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Ding G, Vinturache A, Yu J, Lu M, Pang Y, Tian Y, Zhang J. Optimal delivery timing for twin pregnancies: A population-based retrospective cohort study. Int J Clin Pract 2021; 75:e14014. [PMID: 33420725 DOI: 10.1111/ijcp.14014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/13/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS The optimal timing of delivery for twin pregnancies remains controversial. This study examined the risks of adverse neonatal outcomes and neonatal deaths according to gestational age at delivery in order to determine the optimal gestational age of delivery for twin pregnancies. METHODS This is a retrospective study of twin pregnancies delivered between 34 and 40 weeks of gestation from 1995 to 2000 in the United States. The primary outcomes evaluated were neonatal morbidity and mortality. The composite outcome of neonatal morbidity included the following variables: Apgar score lower than 7 at 5 minutes, assisted ventilation <30 minutes, assisted ventilation ≥30 minutes, hyaline membrane disease, meconium aspiration syndrome, neonatal seizures, birth injury, anaemia, and congenital malformations. Logistic regressions were applied to calculate adjusted odds ratios of the adverse outcomes according to the gestational week at delivery, with either individual twins or twin pairs as the unit of analysis. RESULTS A total of 466 038 twins from 233 019 pregnancies from the US National Center for Health Statistics matched the multiple birth data set included in the study. The composite neonatal morbidity and mortality risks declined from 34 to 38 weeks of gestation and increased thereafter in both individual and pair twins stratified analyses. Amongst neonatal adverse outcomes, the risk of low Apgar score and hyaline membrane disease decreased progressively towards 38 weeks of gestation, only to increase again towards 40 weeks. The risk of meconium aspiration syndrome increased after 38 weeks, in both individual and pair twins. There were no differences in the risk of birth injury and neonatal seizures when stratified by gestational age. CONCLUSIONS The optimal timing for twin delivery appears to be at 38 weeks of gestation, although individual maternal, foetal, and pregnancy characteristics should be considered when determining the best timing for delivery.
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Affiliation(s)
- Guodong Ding
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Angela Vinturache
- Department of Obstetrics & Gynecology, Queen Elizabeth II Hospital, Alberta, Canada
| | - Jing Yu
- Campus Infirmary, Fudan University, Shanghai, China
| | - Min Lu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Pang
- China Novartis Institutes for BioMedical Research Co., Ltd, Shanghai, China
| | - Ying Tian
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
Full-term deliveries are defined as occurring between 39 weeks and 40 weeks and 6 days. Because contemporary research suggests improved outcomes with delivery in the term period compared with the early term period, nonindicated delivery should be pursued no earlier than 39 weeks. There are, however, multiple medical, obstetric, and fetal indications for delivery before 39 weeks, and the obstetric provider must weigh the risks and benefits of delivery versus expectant management on both the mother and fetus. This review serves to provide a basic framework of evidentiary support toward optimizing the term delivery.
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Affiliation(s)
- Timothy Wen
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94158, USA
| | - Amy L Turitz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA.
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Jahanfar S, Lim K, Oviedo-Joekes E. Optimal threshold for birth weight discordance: Does knowledge of chorionicity matter? J Perinatol 2016; 36:704-12. [PMID: 27171760 DOI: 10.1038/jp.2016.82] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 02/16/2016] [Accepted: 03/22/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To establish the optimal threshold of birth weight discordance (BWD) for prediction of stillbirth, perinatal mortality and morbidity in twins born in British Columbia with or without chorionicity information. STUDY DESIGN This is a retrospective population-based cohort study of twins born in British Columbia from 2000 to 2010. Data from one hospital was used to adjust for chorionicity. Multivariate generalized estimating equation and receiver operating characteristic curve analyses were performed to evaluate the predictability of BWD in comparison with other fetal anthropometric measurements. Positive likelihood ratio is used to estimate test accuracy. Survival analysis was conducted to take gestational age and other confounders into account. RESULTS We analyzed two cohorts, with (pairs=1493) and without (pairs=6328) chorionicity information, of which 1.5% experienced stillbirth, 2.9% suffered perinatal mortality and 22.6% identified with perinatal morbidities. BWD was a significant predictor of stillbirth. Standard receiver operating characteristic curve analysis and survival analysis suggested that BWD of ⩾30% is the optimal thresholds for stillbirth and perinatal mortality irrespective of chorionicity. However, the P-value for predictive accuracy of BWD was nonsignificant for perinatal morbidity, after adjusting for confounding variables engaging multivariate analysis. Sex discordance can be used as a proxy for chorionicity. CONCLUSION BWD is a good predictor for stillbirth. A BWD cutoff limit of 30% and higher has optimal accuracy for detecting perinatal mortality.
