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Poster Session 1

Category: Clinical Obstetrics

Poster Session 1

(285) Preeclampsia in monochorionic twins with selective fetal growth restriction

Wednesday, February 11, 2026

10:30 AM - 12:00 PM

Submitting Author(s)

Amelia Jiang-Yu, N/A (she/her/hers)

Undergraduate Student
Johns Hopkins University
Johns Hopkins University/Baltimore, Maryland, United States

Coauthor(s)

CR

Christina Rivera, N/A

Johns Hopkins University
Silver Spring, Maryland, United States
LT

Laura S. Tan, N/A

Undergraduate Student
Johns Hopkins University
Baltimore, Maryland, United States
CS

Camille Shantz, BA

Medical Student
Boston University
Boston, Massachusetts, United States
Jena L. Miller, MD (she/her/hers)

Co-Director; Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
MK

Michelle Kush, MD

Johns Hopkins Center for Fetal Therapy
Johns Hopkins University/BAltimore, Maryland, United States
Ahmet A. Baschat, MBBCH, MD

Director, Johns Hopkins Center for Fetal Therapy
Johns Hopkins University
Johns Hopkins University, Maryland, United States

Presenting Author(s)

Mara Rosner, MD, MPH (she/her/hers)

Assistant Professor
Johns Hopkins Center for Fetal Therapy
Johns Hopkins University/Baltimore, Maryland, United States

Objective:
Selective fetal growth restriction (sFGR) in monochorionic twin (MC) pregnancies is considered a disorder of unequal placental share, whereas preeclampsia (PEC) is a disorder of placental dysfunction. We sought to understand the frequency and characteristics of PEC occurring in the setting of MC twins with sFGR.

Study Design:
Retrospective study of MC pregnancies with sFGR from 6/2014-4/2025. Higher order gestations, Twin to Twin Transfusion at presentation, severe anomalies, and cases that were lost to follow up were excluded. Presentation, course, and outcome characteristics were compared between patients with and without PEC. Data analysis was performed using Pearson Chi-Squared, Fisher’s Exact, or Mann-Whitney U.

Results:
33/197 (16.8%) patients meeting criteria with sFGR developed PEC during their pregnancy. There was no difference in baseline maternal characteristics including nulliparity, overweight or obesity, prior PEC history, or chronic hypertension (cHTN). However, PEC was more common in patients with Type I sFGR (21%) and less common in patients with Type III sFGR (5.8%, p=0.046). There was no difference in aspirin (ASA) utilization or Doppler course in the growth restricted fetus between groups. Unplanned and obstetrically indicated deliveries were more frequent in patients with PEC. Survival outcomes were not different between groups.

Conclusion:

PEC complicated approximately 1 in 6 MC twins with sFGR. PEC in sFGR appeared to be independent of traditional risk factors including cHTN, PEC history, maternal weight category, parity, and ASA course. Ultimately our findings support that pregnancies complicated by sFGR require close maternal and fetal surveillance. The relationship of PEC with sFGR Type requires further study.