1
|
Xu Q, Li M, Wang X, Lu H, Zou W. Dichorionic triamniotic triplets after two blastocysts transfer underwent multifetal pregnancy reduction: two case reports and literature review. BMC Womens Health 2024; 24:492. [PMID: 39237895 PMCID: PMC11375843 DOI: 10.1186/s12905-024-03324-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 08/20/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND The increase in the rate of multiple pregnancies in clinical practice is associated with assisted reproductive technology (ART). Given the high risk of dichorionic triamniotic (DCTA) triplet pregnancies, reducing DCTA triplet pregnancies to twin or singleton pregnancies is often beneficial. CASE PRESENTATION This article reports on two cases of DCTA triplet pregnancies resulting from two blastocyst transfers. Given the high risk of complications such as twin-to-twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twin pregnancies, patients have a strong desire to preserve the dichorionic diamniotic (DCDA) twins. Multifetal pregnancy reduction (MFPR) was performed in both cases to continue the pregnancy with DCDA twins by reducing one of the MCDA twins. Both of the pregnant women in this report eventually gave birth to healthy twins at 37 weeks. CONCLUSIONS For infertile couples with multiple pregnancies but with a strong desire to remain the DCDA twins, our report suggests that reducing DCTA triplets to DCDA twin pregnancies may be an option based on clinical operability and assessment of surgical difficulty.
Collapse
Affiliation(s)
- Qianhua Xu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, China
- Engineering Research Center of Biopreservation and Artificial Organs, Ministry of Education, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Min Li
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, China
- Engineering Research Center of Biopreservation and Artificial Organs, Ministry of Education, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xiaolei Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, China
- Engineering Research Center of Biopreservation and Artificial Organs, Ministry of Education, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Hedong Lu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Disorders and Obstetrics and Gynaecology Diseases, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Weiwei Zou
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, China.
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, China.
- Engineering Research Center of Biopreservation and Artificial Organs, Ministry of Education, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Innovation Research Institute of Engineering Medicine and Medical Equipment, No 81 Meishan Road, Hefei, 230032, Anhui, China.
| |
Collapse
|
2
|
O'Connor C, O'Connor E, Leitao S, Barrett S, O'Donoghue K. Clinical practice guidelines for the antenatal management of dichorionic diamniotic twin pregnancies: a systematic review. BMC Pregnancy Childbirth 2023; 23:347. [PMID: 37179347 PMCID: PMC10182673 DOI: 10.1186/s12884-023-05652-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE This review aimed to identify guidelines with recommendations applicable to the antenatal management of dichorionic diamniotic twin pregnancies within high-income countries, appraise their methodological quality, and discuss the similarities and variability across guidelines. METHOD A systematic literature review of electronic databases was performed. Manual searches of guideline repositories and websites of professional organisations were performed to identify additional guidelines. The protocol for this systematic review was registered on PROSPERO (CRD42021248586, 25 June 2021). AGREE II and AGREE-REX tools were applied to assess the quality of eligible guidelines. A narrative and thematic synthesis described and compared the guidelines and their recommendations. RESULTS Twenty-four guidelines were included, from which 483 recommendations were identified across 4 international organisations and 12 countries. Guidelines addressed eight themes and recommendations were classified accordingly: chorionicity and dating (103 recommendations), fetal growth (105 recommendations), termination of pregnancy (12 recommendations), fetal death (13 recommendations), fetal anomalies (65 recommendations), antenatal care (65 recommendations), preterm labour (56 recommendations) and birth (54 recommendations). Guidelines showed significant variability in recommendations, with conflicting recommendations regarding non-invasive preterm testing, definitions surrounding selective fetal growth restriction, screening for preterm labour and the timing of birth. Guidelines lacked a focus on standard antenatal management of DCDA twins, management of discordant fetal anomaly and single fetal demise. CONCLUSIONS Specific guidance for dichorionic diamniotic twins is overall indistinct and access to guidance regarding the antenatal management of these pregnancies is currently difficult. Management of discordant fetal anomaly or single fetal demise needs greater consideration.
Collapse
Affiliation(s)
- Caroline O'Connor
- INFANT Research Centre, University College Cork, Cork, Ireland.
- Pregnancy Loss Research Group, Department of Obstetrics & Gynecology, University College Cork, Cork, Ireland.
- Department of Obstetrics and Gynecology, Cork University Maternity Hospital, 5th Floor, Wilton Road, Cork, Ireland.
| | - Emily O'Connor
- INFANT Research Centre, University College Cork, Cork, Ireland
- Pregnancy Loss Research Group, Department of Obstetrics & Gynecology, University College Cork, Cork, Ireland
- National Perinatal Epidemiology Center (NPEC), University College Cork, Cork, Ireland
| | - Sara Leitao
- Pregnancy Loss Research Group, Department of Obstetrics & Gynecology, University College Cork, Cork, Ireland
- National Perinatal Epidemiology Center (NPEC), University College Cork, Cork, Ireland
| | - Shauna Barrett
- Cork University Hospital Library, Cork University Hospital, Cork, Ireland
| | - Keelin O'Donoghue
- INFANT Research Centre, University College Cork, Cork, Ireland
- Pregnancy Loss Research Group, Department of Obstetrics & Gynecology, University College Cork, Cork, Ireland
| |
Collapse
|
3
|
Lim SY, Shin SH, Yang HJ, Park SG, Kim EK, Kim HS, Jun JK. Neonatal and developmental outcomes of very preterm twins according to the chorionicity and weight discordance. Sci Rep 2023; 13:6784. [PMID: 37100892 PMCID: PMC10133444 DOI: 10.1038/s41598-023-33428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
Perinatal outcomes of twin pregnancies are determined by several factors, such as gestational age (GA), chorionicity, and discordance at birth. This retrospective study aimed to investigate the association of chorionicity and discordance with neonatal and neurodevelopmental outcomes in preterm twin infants from uncomplicated pregnancy. Data of very preterm twin infants who were both live-born between 2014 and 2019 on the chorionicity of the twin, diagnosis of the twin-to-twin syndrome (TTTS), weight discordance at birth, and neonatal and neurodevelopmental outcomes at 24 months of corrected age (CA) were collected. Of the 204 twin infants analyzed, 136 were dichorionic (DC) and 68 were monochorionic (MC), including 15 pairs with TTTS. After adjusting for GA, brain injury, including severe intraventricular hemorrhage and periventricular leukomalacia, was mostly found in the MC with TTTS group, with a higher incidence of cerebral palsy and motor delay at CA 24 months. After excluding TTTS, multivariable analysis showed no association between chorionicity and neonatal and developmental outcomes, whereas small infants among co-twins (adjusted odds ratio (aOR) 3.33, 95% confidence interval 1.03-10.74) and greater discordance (%) of weight at birth (aOR 1.04, 1.00-1.07) were associated with neurodevelopmental impairment. Monochorionicity might not determine adverse outcomes among very preterm twins from uncomplicated pregnancy.
Collapse
Affiliation(s)
- Soo Yeon Lim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
- Department of Pediatrics, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea.
| | - Hyo Ju Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seul Gi Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea
| | - Jong Kwan Jun
- Department of Obstetrics & Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
4
|
O'Connor C, Leitao S, O'Donoghue K. A protocol for a systematic review of clinical practice guidelines for the antenatal management of dichorionic diamniotic twin pregnancy. HRB Open Res 2021; 4:115. [PMID: 38873346 PMCID: PMC11170067 DOI: 10.12688/hrbopenres.13418.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 06/15/2024] Open
Abstract
Overview: The protocol outlines the process designed to systematically review clinical practice guidelines (CPGs), addressing the antenatal management of dichorionic diamniotic (DCDA) twin pregnancies. Background: CPGs are statements that include recommendations intended to optimise patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. CPGs are typically created by scientific institutes, organisations and professional societies, and high-quality CPGs are fundamental to improve patient outcomes, standardise clinical practice and improve the quality of care. While CPGs are designed to improve the quality of care, to achieve this, the identification and appraisal of current international CPGs is required. Because twin pregnancies are identified as high-risk pregnancies, a systematic review of the CPGs in this field is a useful first step for establishing the required high level of care. Aim: The aim of the systematic review is to identify, appraise and examine published CPGs for the antenatal management of DCDA twin pregnancies, within high-income countries. Methods: We will identify published CPGs addressing any aspect of antenatal management of care in DCDA twin pregnancies, appraise the quality of the identified CPGs using the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) the Appraisal of Guidelines Research and Evaluation - Recommendations excellence (AGREE-REX) instruments and examining the recommendations from the identified CPGs. Ultimately, this protocol aspires to clearly define the process for a reproducible systematic review of CPGs within a high-income country, addressing any aspect of antenatal management of DCDA twin pregnancies. PROSPERO registration: CRD42021248586 (24/06/2021).
