Postpartum Severe Acute Maternal Morbidity According to Gestational Age at Delivery in Twin Pregnancies: a Prospective Cohort Study


Objective: To assess the association between gestational age at delivery and postpartum severe acute maternal morbidity (SAMM) in twin pregnancies.

Methods: Secondary analysis of the JUMODA cohort, a national, prospective, population-based study of twin pregnancies in France. We excluded women with delivery before 32 weeks, with a fetal death or medical termination, with antepartum SAMM, or with antepartum conditions responsible for postpartum SAMM. The primary outcome was a composite of postpartum SAMM. We assessed the association between gestational age at delivery and SAMM by using multivariable multilevel modified Poisson regression modeling.

Results: Among the 7,713 women included, 410 (5.3%) developed postpartum SAMM. Compared with the reference category of 37 weeks, the risk of postpartum SAMM was significantly lower for all categories of earlier gestational age at delivery (from an adjusted RR of 0.34, 95% CI 0.17, 0.68 at 32 weeks to an adjusted RR of 0.71, 95% CI 0.54, 0.94 at 36 weeks), and did not differ for later gestational ages.

Conclusion: In twin pregnancies, compared with delivery at 37 weeks, delivery at earlier gestational ages is associated with a lower risk of postpartum SAMM. Continuing pregnancy beyond 37 weeks is not associated with an increased risk of postpartum SAMM.