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Affiliation(s)
- S Jahanfar
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - K Lim
- Division of Maternal Fetal Medicine, Vancouver, BC, Canada
| | - E Oviedo-Joekes
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
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4
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Yokoyama Y, Jelenkovic A, Sund R, Sung J, Hopper JL, Ooki S, Heikkilä K, Aaltonen S, Tarnoki AD, Tarnoki DL, Willemsen G, Bartels M, van Beijsterveldt TCEM, Saudino KJ, Cutler TL, Nelson TL, Whitfield KE, Wardle J, Llewellyn CH, Fisher A, He M, Ding X, Bjerregaard-Andersen M, Beck-Nielsen H, Sodemann M, Song YM, Yang S, Lee K, Jeong HU, Knafo-Noam A, Mankuta D, Abramson L, Burt SA, Klump KL, Ordoñana JR, Sánchez-Romera JF, Colodro-Conde L, Harris JR, Brandt I, Nilsen TS, Craig JM, Saffery R, Ji F, Ning F, Pang Z, Dubois L, Boivin M, Brendgen M, Dionne G, Vitaro F, Martin NG, Medland SE, Montgomery GW, Magnusson PKE, Pedersen NL, Aslan AKD, Tynelius P, Haworth CMA, Plomin R, Rebato E, Rose RJ, Goldberg JH, Rasmussen F, Hur YM, Sørensen TIA, Boomsma DI, Kaprio J, Silventoinen K. Twin's Birth-Order Differences in Height and Body Mass Index From Birth to Old Age: A Pooled Study of 26 Twin Cohorts Participating in the CODATwins Project. Twin Res Hum Genet 2016; 19:112-24. [PMID: 26996222 PMCID: PMC5100672 DOI: 10.1017/thg.2016.11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We analyzed birth order differences in means and variances of height and body mass index (BMI) in monozygotic (MZ) and dizygotic (DZ) twins from infancy to old age. The data were derived from the international CODATwins database. The total number of height and BMI measures from 0.5 to 79.5 years of age was 397,466. As expected, first-born twins had greater birth weight than second-born twins. With respect to height, first-born twins were slightly taller than second-born twins in childhood. After adjusting the results for birth weight, the birth order differences decreased and were no longer statistically significant. First-born twins had greater BMI than the second-born twins over childhood and adolescence. After adjusting the results for birth weight, birth order was still associated with BMI until 12 years of age. No interaction effect between birth order and zygosity was found. Only limited evidence was found that birth order influenced variances of height or BMI. The results were similar among boys and girls and also in MZ and DZ twins. Overall, the differences in height and BMI between first- and second-born twins were modest even in early childhood, while adjustment for birth weight reduced the birth order differences but did not remove them for BMI.