Collapse
Affiliation(s)
- Caroline O'Connor
- Infant Centre, University College Cork, Cork, Ireland
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Sara Leitao
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- National Perinatal Epidemiology Centre (NPEC), University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Infant Centre, University College Cork, Cork, Ireland
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| |
Collapse
|
5
|
Song B, Wang Z, Chen Y, Wang C, Wei Z, He X, Cao Y. Repeated triplets complicated by monochorionic diamniotic twins following assisted reproduction: a case report and literature review. BMC Pregnancy Childbirth 2020; 20:373. [PMID: 32576252 PMCID: PMC7313207 DOI: 10.1186/s12884-020-03055-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monochorionic twinning involves numerous maternal and fetal complications, triplets complicated by a monochorionic pair are at further increased risk. Here, we report a case of repeated triplets complicated by monochorionic diamniotic twins with successful pregnancy outcomes in a woman using autologous oocytes. CASE PRESENTATION A 30-year-old female undergoing embryo transfer with fresh and frozen embryo cycles with autologous oocytes. The two cycles were confirmed by transvaginal ultrasound to result in successful clinical pregnancies of triplets complicated by a monochorionic twinning. The first pregnancy resulted in a singleton delivery after a selective reduction of the monochorionic pair. The subsequent pregnancy resulted in a dichorionic diamniotic twin pregnancy after the heartbeat of one of the monochorionic twin fetuses stopped at 43 days after embryo transfer. Both of the pregnancies ended with successful live births. CONCLUSIONS Our case report of repeated triplets with monochorionic twins suggests the potential causes and risk factors of monochorionic twinning in assisted reproduction and raises concern regarding the timing of multifetal pregnancy reduction.
Collapse
Affiliation(s)
- Bing Song
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, 230032, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, 230032, China.,Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, 230032, China
| | - Zhe Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
| | - Yujie Chen
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
| | - Chao Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, 230032, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, 230032, China.,Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, 230032, China
| | - Zhaolian Wei
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, China.,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, 230032, China.,Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, 230032, China.,Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, 230032, China
| | - Xiaojin He
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China. .,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, China. .,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, 230032, China. .,Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, 230032, China. .,Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, 230032, China.
| | - Yunxia Cao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China. .,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, 230032, China. .,Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, 230032, China. .,Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, 230032, China. .,Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, 230032, China.
| |
Collapse
|
6
|
Nunes JS, Sousa M, Montenegro N, Matias A. Twin Pregnancies, Crown-rump Length and Birthweight Discordancy: The Influence of Chorionicity. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:529-534. [PMID: 32559796 PMCID: PMC10309241 DOI: 10.1055/s-0040-1712128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The purpose of the present study was to analyze the influence of chorionicity in the biometric parameters crown-rump length (CRL), birthweight (BW), crown-rump length discordancy (CRLD) and birthweight discordancy (BWD), determine the correlation between these latter two in cases of intertwin discordancy, and to analyze the influence of chronicity in the presence of these discordancies with clinical relevance (> 10% and > 15%, respectively). METHODS The present study was a retrospective study based on the twin pregnancy database of the Centro Hospitalar S. João (2010-2015), including 486 fetuses among 66 monochorionic (MC) and 177 dichorionic gestations (DC). The inclusion criteria were multiple pregnancies with 2 fetuses and healthy twin gestations. The exclusion criteria were trichorionic gestations and pregnancies with inconclusive chorionicity, multiple pregnancy with ≥ 3 fetuses and pathological twin gestations. RESULTS No statistically significant difference was found in BW (p = 0.09) and in its discordancy (p = 0.06) nor in CRL (p = 0.48) and its discordancy (p = 0.74) between MCs and DCs. Crown-rump length discordancy and birthweight discordancy were correlated by the regression line "BWD = 0.8864 x CRLD + 0.0743," with r2 = 0.1599. Crown-rump length discordancy > 10% was found in 7.58% of monochorionic and in 13.56% of dichorionic twins. Birthweight discordancy > 15% was detected in 16.67% of monochorionic and in 31.64% of dichorionic twins. CONCLUSION No statistically significant influence of chorionicity was identified in both birthweight and birthweight discordancy, as in crown-rump length and crown-rump length discordancy. Birthweight discordancy was correlated to crown-rump length discordancy in 20% of cases.
Collapse
Affiliation(s)
- Joana Sousa Nunes
- Obstetrics & Gynecology Department, Senhora da Oliveira Hospital, Guimarães, Portugal.,Obstetrics & Gynecology Department, Faculty of Medicine, Minho University, Braga, Portugal
| | - Mário Sousa
- Laboratory of Cell Biology, Microscopy Department, Porto Hospital Centre, Institute of Biomedical Sciences Abel Salazar, Porto University, Porto, Portugal
| | - Nuno Montenegro
- Obstetrics & Gynecology Department, São João Hospital & University Centre, Porto, Portugal
| | - Alexandra Matias
- Obstetrics & Gynecology Department, São João Hospital & University Centre, Porto, Portugal
| |
Collapse
|
7
|
Litwinska E, Syngelaki A, Cimpoca B, Frei L, Nicolaides KH. Outcome of twin pregnancy with two live fetuses at 11-13 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:32-38. [PMID: 31613412 DOI: 10.1002/uog.21892] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To report and compare pregnancy outcome in dichorionic (DC), monochorionic diamniotic (MCDA) and monochorionic monoamniotic (MCMA) twin pregnancies with two live fetuses at 11-13 weeks' gestation and to examine the impact of endoscopic laser surgery for severe twin-twin transfusion syndrome (TTTS) and/or selective fetal growth restriction (sFGR) on the outcome of MCDA twins. METHODS This was a retrospective analysis of prospectively collected data on twin pregnancies undergoing routine ultrasound examination at 11-13 weeks' gestation between 2002 and 2019. In pregnancies with no major abnormalities, we compared overall survival, fetal loss at < 24 weeks' gestation, perinatal death at ≥ 24 weeks, delivery at < 37 and < 32 weeks, and birth weight < 5th percentile between DC, MCDA and MCMA twins. RESULTS The study population of 6225 twin pregnancies with two live fetuses at 11-13 weeks' gestation with no major abnormalities included 4896 (78.7%) DC, 1274 (20.5%) MCDA and 55 (0.9%) MCMA twins. In DC twins, the rate of loss at < 24 weeks' gestation in all fetuses was 2.3%; this rate was higher in MCDA twins (7.7%; relative risk (RR), 3.258; 95% CI, 2.706-3.923) and more so in MCMA twins (21.8%; RR, 9.289; 95% CI, 6.377-13.530). In DC twins, the rate of perinatal death at ≥ 24 weeks in all twins that were alive at 24 weeks was 1.0%; this rate was higher in MCDA twins (2.5%; RR, 2.456; 95% CI, 1.779-3.389) and more so in MCMA twins (9.3%; RR, 9.130; 95% CI, 4.584-18.184). In DC twins, the rate of preterm birth at < 37 weeks' gestation in pregnancies with at least one liveborn twin was 48.6%; this rate was higher in MCDA twins (88.5%; RR, 1.824; 95% CI, 1.760-1.890) and more so in MCMA twins (100%; RR, 2.060; 95% CI, 2.000-2.121). In DC twins, the rate of preterm birth at < 32 weeks was 7.4%; this rate was higher in MCDA twins (14.2%; RR, 1.920; 95% CI, 1.616-2.281) and more so in MCMA twins (26.8%; RR, 3.637; 95% CI, 2.172-6.089). In DC twin pregnancies with at least one liveborn twin, the rate of a small-for-gestational-age neonate among all liveborn twins was 31.2% and in MCDA twins this rate was higher (37.8%; RR, 1.209; 95% CI, 1.138-1.284); in MCMA twins, the rate was not significantly different (33.3%; RR, 1.067; 95% CI, 0.783-1.455). Kaplan-Meier analysis showed a significant difference in survival in MCDA and MCMA twins, compared to DC twins, for both the interval of 12 to < 24 weeks' gestation (log-rank test, P < 0.0001 for both) and that of ≥ 24 to 38 weeks (log-rank test, P < 0.0001 for both). Endoscopic laser ablation of intertwin communicating placental vessels was carried out in 127 (10.0%) MCDA twin pregnancies for TTTS and/or sFGR and, in 111 of these, surgery was performed at < 24 weeks; both fetuses survived in 62 (55.9%) cases, one fetus survived in 25 (22.5%) cases and there were no survivors in 24 (21.6%) cases. On the extreme assumption that, had laser surgery not been carried out in these cases, all fetuses would have died, the total fetal loss rate at < 24 weeks' gestation in MCDA twins would have been 13.5%. CONCLUSIONS The rates of fetal loss at < 24 weeks' gestation, perinatal death at ≥ 24 weeks and preterm birth are higher in MCDA and more so in MCMA twins than in DC twins. In MCDA twins, the rate of fetal loss may have been reduced by endoscopic laser surgery in those that developed early TTTS and/or sFGR. These data would be useful in counseling parents as to the likely outcome of their pregnancy and in defining strategies for surveillance and interventions in the management of the different types of twin pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- E Litwinska
