57. The impact of having twins on maternal cardiovascular adaptation during and after pregnancy

Introduction The cardiovascular adaptation required for pregnancy is considered a stress test for later life cardiovascular disease (CVD). Objective The aim of this study is to assess cardiovascular adaptation in women with a twin pregnancy during and after pregnancy. Methods In a population based prospective cohort study we compared 91 women with a twin pregnancy to 8089 women carrying a singleton. To determine cardiovascular adaptation during pregnancy we measured soluble fms-like tyrosine kinase-1 (sFLT-1), placental growth factor (PGF), systolic (SBP) and diastolic blood pressure (DBP), uterine artery resistance index (RI-UtA) and the occurrence of pre-eclampsia (PE). Six years after pregnancy maternal measurements were obtained on SBP, DBP, cardiac function and retinal calibers. Intima media thickness (IMT) and distensibility of the common carotid artery (CCA), SBP and DBP were also obtained nine years after pregnancy. Results sFLT-1 and PGF concentrations were higher in early and mid pregnancy in women with twin pregnancies compared to women with singleton pregnancies. Late in pregnancy, women with twin pregnancies showed a lower RI-UtA. Also a different DBP pattern was observed. Women with a twin pregnancy had a higher risk for developing PE (OR 3.15; 95% CI 1.52;6.53). Six and nine years after pregnancy, we did not observe differences in the cardiovascular profile. Discussion Women with a twin pregnancy show an altered cardiovascular adaptation during pregnancy compared to women with a singleton pregnancy. This is associated with a substantially increased risk for PE. However, this different cardiovascular stress during pregnancy does not seem to result in altered cardiovascular adaptation years after pregnancy.