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Affiliation(s)
- Yoshie Yokoyama
- Department of Public Health Nursing,Osaka City University,Osaka,Japan
| | - Aline Jelenkovic
- Department of Social Research,University of Helsinki,Helsinki,Finland
| | - Reijo Sund
- Department of Social Research,University of Helsinki,Helsinki,Finland
| | - Joohon Sung
- Department of Epidemiology,School of Public Health,Seoul National University,Seoul,Korea
| | - John L Hopper
- Department of Epidemiology,School of Public Health,Seoul National University,Seoul,Korea
| | - Syuichi Ooki
- Department of Health Science,Ishikawa Prefectural Nursing University,Kahoku,Ishikawa,Japan
| | - Kauko Heikkilä
- Department of Public Health,University of Helsinki,Helsinki,Finland
| | - Sari Aaltonen
- Department of Social Research,University of Helsinki,Helsinki,Finland
| | - Adam D Tarnoki
- Department of Radiology and Oncotherapy,Semmelweis University,Budapest,Hungary
| | - David L Tarnoki
- Department of Radiology and Oncotherapy,Semmelweis University,Budapest,Hungary
| | - Gonneke Willemsen
- Department of Biological Psychology,VU University Amsterdam,Amsterdam,the Netherlands
| | - Meike Bartels
- Department of Biological Psychology,VU University Amsterdam,Amsterdam,the Netherlands
| | | | - Kimberly J Saudino
- Boston University,Department of Psychological and Brain Sciences,Boston,Massachusetts,USA
| | - Tessa L Cutler
- The Australian Twin Registry,Centre for Epidemiology and Biostatistics,The University of Melbourne,Melbourne,Victoria,Australia
| | - Tracy L Nelson
- Department of Health and Exercise Sciences and Colorado School of Public Health,Colorado State University,Fort Collins,Colorado,USA
| | - Keith E Whitfield
- Psychology and Neuroscience,Duke University,Durham,North Carolina,USA
| | - Jane Wardle
- Health Behaviour Research Centre,Department of Epidemiology and Public Health,Institute of Epidemiology and Health Care,University College London,London,UK
| | - Clare H Llewellyn
- Health Behaviour Research Centre,Department of Epidemiology and Public Health,Institute of Epidemiology and Health Care,University College London,London,UK
| | - Abigail Fisher
- Health Behaviour Research Centre,Department of Epidemiology and Public Health,Institute of Epidemiology and Health Care,University College London,London,UK
| | - Mingguang He
- State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangzhou,China
| | - Xiaohu Ding
- State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangzhou,China
| | | | | | - Morten Sodemann
- Department of Infectious Diseases,Odense University Hospital,Odense,Denmark
| | - Yun-Mi Song
- Department of Family Medicine,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South-Korea
| | - Sarah Yang
- Department of Epidemiology,School of Public Health,Seoul National University,Seoul,Korea
| | - Kayoung Lee
- Department of Family Medicine,Busan Paik Hospital,Inje University College of Medicine,Busan,Korea
| | - Hoe-Uk Jeong
- Department of Education,Mokpo National University,Jeonnam,South Korea
| | | | - David Mankuta
- Hadassah Hospital Obstetrics and Gynecology Department,Hebrew University Medical School,Jerusalem,Israel
| | | | | | | | - Juan R Ordoñana
- Department of Human Anatomy and Psychobiology,University of Murcia,Murcia,Spain
| | - Juan F Sánchez-Romera
- Department of Developmental and Educational Psychology,University of Murcia,Murcia,Spain
| | - Lucia Colodro-Conde
- Department of Human Anatomy and Psychobiology,University of Murcia,Murcia,Spain
| | | | | | | | - Jeffrey M Craig
- Murdoch Childrens Research Institute,Royal Children's Hospital,Melbourne,Victoria,Australia
| | - Richard Saffery
- Murdoch Childrens Research Institute,Royal Children's Hospital,Melbourne,Victoria,Australia
| | - Fuling Ji
- Department of Noncommunicable Diseases Prevention,Qingdao Centers for Disease Control and Prevention,Qingdao,China
| | - Feng Ning
- Department of Noncommunicable Diseases Prevention,Qingdao Centers for Disease Control and Prevention,Qingdao,China
| | - Zengchang Pang
- Department of Noncommunicable Diseases Prevention,Qingdao Centers for Disease Control and Prevention,Qingdao,China
| | - Lise Dubois
- School of Epidemiology,Public Health and Preventive Medicine,University of Ottawa,Ottawa,Ontario,Canada
| | | | - Mara Brendgen
- Département de Psychologie,Université du Québec à Montréal,Montréal,Québec,Canada
| | | | - Frank Vitaro
- École de psychoéducation,Université de Montréal,Montréal,Québec,Canada
| | - Nicholas G Martin
- Genetic Epidemiology Department,QIMR Berghofer Medical Research Institute,Brisbane,Queensland,Australia
| | - Sarah E Medland
- Genetic Epidemiology Department,QIMR Berghofer Medical Research Institute,Brisbane,Queensland,Australia
| | - Grant W Montgomery
- Molecular Epidemiology Department,QIMR Berghofer Medical Research Institute,Brisbane,Queensland,Australia
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - Anna K Dahl Aslan
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - Per Tynelius
- Department of Public Health Sciences,Karolinska Institutet,Stockholm,Sweden