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Syngelaki
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - B Cimpoca
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - L Frei
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| |
Collapse
|
8
|
Genotyping of STR and DIP-STR Markers in Plasma Cell-Free DNA for Simple and Rapid Noninvasive Prenatal Diagnosis of Zygosity of Twin Pregnancies. Twin Res Hum Genet 2019; 22:321-329. [PMID: 31619303 DOI: 10.1017/thg.2019.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Due to the high rate of complications, special medical care must be provided especially for monozygotic twin pregnancies, which are characterized as having 2.5 times higher mortality of fetuses. In recent years, examination of cell-free DNA (cfDNA) circulating in maternal plasma has become a useful noninvasive method of prenatal diagnosis. However, fetal DNA constitutes only 3-20% of plasma cfDNA during pregnancy. Short tandem repeats (STRs) are routinely used in forensic examination of DNA mixtures and are able to identify 5% minority components. Haplotypes of deletion/insertion polymorphisms and STRs (DIP-STRs) are able to detect even 0.1% minority components of DNA mixtures. Thus, STRs and DIP-STRs seem to be a perfect tool for detection of fetal alleles in DNA isolated from maternal plasma. Here, we present a novel noninvasive prenatal diagnosis technique of determination of pregnancy zygosity based on examination of feto-maternal microchimerism of plasma cfDNA with the use of STRs and DIP-STRs. Our preliminary results based on 22 STR loci showed 67% sensitivity, 100% specificity and 82% accuracy for prenatal detection of twin dizygosity. The corresponding values for seven DIP-STRs were 13%, 100% and 54%, respectively. Owing to assay performance, low DNA input requirements, low costs (below 10 USD per patient) and simplicity of analysis, genotyping of STR/DIP-STR markers in maternal plasma cfDNA may become a useful supplementary test for noninvasive prenatal diagnosis of twin zygosity in cases when chorionicity and zygosity cannot be reliably determined by ultrasound examination and prognostic value may be provided by a DNA test determining pregnancy zygosity.
Collapse
|
9
|
Abstract
The increase in multiple gestation pregnancies has resulted in significant health care implications for both mother and child. Our ability to diagnose and intervene on an at-risk multi-gestation pregnancy has dramatically improved. It is important for the pediatric surgeon to be equipped with a basic fund of knowledge concerning these pregnancies. An understanding of amnionicity and chorionicity will equip the practitioner with the ability to identify which pregnancies are at risk for specific complications. This article highlights multi-gestation pregnancies that are monochorionic (single shared placenta) and can be complicated by twin-twin transfusion syndrome (TTTS), twin reversed arterial perfusion (TRAP) sequence, twin anemia polycythemia sequence (TAPS), or selective fetal intrauterine growth restriction (sIUGR). The risk of fetal demise is significant in these pregnancies. Understanding recommended surveillance and warning signs can alert surgeons to developing complications. Specialized fetal care centers possess the ability to intervene on these pregnancies in utero.
Collapse
Affiliation(s)
- Ahmed I Marwan
- Division of Pediatric Surgery, University of Colorado School of Medicine, Children's Hospital of Colorado, Colorado Fetal Care Center, United States
| | - Micheal Zaretsky
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Children's Hospital of Colorado, Colorado Fetal Care Center, United States
| | - Brad Feltis
- Children's Minnesota, Midwest Fetal Care Center, United States.
| |
Collapse
|
10
|
Jantsch LB, de Lucca L, Dorneles BN, Konopka CK, Gonçalves TDL. Evaluation of oxidative stress and δ-aminolevulinate dehydratase activity in twin pregnancies. J Matern Fetal Neonatal Med 2019; 33:3071-3076. [PMID: 30688119 DOI: 10.1080/14767058.2019.1568980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose: To assess and understand the maternal oxidative stress in twin pregnancies, currently not studied, through ascertain indicators of oxidative damage in maternal blood in response of two fetuses, as well as the relation of placenta with or without the increase of oxidative stress in these gestations.Materials and methods: The activity of delta-aminolevulinate dehydratase (δ-ALA-D) was analyzed as an indirect marker of oxidative stress, as well as the quantification of thiobarbituric acid reactive substances (TBARS), protein thiol groups (P-SH) and nonprotein thiol groups (NP-SH), vitamin C (VIT C) and catalase activity (CAT) in maternal blood samples from twin (n = 30) and single (n = 30) pregnancies. This study was approved by the Human Ethics Committee UFSM (register by the number 49823015.4.0000.5346).Results: TBARS was significantly higher in twin pregnancies, while thiol groups, VIT C and CAT were decreased, asides from the reduced activity of δ-ALA-D in comparison to single fetus gestations.Conclusions: The study established an oxidative stress increased and an antioxidant ability decreased in twin pregnancies, suggesting a possible relation between the levels of oxidants and antioxidants with the complications in those gestations.
Collapse
Affiliation(s)
- Letícia Bigolin Jantsch
- Department of Clinical and Toxicology Analysis, Postgraduate Program in Pharmaceutical Sciences, Center of Healthy Sciences, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Leidiane de Lucca
- Department of Clinical and Toxicology Analysis, Postgraduate Program in Pharmaceutical Sciences, Center of Healthy Sciences, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Bárbara Nicoli Dorneles
- Department of Clinical and Toxicology Analysis, Postgraduate Program in Pharmaceutical Sciences, Center of Healthy Sciences, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Cristine Kolling Konopka
- Department of Obstetrics and Gynecology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Thissiane de Lima Gonçalves
- Department of Clinical and Toxicology Analysis, Postgraduate Program in Pharmaceutical Sciences, Center of Healthy Sciences, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| |
Collapse
|
11
|
Prevalence and Heritability of Early Childhood Caries Among Monozygotic and Dizygotic Twins. Twin Res Hum Genet 2017; 20:43-52. [PMID: 28105963 DOI: 10.1017/thg.2016.96] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Deciphering the relative importance of genetic and environmental factors, which play a major role in the prevalence of early childhood caries (ECC), can help clinicians with planning a long-term preventive treatment. The objective of the study was to determine the prevalence and heritability of ECC among monozygotic (MZ) and dizygotic (DZ) twins in Chennai, India, in the year 2013. A cross-sectional study was designed to estimate the prevalence of ECC among twins. Zygosity classification for the survey framework was adapted from a highly accurate parental report questionnaire pertaining to the physical similarity between twins. The associated heritability index was estimated. The Decayed, Missing, Filled Surface (DMFS) Index was used as the diagnostic criterion for dental caries. The prevalence of ECC was estimated at 18.7%. The correlation coefficient between the twin pair showed significant correlation. The heritability index for ECC was estimated at 15% higher prevalence of ECC found among children in the age group 25-36 months. The heritability estimate indicated a relatively low genetic influence for early childhood caries among twins. There was no significant difference detected in the concordance rate for the MZ and DZ twins. Further research could be directed toward the prevalence of ECC among higher age group children to explore the role of genetic and environmental factors.
Collapse
|
12
|
Sharing a Placenta is Associated With a Greater Similarity in DNA Methylation in Monochorionic Versus Dichorionic Twin Pars in Blood at Age 14. Twin Res Hum Genet 2016; 18:680-5. [PMID: 26678052 DOI: 10.1017/thg.2015.87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Monozygotic (MZ) twins provide a natural system for investigating developmental plasticity and the potential epigenetic origins of disease. A major difference in the intrauterine environment between MZ pairs is whether they share a common placenta or have separate placentas. Using DNA methylation measured at >400,000 points in the genome on the Illumina HumanMethylation450 array, we demonstrate that the co-twins of MZ pairs (average age of 14) that shared a common placenta (n = 18 pairs) have more similar DNA methylation levels in blood throughout the genome relative to those with separate placentas (n = 16 pairs). Functional annotation of the genomic regions that show significantly different correlation between monochorionic (MC) and dichorionic (DC) MZ pairs found an over-representation of genes involved in the regulation of transcription, neuronal development, and cellular differentiation. These results support the idea that prenatal environmental exposures may have a lasting effect on an individual's epigenetic landscape, and the potential for these changes to have functional consequences.
