Abstract
BACKGROUND: We aimed to investigate risk factors of adverse maternal outcomes associated with preeclampsia (PE) in twin pregnancies and develop a simplified clinical prediction model. METHOD: We recruited pregnant women with preeclampsia who were hospitalized in Fujian Maternal and Child Health Hospital from January 2014 to December 2021, including singleton and twin pregnancies. We further divided twin pregnancies into adverse outcome group and non-adverse outcome group. We performed univariate analysis, the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analysis to identify factors influencing adverse maternal outcomes associated with preeclampsia in twin pregnancies, then established a predictive model. The predictive performance was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration plots and decision curve analysis (DCA). RESULTS: Twin pregnancies with PE showed a higher prevalence of adverse outcomes compared with singleton pregnancies (17.4% VS 13.6%). Gestational age at admission less than 32 + 0 week gestational age, multipara, peak systolic blood pressure, creatinine, neutrophil/high-density lipoprotein ratio (NHR)and decreased platelet count were independent risk factors for the development of adverse outcomes of PE in twin pregnancies. The area under the ROC curve of the prediction model was 0.798 and the calibration curve indicated that adverse maternal outcomes rate predicted by the model was consistent with the actual outcome. CONCLUSIONS: The predictive model can identify women at increased risk of adverse maternal outcomes associated with preeclampsia in twin pregnancies, which can provide suggestion for preeclampsia in twin pregnancies and intervening timely.