| | | | - Robert Plomin
- King's College London,MRC Social,Genetic & Developmental Psychiatry Centre,Institute of Psychiatry,Psychology & Neuroscience,London,UK
| | - Esther Rebato
- Department of Genetics,Physical Anthropology and Animal Physiology,University of the Basque Country UPV/EHU,Leioa,Spain
| | | | - Jack H Goldberg
- Department of Epidemiology,School of Public Health,University of Washington,Seattle,Washington,USA
| | - Finn Rasmussen
- Department of Public Health Sciences,Karolinska Institutet,Stockholm,Sweden
| | - Yoon-Mi Hur
- Department of Education,Mokpo National University,Jeonnam,South Korea
| | - Thorkild I A Sørensen
- Institute of Preventive Medicine,Bispebjerg and Frederiksberg Hospitals,Copenhagen,The Capital Region,Denmark
| | - Dorret I Boomsma
- Department of Biological Psychology,VU University Amsterdam,Amsterdam,the Netherlands
| | - Jaakko Kaprio
- Department of Public Health,University of Helsinki,Helsinki,Finland
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5
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Roesch M, Bourtembourg A, Panouillères M, Ramanah R, Riethmuller D. L’accouchement du deuxième jumeau en présentation céphalique. À propos d’une série de 127 patientes. ACTA ACUST UNITED AC 2016; 45:291-9. [DOI: 10.1016/j.jgyn.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 03/17/2015] [Accepted: 04/01/2015] [Indexed: 11/28/2022]
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6
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Prunet C, Goffinet F, Blondel B. Prise en charge et santé périnatale en cas de grossesse gémellaire : situation en 2010 et évolution récente en France. ACTA ACUST UNITED AC 2015; 44:184-93. [DOI: 10.1016/j.jgyn.2014.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/17/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
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Abstract
OBJECTIVES To describe trends in twin maternity rates, factors which contribute to these trends, and risks associated with twin maternities for mothers and children. POPULATION AND METHOD The review was done on population-based studies, preferably in France and the European Union. RESULTS The rate of twin maternities was 15.6 p 1000 in 2008 and it increased by about 80% between 1972 and 2006. This rise was explained mainly by advanced maternal age and the diffusion of fertility treatments. The major risks for twins were fetal and infant mortality, preterm delivery, small for gestational age, and cerebral palsy. The rate of preterm delivery (<37 weeks) was 44.3% in France in 2003, and the relative risk was 8.8 (95% CI: 7.8-10.0), when compared with single pregnancies. Maternal age and fertility treatments do not change very much the perinatal risk of twins. CONCLUSION Twin pregnancies are a high risk group which needs more intensive medical care than single pregnancies. The perinatal information system should be improved in France to monitor perinatal indicators according to the number of fetuses in a proper way.
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Affiliation(s)
- B Blondel
- INSERM U953, Unité de recherche épidémiologique sur la santé périnatale et la santé des femmes et des enfants, 94805 Villejuif cedex, France.
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[Perinatal outcome of monochorionic and dichorionic twin gestations: a study of 775 pregnancies at Reunion Island]. ACTA ACUST UNITED AC 2013; 42:655-61. [PMID: 23562794 DOI: 10.1016/j.jgyn.2013.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 02/09/2013] [Accepted: 02/28/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To compare the perinatal mortality and morbidity of infants born from monochorionic versus dichorionic twin pregnancies (TP). PATIENTS AND METHODS Retrospective, comparative study of monochorionic and dichorionic TP over 10 years in the south of Reunion Island. Information regarding demographic, gestational and perinatal variables of mothers and infants was collected from the hospital perinatal database. RESULTS Six hundred and twenty dichorionic and 155 monochorionic TP were analyzed. In case of monochorionic TP, mothers had higher rates of pregnancy-related hypertension (OR=1.82, 95%CI=[1.02-3.29] ; P=0.03) and hospitalization (OR=1.48, 95%CI=[1.02-2.16]; P=0.03). Newborns from monochorionic TP had higher morbidity for : very preterm birth (birth before 33 weeks gestation) (OR=1.65, 95%CI=[1.02-2.66]; P=0.02), very low birth weight (birth weight<1500g) (OR=1.73, 95%CI=[1.57-3.13]; P<0.001), Apgar<7 at 1 minute (OR=1.76, 95%CI=[1.18-2.61]; P<0.01) and hospitalization (OR=2.08, 95%CI=[1.58-2.73]; P<0.001). Perinatal mortality was also significantly higher (OR=2.47, 95%CI=[1.54-3.94]; P<0.001), as well intrauterine fetal death (OR=3.96, 95%CI=[1.95-8.05]; P<0.001) CONCLUSION: This study confirms that few differences exist among dichorionic and monochorionic TP with regard to maternal morbidity, while neonatal morbidity and mortality are higher in twins born from monochorionic pregnancies.