Collapse
|
13
|
Brown R. Author's reply re: Zygosity testing should be encouraged for all same-sex twins. AGAINST: The benefit of this knowledge should be weighed against the potential pitfalls. BJOG 2016; 123:1561. [DOI: 10.1111/1471-0528.14064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2016] [Indexed: 11/29/2022]
|
14
|
Maruotti G, Saccone G, Morlando M, Martinelli P. First-trimester ultrasound determination of chorionicity in twin gestations using the lambda sign: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2016; 202:66-70. [DOI: 10.1016/j.ejogrb.2016.04.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/21/2016] [Indexed: 11/16/2022]
|
15
|
Twin Chorionicity and the Risk of Hypertensive Disorders: Gestational Hypertension and Pre-eclampsia. Twin Res Hum Genet 2016; 19:377-82. [PMID: 27160962 DOI: 10.1017/thg.2016.17] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Twin gestation is known to be a risk factor for hypertensive disorders of pregnancy. However, the relationship between hypertensive disorders (pre-eclampsia (PE) and gestational hypertension (GH)) and chorionicity of twin pregnancy is unclear, and published data is conflicting. We decided to analyze the relationship between placentation and prevalence of hypertensive disorders. It was a retrospective cohort study. 312 twin pregnancies delivered between 2009 and 2014 were analyzed, 79 of which were monochorionic and 233 dichorionic. The occurrence of PE and GH was established according to American College of Obstetricians and Gynecologists' (ACOG) guidelines. Hypertensive disorders were diagnosed significantly more often in dichorionic than in monochorionic twin pregnancies (19.7% vs. 8.9%; OR = 2.53 95% CI 1.04-6.45; p = .03). PE occurred more frequently in DCP (13.3% vs. 3.8%; OR = 3.88 95% CI 1.09-16.46; p = .02). There were no differences between those two groups in the prevalence of GH (6.4% vs. 5.1%; p = .79). The logistic regression model for the occurrence of PE included chorionicity, mother's age lower than 18 or higher than 40, pre-gestational obesity, in vitro fertilization, primiparity, gestational age at delivery, gestational diabetes, and active smoking. It showed that dichorionicity remained an independent risk factor for PE (adjusted OR = 4.97.0 95% CI 1.06-23.38; p = .04). Dichorionicity seems to be a risk factor for PE but not for GH development.
Collapse
|
16
|
Vincer MJ, Armson BA, Allen VM, Allen AC, Stinson DA, Whyte R, Dodds L. An Algorithm for Predicting Neonatal Mortality in Threatened Very Preterm Birth. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 37:958-65. [PMID: 26629716 DOI: 10.1016/s1701-2163(16)30045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To develop a prediction model for neonatal mortality using information readily available in the antenatal period. METHODS A multiple logistic regression model of a complete population-based geographically defined cohort of very preterm infants of 23+0 to 30+6 weeks' gestation was used to identify antenatal factors which were predictive of mortality in this population. Infants lt; 23 weeks and those with major anomalies were excluded. RESULTS Between 1996 and 2012, 1240 live born infants lt; 31 weeks' gestation were born to women residing in Nova Scotia. Decreasing gestational age strongly predicted an increased mortality rate. Other factors significantly contributing to increased mortality included classification as small for gestational age, oligohydramnios, maternal psychiatric disorders, antenatal antibiotic therapy, and monochorionic twins. Reduced neonatal mortality was associated with antenatal use of antihypertensive agents and use of corticosteroids of any duration of therapy given at least 24 hours before delivery. An algorithm was developed to estimate the risk of mortality without the need for a calculator. CONCLUSION Prediction of the probability of neonatal mortality is influenced by maternal and fetal factors. An algorithm to estimate the risk of mortality facilitates counselling and informs shared decision making regarding obstetric management.
Collapse
Affiliation(s)
- Michael J Vincer
- The Perinatal Follow-Up Program of Nova Scotia, IWK Health Centre, Halifax NS; Department of Pediatrics, Dalhousie University, Halifax NS; Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
| | - B Anthony Armson
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
| | - Victoria M Allen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
| | - Alexander C Allen
- Department of Pediatrics, Dalhousie University, Halifax NS; Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS; The Perinatal Epidemiology Research Unit, Department of Pediatrics, Dalhousie University, Halifax NS
| | - Dora A Stinson
- The Perinatal Follow-Up Program of Nova Scotia, IWK Health Centre, Halifax NS; Department of Pediatrics, Dalhousie University, Halifax NS; Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
| | - Robin Whyte
- Department of Pediatrics, Dalhousie University, Halifax NS
| | - Linda Dodds
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS; The Perinatal Epidemiology Research Unit, Department of Pediatrics, Dalhousie University, Halifax NS
| |
Collapse
|
17
|
Koshida S, Ono T, Tsuji S, Murakami T, Takahashi K. Perinatal Backgrounds and NICU Bed Occupancy of Multiple-Birth Infants in Japan. TOHOKU J EXP MED 2016; 238:261-5. [DOI: 10.1620/tjem.238.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shigeki Koshida
- Department of Community Perinatal Medicine, Shiga University of Medical Science
| | - Tetsuo Ono
- Department of Obstetrics and Gynecology, Shiga University of Medical Science
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science
| | - Kentaro Takahashi
- Department of Community Perinatal Medicine, Shiga University of Medical Science
| |
Collapse
|
18
|
Walsh CA, Wilkinson M, Downey P, Mooney EE, Carroll S. 'False' lambda sign in monochorionic twin pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:376-377. [PMID: 25708185 DOI: 10.1002/uog.14827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/13/2015] [Indexed: 06/04/2023]
Affiliation(s)
- C A Walsh
- Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland
| | - M Wilkinson
- Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland
| | - P Downey
- Department of Pathology, National Maternity Hospital, Dublin, Ireland
| | - E E Mooney
- Department of Pathology, National Maternity Hospital, Dublin, Ireland
| | - S Carroll
- Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland
| |
Collapse
|
19
|
Carter EB, Bishop KC, Goetzinger KR, Tuuli MG, Cahill AG. The impact of chorionicity on maternal pregnancy outcomes. Am J Obstet Gynecol 2015; 213:390.e1-7. [PMID: 25986034 DOI: 10.1016/j.ajog.2015.05.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/27/2015] [Accepted: 05/13/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Women carrying twin pregnancies often receive similar counseling, regardless of chorionicity, with the notable exception of twin-twin transfusion syndrome (TTTS); however, little is known about whether the presence of 1 vs 2 placentas confers dissimilar maternal risks. We sought to determine differences in maternal and neonatal outcomes based on chorionicity. STUDY DESIGN This was a retrospective cohort study of all twin pregnancies at our institution undergoing routine second-trimester ultrasound for anatomic survey from 1990 through 2010. Secondary outcomes included other adverse maternal and neonatal outcomes. Relative risks and adjusted odds ratios (aORs) were calculated. Cluster analysis was used to account for nonindependence of twin pairs. RESULTS Of 2301 pregnancies, 1747 (75.9%) were dichorionic and 554 (24.1%) were monochorionic. Rates of preeclampsia, gestational diabetes, placental abruption, placenta previa, preterm labor, and preterm premature rupture of membranes (PPROM) were not significantly different in dichorionic vs monochorionic pregnancies. Early preterm delivery less than 34 weeks (aOR, 1.47; 95% confidence interval [CI], 1.17-1.86) and less than 28 weeks (aOR, 2.58; 95% CI, 1.58-4.20) were more likely in monochorionic twins, as was neonatal intensive care unit admission (aOR, 1.41; 95% CI, 1.12-1.78). Monochorionic twins delivered earlier at a mean gestational age of 34.2 weeks vs 35.0 weeks for dichorionic twins (P < .001). Hospital length of stay was significantly longer for monochorionic twins with a mean of 13.7 days vs 10.8 days for dichorionic twins (P = .01). CONCLUSION There are no significant differences in maternal outcomes by chorionicity; however, monochorionicity is associated with increased fetal risks. This information may be helpful in guiding more targeted counseling to expectant parents of twins that, although the presence of an additional placenta does not confer additional maternal risks, monochorionic infants tend to deliver earlier and require longer hospital stays.
