004506","article-title":"Outcomes associated with hypertensive disorders of pregnancy in twin compared with singleton gestations","volume":"138","author":"Aviram","year":"2021","journal-title":"Obstet Gynecol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss6909a1","article-title":"Assisted Reproductive Technology Surveillance - United States, 2017","volume":"69","author":"Sunderam","year":"2020","journal-title":"MMWR Surveill Summ."},{"key":"B37","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1016\/S0140-6736(02)07804-2","article-title":"Surgically obtained sperm, and risk of gestational hypertension and preeclampsia","volume":"359","author":"Wang","year":"2002","journal-title":"Lancet."},{"key":"B38","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1186\/s12884-021-03938-8","article-title":"Assisted reproductive technology and hypertensive disorders of pregnancy: systematic review and meta-analyses","volume":"21","author":"Chih","year":"2021","journal-title":"BMC Pregnancy Childbirth."},{"key":"B39","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1093\/humupd\/dmx031","article-title":"Is frozen embryo transfer better for mothers and babies? can cumulative meta-analysis provide a definitive answer?","volume":"24","author":"Maheshwari","year":"2018","journal-title":"Hum Reprod Update."},{"key":"B40","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.ajog.2017.10.226","article-title":"Maternal hemodynamics: a method to classify hypertensive disorders of pregnancy","volume":"218","author":"Ferrazzi","year":"2018","journal-title":"Am J Obstet Gynecol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1097\/AOG.0000000000000451","article-title":"Clinical risk factors for preeclampsia in the 21st century","volume":"124","author":"Par\u00e9","year":"2014","journal-title":"Obstet Gynecol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"173","DOI":"10.5001\/omj.2013.49","article-title":"Perinatal outcome of monochorionic in comparison to dichorionic twin pregnancies","volume":"28","author":"Al Riyami","year":"2013","journal-title":"Oman Med J."},{"key":"B43","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1097\/AOG.0000000000000579","article-title":"Trends and correlates of monozygotic twinning after single embryo transfer","volume":"125","author":"Kanter","year":"2015","journal-title":"Obstet Gynecol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1017\/thg.2016.17","article-title":"Twin Chorionicity and the Risk of Hypertensive Disorders: Gestational Hypertension and Pre-eclampsia","volume":"19","author":"Bartnik","year":"2016","journal-title":"Twin Res Hum Genet."},{"key":"B45","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1016\/S0002-9378(85)80223-4","article-title":"Preeclampsia: an imbalance in placental prostacyclin and thromboxane production","volume":"152","author":"Walsh","year":"1985","journal-title":"Am J Obstet Gynecol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1056\/NEJMoa1704559","article-title":"Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia","volume":"377","author":"Rolnik","year":"2017","journal-title":"N Engl J Med."},{"key":"B47","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/j.ajog.2017.07.038","article-title":"Aspirin for evidence-based preeclampsia prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history","volume":"217","author":"Poon","year":"2017","journal-title":"Am J Obstet Gynecol."},{"key":"B48","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/S0140-6736(98)08049-0","article-title":"Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis","volume":"355","author":"von Dadelszen","year":"2000","journal-title":"Lancet."},{"key":"B49","doi-asserted-by":"publisher","first-page":"2123","DOI":"10.1097\/HJH.0000000000001456","article-title":"In-utero exposure to antihypertensive medication and neonatal and child health outcomes: a systematic review","volume":"35","author":"Fitton","year":"2017","journal-title":"J Hypertens."},{"key":"B50","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1186\/s12884-015-0654-5","article-title":"Pregnancy outcomes before and after institution of a specialised twins clinic: a retrospective cohort study","volume":"15","author":"Henry","year":"2015","journal-title":"BMC Pregnancy Childbirth."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.839882\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T07:38:02Z","timestamp":1662104282000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.839882\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,2]]},"references-count":50,"alternative-id":["10.3389\/fped.2022.839882"],"URL":"https:\/\/doi.org\/10.3389\/fped.2022.839882","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,2]]},"article-number":"839882"}}