Doctor: Diane Korb
Title: Severe maternal morbidity in women with twin pregnancies
Supervisors: Catherine Deneux, Thomas Schmitz
Doctoral school: ED 393 Epidemiology and Biomedical Information Sciences, Université Paris Cité
Date of thesis defense: 12/2020
Jury: Jean Bouyer, Damien Subtil, Catherine Arnaud, Alexandre Dumont, Sophie Alexander
The rate of twin pregnancies is 1.5% in France. Neonatal risks associated with twin pregnancy are well characterized, in contrast to maternal complications. The objective of this thesis was to assess severe short-term acute maternal morbidity and its determinants in women with twin pregnancy in the French population-based cohort, JUMODA. About one in 17 women with a twin pregnancy developed a severe maternal morbidity event (6.1% (95% CI 5.6-6.6)). This risk exceeded 25% for some particular subgroups of women. Two potential risk factors of severe maternal morbidity were analyzed: the mode of conception and the mode of delivery. The risk of severe maternal morbidity was higher among women with IVF using either autologous oocytes (aOR 1.5, 95% CI 1.1–1.9) or oocyte donation (aOR 2.7, 95% CI 1.8–4.1) than in those who conceived naturally. There was no overall association between the planned mode of delivery and severe acute maternal morbidity, except for women older than 35 years, at higher risk of severe maternal morbidity after planned cesarean delivery than after planned vaginal delivery (aRR 1.44, 95% CI 1.02–2.06). Compared to vaginal delivery for both twins, the risk of severe acute maternal morbidity was higher in case of cesarean for both twins (aRR 1.56, 95% IC 1.16-2.10) or for the second twin (aRR 2.22, 95% IC 1.27-3.88). Twin pregnancy is therefore a high risk situation for severe maternal complications. Our results will make it possible to personalize the information given to women with twin pregnancy on their risks of complications according to their own characteristics, and to inform, prior to pregnancy, the choice of the mode of conception, and then that of the delivery route.