Collapse
Affiliation(s)
- Ebony B Carter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO.
| | - Katherine C Bishop
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| | - Katherine R Goetzinger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| | - Methodius G Tuuli
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| | - Alison G Cahill
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| |
Collapse
|
20
|
Ben-Ami I, Daniel-Spiegel E, Battino S, Melcer Y, Floeck A, Geipel A, Miron P, Maymon R. The association of crown-rump length discrepancy with birthweight discordance in spontaneous versus IVF monochorionic twins: a multicenter study. Prenat Diagn 2015; 35:864-9. [PMID: 25989950 DOI: 10.1002/pd.4623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The objective of this study was to compare the associations of crown-rump length (CRL) discrepancy with birthweight discordance in spontaneous versus in vitro fertilization (IVF) monochorionic (MC) twin pregnancies. METHOD This is a multicenter retrospective study on women with twin pregnancies assessed for nuchal translucency between January 1997 and July 2013. The study group was subdivided into MC twins conceived spontaneously and after IVF. Pregnancies with later fetal death or twin transfusion syndrome were excluded. A large-weight discordance was defined as a difference of birthweights of >15%. RESULTS The study group included 171 pregnancies; of them, 142 (83%) were spontaneous and 29 (17%) were IVF conceived. In the entire cohort, we found a significant correlation between birthweight discordance and CRL discrepancy (r = 0.173, P < 0.05). While a significant correlation was found between CRL discrepancy and birthweight discordance in spontaneous-conceived pregnancies (n = 142, r = 0.24, P = 0.005), such correlation was not present in IVF pregnancies (n = 29, r = -0.7, P = 0.724). A logistic regression analysis found significant odds of larger-weight discordance for each increase of 1% in CRL discrepancy among spontaneously conceived pregnancies (odds ratio = 1.1, confidence interval = 1.03-1.2, P = 0.005). A receiver operating characteristic (ROC) for large-weight discordance in the spontaneously conceived pregnancies demonstrated an area under the ROC curve of 0.613 (P = 0.039). CONCLUSION The significant correlation between CRL discrepancy and birthweight discordance in spontaneous versus IVF MC twin pregnancies might suggest differential monozygotic twinning process.
Collapse
Affiliation(s)
- Ido Ben-Ami
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Etty Daniel-Spiegel
- Department of Obstetrics and Gynecology, Haemek Medical Center, Afula, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Shlomo Battino
- Department of Obstetrics and Gynecology, Haemek Medical Center, Afula, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Women Health Center Clalit, Afula, Israel
| | - Yaakov Melcer
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anne Floeck
- Department of Obstetrics and Prenatal Medicine, University Medical School, Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Medical School, Bonn, Germany
| | - Pierre Miron
- Centre de Procreation FERTILYS, Laval, Quebec, Canada
| | - Ron Maymon
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
21
|
Abstract
It is well established that the death of one fetus in a monochorionic twin pregnancy places the surviving twin at significant risk for neuro-developmental delay or death. Although the early 1st trimester "vanishing twin" has not traditionally been considered a major risk, the precise gestational threshold beyond which a surviving twin is at risk remains uncertain. Most experts recommend serial ultrasounds and fetal MRI in the survivor, to look for evidence of ischaemic brain injury. We present a case of early monochorionic twin demise at 14-16 weeks, with evolving ventriculomegaly and ischaemic changes on fetal MRI in the co-twin, leading to termination of pregnancy at 28 weeks.
Collapse
Affiliation(s)
- Colin A Walsh
- Department of Fetal MedicineRoyal North Shore HospitalSydneyNew South WalesAustralia; Northern Clinical School University of SydneySydneyNew South WalesAustralia
| |
Collapse
|
22
|
Kristiansen MK, Joensen BS, Ekelund CK, Petersen OB, Sandager P. Perinatal outcome after first-trimester risk assessment in monochorionic and dichorionic twin pregnancies: a population-based register study. BJOG 2015; 122:1362-9. [DOI: 10.1111/1471-0528.13326] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 11/29/2022]
Affiliation(s)
- MK Kristiansen
- Department of Obstetrics and Gynaecology; Aarhus University Hospital; Skejby Denmark
| | - BS Joensen
- Department of Obstetrics and Gynaecology; Aarhus University Hospital; Skejby Denmark
| | - CK Ekelund
- Fetal Medicine Unit; Department of Obstetrics; Copenhagen University Hospital; Rigshospitalet Denmark
| | - OB Petersen
- Department of Obstetrics and Gynaecology; Aarhus University Hospital; Skejby Denmark
| | - P Sandager
- Department of Obstetrics and Gynaecology; Aarhus University Hospital; Skejby Denmark
| | | |
Collapse
|
23
|
Ooi G, Townsend G, Seow WK. Bacterial colonization, enamel defects and dental caries in 4-6-year-old mono- and dizygotic twins. Int J Paediatr Dent 2014; 24:152-60. [PMID: 23721206 DOI: 10.1111/ipd.12041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Knowledge of the genetic and environmental influences in caries aetiology has relevance for preventive dentistry. AIMS This classical twin study compared concordance of mutans streptococci (MS) and lactobacilli (LB) colonization, enamel defects, and caries in a cohort of 4-6-year-old mono- (MZ) and dizygotic (DZ) twin pairs. DESIGN The twins were examined for prevalence and concordance of enamel opacities and hypoplasia, oral counts of MS and LB, and dental caries. Bacterial counts were assessed using a commercial microbiological kit. RESULTS Thirty-four MZ and 50 DZ twins (mean gestational age 35.0 ± 2.4 weeks, and birthweight 2.4 ± 0.6 kg) were examined. There were no statistically significant differences between MZ and DZ twins in the prevalence of MS, LB, and enamel hypoplasia. Concordance rates for MS and LB presence and prevalence of enamel defects within MZ and DZ twin pairs were not significantly different. There were more children with caries in DZ compared with MZ twins (18% vs 3%, P = 0.0029), most likely due to increased daily frequency of sugar consumption and less toothbrushing. CONCLUSIONS Concordance data from MZ and DZ twins did not demonstrate any statistically significant difference in susceptibility for enamel defects and colonization of MS and LB.
Collapse
Affiliation(s)
- Gregory Ooi
- Queensland Health, Children's Oral Health Service, Royal Children's Hospital, Herston, Qld, Australia
| | | | | |
Collapse
|
24
|
Sparks TN, Cheng YW, Phan N, Caughey AB. Does risk of preeclampsia differ by twin chorionicity? J Matern Fetal Neonatal Med 2013; 26:1273-7. [PMID: 23425367 DOI: 10.3109/14767058.2013.777701] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Examine whether dichorionic (DC) and monochorionic (MC) twins exhibit different rates and severity of preeclampsia. METHODS Retrospective cohort study of 695 twin pregnancies from 2002 to 2007. DC pregnancies were compared to MC pregnancies, with the primary outcome of interest being development of preeclampsia, and the secondary outcome being severity of preeclampsia. Chi square test compared proportions and multivariable analyses controlled for potential confounders. RESULTS Any preeclampsia developed in 21.1% (104/492) of DC and 10.8% (22/203) of MC pregnancies (p = 0.001), mild preeclampsia in 13.8% (68/492) of DC and 4.9% (10/203) of MC pregnancies (p = 0.001) and severe preeclampsia in 7.3% (36/492) of DC and 5.9% (12/203) of MC pregnancies (p = 0.506). DC pregnancies showed higher odds of mild preeclampsia compared to MC pregnancies (aOR 5.85, 95% CI 1.31-26.13) after controlling for several potential confounders including gestational age at delivery. CONCLUSIONS A statistically significant larger proportion of women with DC twins developed any preeclampsia, and specifically mild preeclampsia, compared to those with MC twins. Additionally, after controlling for several potential confounders, women with DC pregnancies demonstrated higher odds of developing mild preeclampsia compared to those with MC pregnancies. Mechanisms of preeclampsia development may differ by twin chorionicity.