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Wilmink FA, Hukkelhoven CW, Mol BWJ, van der Post JA, Steegers EA, Papatsonis DN. Neonatal outcome following elective cesarean section of twin pregnancies beyond 35 weeks of gestation. Am J Obstet Gynecol 2012; 207:480.e1-7. [PMID: 23017224 DOI: 10.1016/j.ajog.2012.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 07/27/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We sought to assess neonatal morbidity and mortality of elective cesarean section (CS) of uncomplicated twin pregnancies per week of gestation >35(+0). STUDY DESIGN We performed a retrospective cohort study in our nationwide database including all elective CS of twin pregnancies. Two main composite outcome measures were defined, ie, severe adverse neonatal outcome and mild neonatal morbidity. RESULTS We report on 2228 neonates. More than 17% were born <37(+0) weeks of gestation. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for severe adverse neonatal outcome at 35(+0-6), 36(+0-6), and 37(+0-6) weeks were, OR, 9.4; 95% CI, 3.2-27.6; OR, 1.7; 95% CI, 0.5-5.3; and OR, 0.7; 95% CI, 0.2-2.0, respectively; and for mild neonatal morbidity, OR, 4.7; 95% CI, 2.6-8.7; OR, 4.9; 95% CI, 3.1-7.9; and 1.4; 95% CI, 0.9-2.1, respectively, compared to neonates born ≥38(+0) weeks of gestation. CONCLUSION In uncomplicated twin pregnancies elective CS can best be performed between 37(+0) and 39(+6) weeks of gestation.
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Algert CS, Morris JM, Bowen JR, Giles W, Roberts CL. Twin deliveries and place of birth in NSW 2001-2005. Aust N Z J Obstet Gynaecol 2010; 49:461-6. [PMID: 19780726 DOI: 10.1111/j.1479-828x.2009.01054.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Twin pregnancies have an elevated risk of adverse outcomes, particularly preterm twins. AIMS Describe the distribution of twin deliveries by hospital level, the associated perinatal and maternal morbidity, and determine predictors of perinatal morbidity and urgent transfer to a neonatal intensive care unit. METHODS Longitudinally linked New South Wales delivery and hospital records for the years 2001-2005 were used to identify perinatal and maternal morbidity/mortality in twin pregnancies. Regression analysis was used to examine predictive factors, including birth hospital volume. RESULTS At < or = 32 weeks, 88.1% of twins were delivered in tertiary referral hospitals. By 34-35 weeks, only 39.7% of twins were delivered in tertiary units. Gestational age was the primary predictor of perinatal morbidity/mortality. Perinatal morbidity/mortality and maternal morbidity were lowest for deliveries at 38 weeks. There was no evidence that planned caesarean section at < or = 38 weeks was protective against perinatal morbidity/mortality. There was an increased risk of perinatal morbidity/mortality (odds ratio (OR) = 2.22) for twins delivered at 33-35 weeks gestation at hospitals with < 500 deliveries per annum, and an increased risk of urgent neonatal transfer (OR = 2.06). Twin pairs for whom there was a > or = 20% discordance in birthweight had an increased risk of morbidity/mortality at 36-38 weeks (OR = 1.79). CONCLUSIONS Both infant and maternal morbidity increase from 39 weeks gestation. Delivery of twins before 36 weeks at smaller hospitals (< 500 deliveries per annum) should be avoided. A twin pregnancy where there is a > or = 20% difference in estimated fetal weights should be considered for referral to a tertiary obstetric unit.
