Effect on Neonatal Outcomes in Gestational Hypertension in Twin Compared With Singleton Pregnancies
Bibliographic record
Abstract
OBJECTIVE: We tested the hypothesis that gestational hypertension may have a more benign effect on neonatal outcomes in twin compared with singleton pregnancies, because the elevated blood pressure in twin pregnancies may partly or merely reflect the extra demand for blood supply. METHODS: A retrospective cohort study of 102,988 twin and 5,523,797 singleton live births using the U.S. birth cohort linked birth and infant death data sets, 1998-2000. Main outcomes are relative risks (RRs) of adverse neonatal outcomes: preterm birth, intrauterine growth restriction (less than the third percentile), low 5-minute Apgar score (less than 4), and neonatal death comparing gestational hypertensive with no-event healthy pregnancies for twins and singletons. RESULTS: For singletons, crude RRs (95% confidence intervals) comparing gestational hypertensive with healthy pregnancies were 2.23 (2.20-2.25) for preterm birth (17.4 compared with 7.8%), 2.49 (2.45-2.53) for intrauterine growth restriction (7.4 compared with 3.0%), 1.33 (1.21-1.45) for low 5-minute Apgar score (2.6 compared with 2.0 per 1,000), and 1.07 (0.96-1.19) for neonatal death (1.9 compared with 1.8 per 1,000), respectively. For twins, the corresponding RRs were much lower or showed reversed associations: 1.21 (1.19-1.24) (63.6 compared with 52.4%), 1.04 (0.98-1.11) (16.4 compared with 16.4%), 0.32 (0.23-0.46) (4.1 compared with 12.7 per 1,000), and 0.21 (0.14-0.30) (3.6 compared with 17.2 per 1,000), respectively. The adjusted odds ratios showed a similar risk pattern in twin compared with singleton pregnancies after controlling for maternal race, age, education, marital status, parity, smoking, alcohol use, perinatal care use, and mode of delivery. CONCLUSION: Gestational hypertension has a much more benign effect on neonatal outcomes in twin compared with singleton pregnancies. There might be a need for twin- or multiple fetus-specific recommendations for hypertension management in pregnancy, but further interventional studies are needed to test the hypothesis. LEVEL OF EVIDENCE: II-2.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".