Collapse
Affiliation(s)
- Teresa N Sparks
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital/Massachusetts General Hospital , Boston, MA 02115, USA.
| | | | | | | |
Collapse
|
25
|
Frost M, Petersen I, Brixen K, Beck-Nielsen H, Holst JJ, Christiansen L, Højlund K, Christensen K. Adult glucose metabolism in extremely birthweight-discordant monozygotic twins. Diabetologia 2012; 55:3204-12. [PMID: 22955993 DOI: 10.1007/s00125-012-2695-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 06/21/2012] [Indexed: 01/20/2023]
Abstract
AIMS/HYPOTHESIS Low birthweight (BW) is associated with increased risk of type 2 diabetes. We compared glucose metabolism in adult BW-discordant monozygotic (MZ) twins, thereby controlling for genetic factors and rearing environment. METHODS Among 77,885 twins in the Danish Twin Registry, 155 of the most BW-discordant MZ twin pairs (median BW difference 0.5 kg) were assessed using a 2 h oral glucose tolerance test with sampling of plasma (p-)glucose, insulin, C-peptide, glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1. HOMA for beta cell function (HOMA-β) and insulin resistance (HOMA-IR), and also insulin sensitivity index (BIGTT-SI) and acute insulin response (BIGTT-AIR), were calculated. Subgroup analyses were performed in those with: (1) double verification of BW difference; (2) difference in BW >0.5 kg; and (3) no overt metabolic disease (type 2 diabetes, hyperlipidaemia or thyroid disease). RESULTS No intra-pair differences in p-glucose, insulin, C-peptide, incretin hormones, HOMA-β, HOMA-IR or BIGTT-SI were identified. p-Glucose at 120 min was higher in the twins with the highest BW without metabolic disease, and BIGTT-AIR was higher in those with the highest BW although not in pairs with a BW difference of >0.5 kg. CONCLUSIONS/INTERPRETATION BW-discordant MZ twins provide no evidence for a detrimental effect of low BW on glucose metabolism in adulthood once genetic factors and rearing environment are controlled for.
Collapse
Affiliation(s)
- M Frost
- The Danish Twin Registry, Department of Epidemiology, University of Southern Denmark, JB Winsløvsvej 9, Odense C, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
AbstractThe science of genetics is undergoing a paradigm shift. Recent discoveries, including the activity of retrotransposons, the extent of copy number variations, somatic and chromosomal mosaicism, and the nature of the epigenome as a regulator of DNA expressivity, are challenging a series of dogmas concerning the nature of the genome and the relationship between genotype and phenotype. According to three widely held dogmas, DNA is the unchanging template of heredity, is identical in all the cells and tissues of the body, and is the sole agent of inheritance. Rather than being an unchanging template, DNA appears subject to a good deal of environmentally induced change. Instead of identical DNA in all the cells of the body, somatic mosaicism appears to be the normal human condition. And DNA can no longer be considered the sole agent of inheritance. We now know that the epigenome, which regulates gene expressivity, can be inherited via the germline. These developments are particularly significant for behavior genetics for at least three reasons: First, epigenetic regulation, DNA variability, and somatic mosaicism appear to be particularly prevalent in the human brain and probably are involved in much of human behavior; second, they have important implications for the validity of heritability and gene association studies, the methodologies that largely define the discipline of behavior genetics; and third, they appear to play a critical role in development during the perinatal period and, in particular, in enabling phenotypic plasticity in offspring. I examine one of the central claims to emerge from the use of heritability studies in the behavioral sciences, the principle of minimal shared maternal effects, in light of the growing awareness that the maternal perinatal environment is a critical venue for the exercise of adaptive phenotypic plasticity. This consideration has important implications for both developmental and evolutionary biology.
Collapse
|
27
|
Jäderberg I, Thomsen SF, Kyvik KO, Skytthe A, Backer V. Atopic diseases in twins born after assisted reproduction. Paediatr Perinat Epidemiol 2012; 26:140-5. [PMID: 22324500 DOI: 10.1111/j.1365-3016.2011.01246.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examined the risk of atopic diseases in twins born after assisted reproduction. Data on atopic diseases and assisted reproduction in 9694 twin pairs, 3-20 years of age, from the Danish Twin Registry were collected via multidisciplinary questionnaires. The risk of atopic diseases in twins born after assisted reproduction was compared with the risk in twins born after spontaneous conception using logistic regression and variance components analysis. Children born after assisted reproduction did not have a different risk of atopic outcomes (adjusted odds ratios [95% confidence intervals] for asthma: 0.95 [0.85, 1.07], P = 0.403; hay fever: 1.01 [0.86, 1.18], P = 0.918; and atopic dermatitis: 1.02 [0.81, 1.11], P = 0.773 respectively) compared with children born after spontaneous conception. Assisted reproduction did not modify the heritability of atopic diseases. This study does not support an association between assisted reproduction and development of atopic diseases. This result must be confirmed in subsequent studies, preferably of singleton populations.
Collapse
Affiliation(s)
- Ida Jäderberg
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | | | | | | | | |
Collapse
|
28
|
Pires S, Nogueira AJA, Pinho O, Delgado T, Sousa M, Santos R, Jorge P. Statistical Approach to Prenatal Zygosity Assessment Following a Decade of Molecular Aneuploidy Screening. Twin Res Hum Genet 2012; 14:221-7. [DOI: 10.1375/twin.14.3.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In twin pregnancy studies, molecular genetic techniques have rarely been used to determine zygosity, despite their known precision and accuracy. The present work aimed to assess the power of discrimination in zygosity assessment, using a set of microsatellite markers that were routinely used for aneuploidy screening by multiplex-PCR in a prenatal context. Rapid aneuploidy screening using a group of 20 microsatellite markers (STRs) located on chromosomes 13, 18, 21 and X has been performed in our lab for over 10 years, with a total of approximately 1,500 samples studied to date. A retrospective analysis of the 257 prenatal samples from multiple pregnancies was carried out. A subset of 14 cases presenting theoretical monozygosity were re-evaluated by the use of biostatistics tools accessed via the ZygProb website. Further monozygosity determination relative to dizygosity was calculated, given an estimated overall error value of 0.093%. The results show that monozygosity had been correctly determined in all our previously studied twins. This work demonstrates that accurate zygosity assessment can be achieved with the same STRs applied in aneuploidy screening with a high power of discrimination and a matching probability of over 99.999999%.
Collapse
|
29
|
Guilherme R, Drunat S, Delezoide AL, Ray CL, Oury JF, Luton D. Zygosity and Chorionicity in the Prognosis of Triplet Pregnancies: Contribution of Microsatellites. Twin Res Hum Genet 2012; 11:648-55. [DOI: 10.1375/twin.11.6.648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractWe assess the prognostic values of zygosity and chorionicity in triplet pregnancies (TP) with the assistance of microsatellites analysis. 53 consecutive TP whose prenatal care and delivery occurred in our maternity hospital were included in this prospective study. Zygosity of all sets of triplets (alive or stillbirth, after 22 weeks of gestation) was determined by PCR-amplified microsatellites markers analysis. Chorionicity was determined by placental analysis in our fetopathology referral department and validated by molecular analysis of zygosity. Placental conformations, obstetrical and neonatal outcomes of TP were studied according to their zygosity and chorionicity. Monozygotic and to a greater extent, dizygotic TP were associated with an increase in placental ischemic injuries, velamentous cord insertions, twin-twin transfusion syndromes, fetal anomalies, and perinatal mortality when compared with the trizygotic TP (p<0.05). Monochorionic and more significantly, dichorionic TP presented with the same increases as trichorionic TP (p<0.05). Thus chorionicity easily determined by ultrasound evaluation during the first trimester of the pregnancy must remain the main prognosis criterion in TP. Taking into account the rare indications of prenatal diagnosis of zygosity, it became apparent that chorionicity has a greater impact than zygosity when distinguishing high-risk groups of TP.
Collapse
|
30
|
Lee KA, Oh KJ, Lee SM, Kim A, Jun JK. The Frequency and Clinical Significance of Twin Gestations According to Zygosity and Chorionicity. Twin Res Hum Genet 2012; 13:609-19. [DOI: 10.1375/twin.13.6.609] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background:Although the clinical importance of chorionicity in twin pregnancies has been studied widely, the significance of perinatal determination of zygosity using molecular genetic analyses remains controversial. The purpose of this study was to determine the frequency and clinical significance of twin gestations according to zygosity and chorionicity in a Korean population.Methods:We enrolled 569 women who delivered twin newborns (> 24 weeks) at Seoul National University Hospital between 1999 and 2008. Chorionicity was established by histologic examination of placentae. Zygosity was determined with sex of neonates, chorionicity, and DNA analysis of umbilical cord blood.Results:The frequency of dizygotic (DZ) twins was 71.0% (404/569 pairs) based on the opposite sex (238/404 [58.9%]) and DNA analyses (166/404 [41.1%]); that of monozygotic (MZ) twins was 29.0% (165/569), including monochorionic (MC) (72.1% [119/165]) and dichorionic (DC) twins (27.9% [46/165]), which was confirmed by DNA analyses. Among spontaneously conceived twins, the frequency of MZ twins was more than twice that of DZ twins. The risk of low birth weight was 1.8-fold higher among MZDC twins and 1.9-fold higher among MZMC twins than among DZDC twins (p< .05). Bronchopulmonary dysplasia occurred more frequently among MZMC twins than among DZDC twins (adjusted OR 8.42, 95% CI 1.82–39.08,p< .01). However, the frequencies of other neonatal morbidities were not significantly higher in the MZMC group than in the MZDC and DZDC groups. The perinatal mortality rate was 15 per 1000 total births in the DZDC twins, 20 per 1000 total births in the MZDC and 56 per 1000 total births in the MZMC (p< .01).Conclusions:Although monozygosity was shown to be a risk factor for perinatal death and accurate determination of zygosity plays a great role in the future consideration of organ transplantation and twin studies, the value of zygosity determination along with chorionicity in relation to overall neonatal morbidity was not definite.