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Affiliation(s)
- Charles S Algert
- Kolling Institute, University of Sydney, Northern Clinical School, Level 4, Wallace Freeborn Building (E25), Sydney, NSW 2006, Australia.
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Picone O. Surveillance des grossesses gémellaires bichoriales biamniotiques non compliquées. ACTA ACUST UNITED AC 2009; 38:S51-5. [DOI: 10.1016/s0368-2315(09)73560-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Gielen M, Lindsey PJ, Derom C, Loos RJF, Souren NY, Paulussen ADC, Zeegers MP, Derom R, Vlietinck R, Nijhuis JG. Twin-specific intrauterine 'growth' charts based on cross-sectional birthweight data. Twin Res Hum Genet 2008; 11:224-35. [PMID: 18361725 DOI: 10.1375/twin.11.2.224] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The assessment of fetal growth is an essential component of good antenatal care, especially for twins. The aims of this study are to develop twin-specific intrauterine 'growth' charts, based on cross-sectional birthweight data, for monochorionic and dichorionic twins according to sex and parity, and to detect twins at risk for neonatal death by comparing the use of twin-specific and singleton charts. The study sample consisted of 76,471 singletons and 8454 twins (4227 pairs) born in East Flanders (Belgium). Birthweights were analyzed using a nonlinear Gaussian regression. After 33 weeks of gestation, the birthweights of twins started to deviate from singletons (difference of 900 grams at 42 weeks). Birthweights of dichorionic twins continued to increase, whereas those of monochorionic twins decreased after week 40 (difference of more than 300 g at 42 weeks). After 31 weeks of gestation, neonatal mortality increased as centile decreased, and was especially high if birthweight was below the twin-specific third centile: .032 (below) versus .007 (above). Using singleton centiles, this was less obvious. In conclusion, twin-specific growth charts, taking chorionicity into account, are more accurate to detect twins at risk for neonatal death. Therefore the presented charts, based on cross-sectional birthweight data, enable an improved assessment of twin growth.
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Affiliation(s)
- Marij Gielen
- Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Department of Genetics and Cell Biology, Maastricht University, Maastricht, the Netherlands.
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Modeling genetic and environmental factors to increase heritability and ease the identification of candidate genes for birth weight: a twin study. Behav Genet 2007; 38:44-54. [PMID: 18157630 PMCID: PMC2226023 DOI: 10.1007/s10519-007-9170-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 09/17/2007] [Indexed: 10/28/2022]
Abstract
Heritability estimates of birth weight have been inconsistent. Possible explanations are heritability changes during gestational age or the influence of covariates (e.g. chorionicity). The aim of this study was to model birth weights of twins across gestational age and to quantify the genetic and environmental components. We intended to reduce the common environmental variance to increase heritability and thereby the chance of identifying candidate genes influencing the genetic variance of birth weight. Perinatal data were obtained from 4232 live-born twin pairs from the East Flanders Prospective Twin Survey, Belgium. Heritability of birth weights across gestational ages was estimated using a non-linear multivariate Gaussian regression with covariates in the means model and in covariance structure. Maternal, twin-specific, and placental factors were considered as covariates. Heritability of birth weight decreased during gestation from 25 to 42 weeks. However, adjusting for covariates increased the heritability over this time period, with the highest heritability for first-born twins of multipara with separate placentas, who were staying alive (from 52% at 25 weeks to 30% at 42 weeks). Twin-specific factors revealed latent genetic components, whereas placental factors explained common and unique environmental factors. The number of placentas and site of the insertion of the umbilical cord masked the effect of chorionicity. Modeling genetic and environmental factors leads to a better estimate of their role in growth during gestation. For birth weight, mainly environmental factors were explained, resulting in an increase of the heritability and thereby the chance of finding genes influencing birth weight in linkage and association studies.
