Early- versus late-onset preeclampsia in dichorionic diamniotic twin pregnancies: Which one is associated with an increased risk of adverse outcome

The perinatal outcome of early-onset (<34 weeks) and late-onset preeclampsia (≥34 weeks) has not been adequately studied in twin pregnancies. The aim of this study was to compare maternal and neonatal outcomes of twin pregnancies complicated by early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE).Material and methods: We collected data regarding gestational age-matched dichorionic twin pregnancies complicated by EO-PE (n=86) as well as data regarding LO-PE (n=184) delivered at Hafez and Hazrat Zeinab hospitals, from March 2013 to May 2018.Results: Maternal variables such as age, preconception BMI, and parity were comparable in both groups. After matching for gestational age, extremely low birth weight, NICU admission, intrauterine fetal death, neonatal death, non-cephalic presentation, antenatal magnesium sulfate and corticosteroid therapy were higher in EO-PE neonates (n=172) than LO-PE neonates (n=368). However, structural anomaly, respiratory distress, intrauterine growth restriction, length of NICU stay, and APGAR 1-min and 5-min scores were equal between the two groups. Also, an association was observed between LO-PE and assisted reproductive technology.Conclusion: There was a higher rate of LO-PE than EO-PE among twin pregnancies. Despite similar maternal outcome and gestational age, neonatal and fetal outcomes were worse for EOPE twins. Therefore, closer fetal surveillance and delivery at tertiary care center with advanced NICU are recommended for EO-PE twins