Collapse
|
31
|
Abstract
The incidence of monozygotic twinning in pregnancies achieved with assisted reproductive technologies (ART) is significantly higher than spontaneously conceived pregnancies. The factors associated with ART that predispose the embryos to splitting are not well-characterized. Assisted hatching and extended embryo culture are two ART laboratory methods that have been risk factors for monozygotic twinning. The methods and strategies that may be employed to avoid monozygotic twinning are discussed in this chapter.
Collapse
Affiliation(s)
- Amy E Sparks
- IVF and Reproductive Testing Laboratories, Department of Obstetrics and Gynecology, Center for Advanced Reproductive Care, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| |
Collapse
|
32
|
Glinianaia SV, Obeysekera MA, Sturgiss S, Bell R. Stillbirth and neonatal mortality in monochorionic and dichorionic twins: a population-based study. Hum Reprod 2011; 26:2549-57. [PMID: 21727159 DOI: 10.1093/humrep/der213] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chorionicity is one of the main predictors of higher perinatal mortality in twins. The aim of this large population-based study was to analyse stillbirth and neonatal mortality by cause of death and chorionicity and to quantify the risk of stillbirth by gestational age in dichorionic (DC) and monochorionic (MC) twins. METHODS We used data on twin maternities delivered in the North of England from 1998 to 2007 and notified to the Northern Survey of Twin and Multiple Pregnancy. Prospective risk of stillbirth by gestational age at death was calculated using number of stillborn fetuses at or beyond a given gestational period per 1000 fetuses in ongoing pregnancies. RESULTS There were 4565 twin maternities (9130 twins) with an overall twinning rate of 14.9 per 1000 maternities. The overall stillbirth and neonatal mortality rates in twins during 1998-2007 were 18.0/1000 births and 23.0/1000 live births, respectively. Stillbirth and neonatal mortality rates were significantly higher in MC than DC twins: 44.4 versus 12.2 per 1000 births [relative risk (RR): 3.6; 95% CI: 2.6-5.1], and 32.4 versus 21.4 per 1000 live births (RR: 1.5; 95% CI: 1.04-2.2), respectively. There was no significant improvement over time in either stillbirth or neonatal mortality rates in either group. The prospective risk of antepartum stillbirth was higher for MC than DC twins at all preterm gestations and the highest risk was before 28 weeks' gestation. CONCLUSIONS MC twins have higher rates of stillbirth and neonatal mortality than DC twins, and rates did not improve over 1998-2007. The prospective risk of antepartum stillbirth is much higher for MC twins at all gestational ages.
Collapse
Affiliation(s)
- Svetlana V Glinianaia
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
| | | | | | | |
Collapse
|
33
|
Antoniou EE, Derom C, Thiery E, Fowler T, Southwood TR, Zeegers MP. The Influence of Genetic and Environmental Factors on the Etiology of the Human Umbilical Cord: The East Flanders Prospective Twin Survey1. Biol Reprod 2011; 85:137-43. [DOI: 10.1095/biolreprod.110.088807] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
34
|
Investigation of the factors affecting the perinatal outcome of monochorionic diamniotic twins. Arch Gynecol Obstet 2010; 283:1239-43. [DOI: 10.1007/s00404-010-1549-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 06/01/2010] [Indexed: 11/24/2022]
|
35
|
Salomon L, Stirnemann J, Bernard JP, Essaoui M, Chalouhi G, El Sabbagh A, Ville Y. Surveillance des grossesses gémellaires monochoriales biamniotiques non compliquées. ACTA ACUST UNITED AC 2009; 38:S45-50. [DOI: 10.1016/s0368-2315(09)73559-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
36
|
Wadhawan R, Oh W, Perritt RL, McDonald SA, Das A, Poole WK, Vohr BR, Higgins RD. Twin gestation and neurodevelopmental outcome in extremely low birth weight infants. Pediatrics 2009; 123:e220-7. [PMID: 19139085 PMCID: PMC2842087 DOI: 10.1542/peds.2008-1126] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this work was to compare the risk-adjusted incidence of death or neurodevelopmental impairment at 18 to 22 months' corrected age between twin and singleton extremely low birth weight infants. We hypothesized that twin gestation is independently associated with increased risk of death or adverse neurodevelopmental outcomes at 18 to 22 months' corrected age in these infants. METHODS We conducted a retrospective study of inborn extremely low birth weight infants admitted to Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network units between 1997 and 2005, who either died or had follow-up data available at 18 to 22 months' corrected age. Neurodevelopmental impairment, the primary outcome variable, was defined as the presence of any 1 of the following: moderate or severe cerebral palsy, severe bilateral hearing loss, bilateral blindness, Bayley Mental Developmental Index or Psychomotor Developmental Index of <70. Death was included with neurodevelopmental impairment as a composite outcome. Results were compared for both twins, twin A, twin B, same-gender twins, unlike-gender twins, and singleton infants. Logistic regression analysis was performed to control for demographic and clinical factors that were different among the groups. RESULTS The cohort of infants who either died or were assessed for neurodevelopmental impairment consisted of 7630 singleton infants and 1376 twins. Logistic regression adjusting for clinical and sociodemographic risk factors showed an increased risk of death or neurodevelopmental impairment for twins as a group when compared with the singletons. On analyzing twin A and B separately as well, risk of death or neurodevelopmental impairment was increased in both twin A and twin B. CONCLUSIONS Twin gestation in extremely low birth weight infants is associated with an independent increased risk of death or neurodevelopmental impairment at 18 to 22 months' corrected age compared with singleton-gestation infants. Both first- and second-born twins are at increased risk.
Collapse
Affiliation(s)
- Rajan Wadhawan
- West Coast Neonatology, All Children's Hospital, 880 Sixth St South, Suite 470, St Petersburg, FL 33701, USA.
| | - William Oh
- Women & Infant's Hospital, Providence, RI,NICHD Neonatal Research Network, Bethesda, MD
| | | | | | - Abhik Das
- NICHD Neonatal Research Network, Bethesda, MD
| | | | - Betty R Vohr
- Women & Infant's Hospital, Providence, RI,NICHD Neonatal Research Network, Bethesda, MD
| | | |
Collapse
|
37
|
Hartley RS, Hitti J. Increasing rates of sex-discordant twins no longer correspond to decreasing perinatal mortality rates. J Perinat Med 2008; 36:228-34. [PMID: 18576932 DOI: 10.1515/jpm.2008.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze dizygotic twinning rates and outcomes over a 25-year period. METHODS Birth and fetal death certificates from 1980-2004 in Washington State, USA, were analyzed retrospectively to find factors associated with the increase in sex-discordant twins through time. "Low" and "high" fertility treatment groups were defined according to demographic traits. Perinatal mortality was defined as fetal or neonatal death of one or both twins and Weinberg's rule was used to estimate mortality for monozygotic and dizygotic pairs. RESULTS Controlling simultaneously for maternal age, race, parity, and education did not eliminate the trend of increasing sex-discordant twins from 1992-2004 (M-H chi2 P=0.001). The "low" fertility group had a non-significant decline in sex-discordant twins (M-H chi2 P=0.24), whereas the "high" fertility group had a significant increase (M-H chi2 P=0.001). Perinatal mortality decreased for monozygtic twin pairs throughout the study period, but decreased until the mid-1990s and then increased slightly through 2004 for the dizygotic twin pairs. CONCLUSION Advancing maternal age and increasing use of fertility treatments are largely responsible for the increase in dizygotic twins from 1980-2004 and may also be responsible for the stalling of the decline in perinatal mortality rate.
