Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-14T08:55:26.320Z Has data issue: false hasContentIssue false

Chapter 16 - Hormones and Multiple Pregnancy

from Section II - Hormones and Gestational Disorders

Published online by Cambridge University Press:  09 November 2022

By
Viola Seravalli ,
Noemi Strambi  and
Mariarosaria Di Tommaso
Edited by
Felice Petraglia ,
Mariarosaria Di Tommaso  and
Federico Mecacci
Felice Petraglia
Affiliation:
Università degli Studi, Florence
Mariarosaria Di Tommaso
Affiliation:
Università degli Studi, Florence
Federico Mecacci
Affiliation:
Università degli Studi, Florence
Get access

Summary

In multiple gestations, an increased fetal-placental mass is believed to be responsible for higher maternal levels of placental hormones, such as human chorionic gonadotropin, estrogens, progesterone, and others, compared to singleton gestations. While some of these differences may confer an advantage to twins in terms of chance of survival in early pregnancy, on the other hand they can increase the risk of developing pathological conditions in pregnancy, such as gestational diabetes and obstetric cholestasis, which seem to occur more frequently in multiple than in singleton gestations.

Twin pregnancies have an increased risk of pre-term delivery compared to singleton gestations, and the reason for this is not completely understood. Differences in placental hormone profiles and in the degree of uterine stretch might explain this effect. Furthermore, the pathophysiological mechanisms involved in pre-term delivery may require different preventive and therapeutic strategies compared to singleton pregnancies.

