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Licensed Unlicensed Requires Authentication Published by De Gruyter February 18, 2021

Pregnancy and neonatal outcomes of twin pregnancies – the role of maternal age

  • Shlomi Toussia-Cohen EMAIL logo , Aya Mohr-Sasson , Abraham Tsur , Gabriel Levin , Raoul Orvieto , Ronit Machtinger and Raanan Meyer



We aim to study the association of maternal age with maternal and neonatal complications in twin pregnancies.


A retrospective cohort study of dichorionic–diamniotic twin pregnancies stratified into three groups according to maternal age (“A” <25, “B” 25–34 and “C” 35–44 years old). Outcome measures included pregnancy, delivery and neonatal complications. A sub-analysis of in vitro fertilization pregnancies only was conducted.


Compared with younger women (groups A [n=65] and B [n=783]), older women [group C (n=392)] demonstrated significantly higher rates of gestational diabetes mellitus (B 6.6% vs. A 0%, p =0.027, C 10.2% vs. B 6.6%, p =0.032), were more likely to undergo cesarean deliveries (C 66.6%, B 57.6%, A 52.3%, p =0.007), and were at increased risk of having more than 20% difference in weight between the twins (C 24.5%, B 17.4%, A 16.9%, p =0.013). Other outcomes, including preeclampsia, did not differ between the groups. A sub-analysis of the in vitro fertilization only pregnancies was performed. Compared with younger women (groups A [n=18] and B [n=388]), older women (group C [n=230]) underwent more cesarean deliveries (p=0.004), and had more than 20% difference in weight between the twins (p<0.004). Other outcomes, including gestational diabetes mellitus rates and preeclampsia, did not differ between the groups.


Women at advanced maternal age with dichorionic twin pregnancies had significantly higher rates of gestational diabetes mellitus, cesarean deliveries and fetal weight discordancy as compared with younger women. In contrast, the incidence of preeclampsia was not affected by maternal age.

Corresponding author: Shlomi Toussia-Cohen, MD, The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer 52621, Ramat-Gan, Israel; and The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel, Phone: +972 546 308521, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Source of the study: Chaim Sheba Medical Center, Ramat-Gan, Israel.

  5. Informed consent: Informed consent was obtained from all individuals included in this study.

  6. Ethical approval: The study protocol was approved by the institutional review board of the Sheba Medical Center, #1411-14-SMC.


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2020-08-12
Accepted: 2021-01-04
Published Online: 2021-02-18
Published in Print: 2021-06-25

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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