Collapse
|
38
|
Ruder EH, Dorgan JF, Kranz S, Kris-Etherton PM, Hartman TJ. Examining breast cancer growth and lifestyle risk factors: early life, childhood, and adolescence. Clin Breast Cancer 2008; 8:334-42. [PMID: 18757260 DOI: 10.3816/cbc.2008.n.038] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The perinatal period, childhood, and adolescence are important intervals for breast cancer risk development. Endogenous estrogen exposure is thought to be highest in utero, and exposure to estrogens throughout life plays an important role in increasing breast cancer risk. Some evidence suggests that breast tissue is not fully differentiated until after the first full-term pregnancy; thus, breast tissue might be more susceptible to carcinogenic influences during early life and adolescence. Birth characteristics of the daughter, including gestational age, birth weight, and birth length are associated with maternal hormone levels during the index pregnancy, and birth size has been related to daughter's timing of puberty and adult breast cancer incidence. Furthermore, early life and adolescence are critical times for maturation of the hypothalamic pituitary ovarian axis, which regulates production of ovarian hormones including estrogen and progesterone. Childhood height, growth, diet, and body mass index (BMI) have also been associated with breast cancer risk later in life. Of the examined characteristics, we conclude that the available evidence is suggestive of a positive relationship of breast cancer risk with birth weight, birth length, and adolescent height, and an inverse relationship with gestational age and childhood BMI, although several inconsistencies exist in the literature. The best evidence for a relationship of adolescent diet and adult breast cancer risk is indirect, and the relationship of diet, weight status, and weight gain in childhood deserves further attention. The interaction of birth characteristics with established risk factors over the life course, such as age at menarche, in addition to gene-environment interactions, require more research. Further study is also needed to clarify the biologic mechanisms influencing the observed associations.
Collapse
Affiliation(s)
- Elizabeth H Ruder
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.
| | | | | | | | | |
Collapse
|
39
|
Kusanovic JP, Romero R, Espinoza J, Nien JK, Kim CJ, Mittal P, Edwin S, Erez O, Gotsch F, Mazaki-Tovi S, Than NG, Soto E, Camacho N, Gomez R, Quintero R, Hassan SS. Twin-to-twin transfusion syndrome: an antiangiogenic state? Am J Obstet Gynecol 2008; 198:382.e1-8. [PMID: 18395032 PMCID: PMC2678902 DOI: 10.1016/j.ajog.2008.02.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 01/14/2008] [Accepted: 02/06/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE An imbalanced chronic blood flow between the donor and recipient twin through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS). Vascular endothelial growth factor receptor-1 (VEGFR-1) mRNA is overexpressed only in the syncytiotrophoblast of the donor twin in some cases of TTTS. This study was conducted to determine maternal plasma concentrations of placental growth factor (PlGF), soluble VEGFR-1, and soluble endoglin (s-Eng) in monochorionic-diamniotic pregnancies with and without TTTS. STUDY DESIGN This case-control study included monochorionic-diamniotic pregnancies between 16-26 weeks with and without TTTS. Maternal plasma concentrations of PlGF, sVEGFR-1, and s-Eng were determined with ELISA. A P value < .05 was considered statistically significant. RESULTS Patients with TTTS had higher median plasma concentrations of s-Eng (14.8 ng/mL vs 7.8 ng/mL; P < .001) and sVEGFR-1 (6383.1 pg/mL vs 3220.1 pg/mL; P < .001]; and lower median plasma concentrations of PlGF (115.5 pg/mL vs 359.3 pg/mL; P = .002) than those without TTTS. CONCLUSION We propose that an antiangiogenic state may be present in some cases of TTTS.
Collapse
|
40
|
Abstract
Any discussion of multiple pregnancy figures prominently in the consideration of the medicolegal aspects of placental pathology. Multiple gestations are common and becoming more so with assisted reproductive techniques, and multiples are associated with a disproportionate share of complications that may result in disputes over quality of care. Higher rates of intrauterine growth retardation, prematurity, stillbirth, morbidity, mortality, cerebral palsy, anomalous development, and malformation as compared with singletons are well documented in multiple pregnancy and should be anticipated. Monochorionic placentation and complications of vascular anastomosis are important factors contributing to poor outcome. Other factors, although occurring in all gestations, are relevant because they are more common in multiple gestations.
Collapse
Affiliation(s)
- Deborah J Gersell
- Department of Pathology, St. John's Mercy Medical Center, 615 S. New Ballas Road, St. Louis, MO 63141, USA
| |
Collapse
|
41
|
Devlin B, Klei L, Myles-Worsley M, Tiobech J, Otto C, Byerley W, Roeder K. Genetic liability to schizophrenia in Oceanic Palau: a search in the affected and maternal generation. Hum Genet 2007; 121:675-84. [PMID: 17436020 DOI: 10.1007/s00439-007-0358-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 03/20/2007] [Indexed: 12/22/2022]
Abstract
While liability to schizophrenia (Scz) is due to genetic and environmental factors, specific factors are largely unknown. We postulate a two-hit model for Scz, in which initial liability is generated during fetal brain development: this "hit" is precipitated by environmental stressors biologically interacting with maternal genetic vulnerability to the stress. Additional liability to Scz is generated by individual genetic vulnerability. To evaluate these putative levels of vulnerability, we search in the genome of both affected individuals and their mothers for variation that differs, statistically, from that in the general population. For parental analyses, mothers were treated as "affected," rather than their offspring, and the fathers were treated as "controls". We used a sample from the Palauan population: 175 individuals diagnosed with Scz, broadly defined; 87 mothers and 45 fathers of affected individuals. Pedigree and diagnostic data were available on 2,953 living and deceased subjects. DNA from 553 individuals was genotyped for short tandem repeats (STR) spaced approximately every 10 cM across the genome. We tested for association between affection status and STR alleles; such an approach was reasonable, despite the widely spaced markers, because this population has far-ranging linkage disequilibrium (LD). Results for the truly affected individuals were modest, whereas results from the maternal generation were promising. For a recessive model and a test for excess allele matching across mothers, significant findings occurred for D20S481, D10S1221, D6S1021, D13S317, and D18S976. Regions in which at least two adjacent markers produced substantial association statistics include 2p12-11.2, 2q24.1-32.1, 6q12-14.1, 10q23.2-24.21, 12q23.2-24.21 and 17q23.2-23.3.
Collapse
Affiliation(s)
- Bernie Devlin
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | | | | | | | | | | | | |
Collapse
|
42
|
Chavez MR, Ananth CV, Kaminsky LM, Smulian JC, Yeo L, Vintzileos AM. Fetal transcerebellar diameter measurement for prediction of gestational age in twins. Am J Obstet Gynecol 2006; 195:1596-600. [PMID: 16707078 DOI: 10.1016/j.ajog.2006.03.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 02/27/2006] [Accepted: 03/18/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was undertaken to determine the accuracy of our previously published and prospectively validated institution-specific singleton transcerebellar diameter (TCD) nomogram in the prediction of gestational age (GA) in twin pregnancies. We further evaluated whether the prediction of GA in twin gestations using the singleton TCD nomogram differs between monochorionic and dichorionic twins. STUDY DESIGN In our previously published studies, we retrospectively constructed a cross-sectional nomogram using TCD measurements in 24,026 well-dated, singleton fetuses, and prospectively validated the nomogram using 2,597 singleton fetuses. The current study comprised of 1,278 well-dated twins (19.6% monochorionic) seen in our ultrasound unit between August 1994 and May 2003, and the singleton TCD nomogram was validated in these twin gestations. The actual GA was subtracted from the GA predicted by the TCD nomogram and the concordance between actual and predicted GAs was assessed on the basis of the Pearson's correlation coefficient (r). This was performed separately for monochorionic and dichorionic twins. RESULTS Concordance between the actual and predicted twin TCD measurements based on our previously published singleton TCD nomogram was high (Pearson's correlation, r = 0.95, P < .0001). Between 16 and 23 weeks' gestation, the predicted mean GA was within 6 days of actual GA. Between 24 and 30 weeks, the predicted mean GA was within 3 days, and at 32 weeks or more, the predicted mean GA was within 5 days of the actual GA. Prediction of GA based on the singleton TCD nomogram was equally accurate in both monochorionic and dichorionic twin gestations (P = .686). CONCLUSION This study demonstrates that our previously validated singleton TCD nomogram is reliable and accurate in twins irrespective of placental chorionicity.
Collapse
Affiliation(s)
- Martin R Chavez
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School/Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | | | | | | | | | | |
Collapse
|
43
|
Blickstein I. Monochorionicity in perspective. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:235-8. [PMID: 16482610 DOI: 10.1002/uog.2730] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
|