Type
Chapter
Information
Hormones and Pregnancy
Basic Science and Clinical Implications
 , pp. 183 - 188
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Houghton, LC, Lauria, M, Maas, P, et al. Circulating maternal and umbilical cord steroid hormone and insulin-like growth factor concentrations in twin and singleton pregnancies. J Dev Orig Health Dis. 2019, 10(2):232–236.CrossRefGoogle ScholarPubMed
Kuijper, EA, Twisk, JW, Korsen, T, et al. Mid-pregnancy, perinatal, and neonatal reproductive endocrinology: A prospective cohort study in twins and singleton control subjects. Fertil Steril. 2015, 104(6):1527–15234.e1–9.CrossRefGoogle ScholarPubMed
Póvoa, A, Xavier, P, Matias, A, et al. First trimester β-hCG and estradiol levels in singleton and twin pregnancies after assisted reproduction. J Perinat Med. 2018, 46(8):853–856.Google Scholar
Smith, R, Smith, JI, Shen, X, et al. Patterns of plasma corticotropin-releasing hormone, progesterone, estradiol, and estriol change and the onset of human labor. J Clin Endocrinol Metab. 2009, 94(6):2066–2074.CrossRefGoogle ScholarPubMed
Thomas, HV, Murphy, MF, Key, TJ, et al. Pregnancy and menstrual hormone levels in mothers of twins compared to mothers of singletons. Ann Hum Biol. 1998, 25(1):69–75.Google Scholar
Fridström, M, Garoff, L, Sjöblom, P, et al. Human chorionic gonadotropin patterns in early pregnancy after assisted reproduction. Acta Obstet Gynecol Scand. 1995, 74(7):534–538.Google Scholar
Norman, RJ, McLoughlin, JW, Borthwick, GM, et al. Inhibin and relaxin concentrations in early singleton, multiple, and failing pregnancy: Relationship to gonadotropin and steroid profiles. Fertil Steril. 1993, 59(1):130–137.Google Scholar
Seravalli, V, Di Tommaso, M, Challis, JR, et al. Endocrinology of maternal-placental axis. In: Petraglia, F C, (Eds.). Female Reproductive Dysfunction. 2020; 397–410. Springer, Cham.Google Scholar
Lambers, MJ, Mager, E, Goutbeek, J, et al. Factors determining early pregnancy loss in singleton and multiple implantations. Hum Reprod. 2007, 22(1):275–279.CrossRefGoogle ScholarPubMed
Matias, A, La Sala, GB, and Blickstein, I. Early loss rates of entire pregnancies after assisted reproduction are lower in twin than in singleton pregnancies. Fertil Steril. 2007, 88(5):1452–1454.CrossRefGoogle ScholarPubMed
Gonzalez, MC, Reyes, H, Arrese, M, et al. Intrahepatic cholestasis of pregnancy in twin pregnancies. J Hepatol. 1989, 9(1):84–90.CrossRefGoogle ScholarPubMed
Gardiner, FW, McCuaig, R, Arthur, C, et al. The prevalence and pregnancy outcomes of intrahepatic cholestasis of pregnancy: A retrospective clinical audit review. Obstet Med. 2019, 12(3):123–128.Google Scholar
Arrese, M, and Reyes, H. Intrahepatic cholestasis of pregnancy: A past and present riddle. Ann Hepatol. 2006, 5(3):202–205.Google Scholar
Lammert, F, Marschall, HU, Glantz, A, et al. Intrahepatic cholestasis of pregnancy: Molecular pathogenesis, diagnosis and management. J Hepatol. 2000, 33(6):1012–1021.CrossRefGoogle ScholarPubMed
Reyes, H, and Simon, FR. Intrahepatic cholestasis of pregnancy: An estrogen-related disease. Semin Liver Dis. 1993, 13(3):289–301.CrossRefGoogle ScholarPubMed
Wagner, M, and Trauner, M. Transcriptional regulation of hepatobiliary transport systems in health and disease: Implications for a rationale approach to the treatment of intrahepatic cholestasis. Ann Hepatol. 2005, 4(2):77–99.CrossRefGoogle Scholar
Alkaabi, J, Almazrouei, R, Zoubeidi, T, et al. Burden, associated risk factors and adverse outcomes of gestational diabetes mellitus in twin pregnancies in Al Ain, UAE. BMC Pregnancy Childbirth. 2020, 20(1):612.Google Scholar
Schwartz, DB, Daoud, Y, Zazula, P, et al. Gestational diabetes mellitus: Metabolic and blood glucose parameters in singleton versus twin pregnancies. Am J Obstet Gynecol. 1999, 181(4):912–914.CrossRefGoogle ScholarPubMed
Warren, WB, Goland, RS, Wardlaw, SL, et al. Elevated maternal plasma corticotropin releasing hormone levels in twin gestation. J Perinat Med. 1990, 18(1):39–44.Google Scholar
Spellacy, WN, Buhi, WC, and Birk, SA. Human placental lactogen levels in multiple pregnancies. Obstet Gynecol. 1978, 52(2):210–212.Google ScholarPubMed
Roach, VJ, Lau, TK, Wilson, D, et al. The incidence of gestational diabetes in multiple pregnancy. Aust N Z J Obstet Gynaecol. 1998, 38(1):56–57.Google Scholar
Swerdlow, AJ, De Stavola, BL, Swanwick, MA, et al. Risks of breast and testicular cancers in young adult twins in England and Wales: Evidence on prenatal and genetic aetiology. Lancet. 1997, 350(9093):1723–1728.Google Scholar
Trichopoulos, D. Hypothesis: Does breast cancer originate in utero? Lancet. 1990, 335(8695):939–940.CrossRefGoogle ScholarPubMed
Tapp, AL, Maybery, MT, and Whitehouse, AJ. Evaluating the twin testosterone transfer hypothesis: A review of the empirical evidence. Horm Behav. 2011, 60(5):713–722.Google Scholar
Galiano, V, Solazzo, G, Rabinovici, J, et al. Cord blood androgen levels of females from same sex and opposite sex twins – A pilot study. Clin Endocrinol (Oxf). 2021, 94(1):85–89.CrossRefGoogle ScholarPubMed
Hollier, LP, Keelan, JA, Hickey, M, et al. Measurement of androgen and estrogen concentrations in cord blood: accuracy, biological interpretation, and applications to understanding human behavioral development. Front Endocrinol (Lausanne). 2014, 5:64.Google Scholar
TambyRaja, RL, and Ratnam, SS. Plasma steroid changes in twin pregnancies. Prog Clin Biol Res. 1981;69a:189–195.Google ScholarPubMed
Stock, S, and Norman, J. Preterm and term labour in multiple pregnancies. Semin Fetal Neonatal Med. 2010, 15(6):336–341.CrossRefGoogle ScholarPubMed
Heine, RP, McGregor, JA, Goodwin, TM, et al. Serial salivary estriol to detect an increased risk of preterm birth. Obstet Gynecol. 2000, 96(4):490–497.Google Scholar
Lachelin, GC, McGarrigle, HH, Seed, PT, et al. Low saliva progesterone concentrations are associated with spontaneous early preterm labour (before 34 weeks of gestation) in women at increased risk of preterm delivery. BJOG. 2009, 116(11):1515–1519.Google Scholar
Lim, H, Powell, S, McNamara, HC, et al. Placental hormone profiles as predictors of preterm birth in twin pregnancy: A prospective cohort study. PLoS ONE. 2017, 12(3):e0173732.CrossRefGoogle ScholarPubMed
Johnsson, VL, Pedersen, NG, Worda, K, et al. Plasma progesterone, estradiol, and unconjugated estriol concentrations in twin pregnancies: Relation with cervical length and preterm delivery. Acta Obstet Gynecol Scand. 2019, 98(1):86–94.Google Scholar
da Fonseca, EB, Bittar, RE, Carvalho, MH, et al. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: A randomized placebo-controlled double-blind study. Am J Obstet Gynecol. 2003, 188(2):419–424.CrossRefGoogle Scholar
Hassan, SS, Romero, R, Vidyadhari, D, et al. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: A multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol. 2011, 38(1):18–31.CrossRefGoogle ScholarPubMed
Norman, JE, Mackenzie, F, Owen, P, et al. Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): A randomised, double-blind, placebo-controlled study and meta-analysis. Lancet. 2009, 373(9680):2034–2040.Google Scholar
Rouse, DJ, Caritis, SN, Peaceman, AM, et al. A trial of 17 alpha-hydroxyprogesterone caproate to prevent prematurity in twins. N Engl J Med. 2007, 357(5):454–461.CrossRefGoogle ScholarPubMed
Lyall, F, Lye, S, Teoh, T, et al. Expression of Gsalpha, connexin-43, connexin-26, and EP1, 3, and 4 receptors in myometrium of prelabor singleton versus multiple gestations and the effects of mechanical stretch and steroids on Gsalpha. J Soc Gynecol Investig. 2002, 9(5):299–307.Google Scholar
Turton, P, Neilson, JP, Quenby, S, et al. A short review of twin pregnancy and how oxytocin receptor expression may differ in multiple pregnancy. Eur J Obstet Gynecol Reprod Biol. 2009, 144 Suppl 1:S40–44.Google Scholar
Turton, P, Arrowsmith, S, Prescott, J, et al. A comparison of the contractile properties of myometrium from singleton and twin pregnancies. PLoS ONE. 2013, 8(5):e63800.Google Scholar
Wray, S. Insights from physiology into myometrial function and dysfunction. Exp Physiol. 2015, 100(12):1468–1476.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×