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14
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Hack KEA, Derks JB, Elias SG, Franx A, Roos EJ, Voerman SK, Bode CL, Koopman-Esseboom C, Visser GHA. Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study. BJOG 2007; 115:58-67. [PMID: 17999692 DOI: 10.1111/j.1471-0528.2007.01556.x] [Citation(s) in RCA: 254] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate mortality and morbidity in a large cohort of twin pregnancies according to chorionicity. We aimed to estimate the optimal time of delivery. DESIGN Historical cohort design. Setting Two teaching hospitals. POPULATION Twin pregnancies delivered in the University Medical Centre, Utrecht, and the St Elisabeth Hospital, Tilburg (1995-2004), The Netherlands (n = 1407). METHODS Pregnancy outcomes were documented according to chorionicity. Mortality >/=32 weeks was reviewed carefully with special attention to antenatal fetal monitoring, autopsy and placental histopathology to find an explanation for adverse outcome. MAIN OUTCOME MEASURES Perinatal mortality and morbidity in monochorionic (MC) and dichorionic (DC) twins. RESULTS Perinatal mortality was 11.6% in MC twin pregnancies and 5.0% in DC twin pregnancies. After 32 weeks, the risk of intrauterine death (IUD) was significantly higher in MC twins than in DC twins (hazard ratio 8.8, 95% CI 2.7-28.9). In most of these cases of IUD, no antenatal signs of impaired fetal condition had been present. Median gestational age was 1 week longer in DC twins than in MC twins, and the mean birthweight was 221 g higher. Severe birthweight discordancy (>20%) occurred more often in MC twins than in DC twins (OR 1.23, 95% CI 0.97-1.55). The incidence of necrotising enterocolitis (NEC) was higher in MC twins, after adjustment for age and weight at birth (OR 4.05, 95% CI 1.97-8.35). There was a trend towards higher neuromorbidity in MC twins. CONCLUSIONS This is the largest cohort study of twin pregnancies evaluating outcome according to chorionicity thus far. MC twins are at increased risk for fetal death (even at term), NEC and neuromorbidity. Current antenatal care is insufficient to predict and prevent this excess perinatal mortality and morbidity. Planned delivery at or even before 37 weeks of gestation seems to be justified for MC twins.
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Affiliation(s)
- K E A Hack
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Marpeau L, Sentilhes L. Contre la césarienne systématique des grossesses gémellaires. ACTA ACUST UNITED AC 2007; 35:588-90. [DOI: 10.1016/j.gyobfe.2007.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gielen M, Lindsey PJ, Derom C, Loos RJF, Derom R, Nijhuis JG, Vlietinck R. Twin birth weight standards. Neonatology 2007; 92:164-73. [PMID: 17476117 DOI: 10.1159/000102055] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 12/11/2006] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this study was to present customized twin-specific birth weight standards. The relative contribution of gestational age, maternal factors, twin factors and placental factors to the birth weight was evaluated in a multivariate approach. SUBJECTS AND METHODS Perinatal data were obtained from 10,177 live-born twins from the East Flanders Prospective Twin Survey. Of 8,454 twins (4,227 pairs), of whom all data were available, the birth weights at different gestational ages were analyzed using a non-linear multivariate gaussian regression. RESULTS All considered covariates influenced birth weight of twins significantly, with the exception of sex of the co-twin and mode of conception and delivery. At 37 weeks of gestation, a difference of >1 kg existed between favourable and adverse prenatal environment. Up to 40 weeks, sex, site of the umbilical cord, parity, and birth order had a greater influence on birth weight than zygosity, chorionicity and fusion of the placentas. From 34 weeks on, the birth weight of the second-born twin deviated and after 40 weeks, birth weight of monozygotic monochorionic twins dropped, while the other twins continued to grow. CONCLUSION Customized twin-specific birth weight standards, which take these covariates into account, offer the opportunity for a better assessment of the influence of birth weight of the twin on neonatal health in future research. Already the Developmental Origins of Health and Disease hypothesis showed that these prenatal conditions might also be important for the follow-up of the twin.
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Affiliation(s)
- Marij Gielen
- Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Department of Population Genetics, Genomics and Bioinformatics, Maastricht University, Maastricht, The Netherlands.
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Lee YM, Cleary-Goldman J, D'Alton ME. The impact of multiple gestations on late preterm (near-term) births. Clin Perinatol 2006; 33:777-92; abstract viii. [PMID: 17148004 DOI: 10.1016/j.clp.2006.09.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multiple pregnancies currently account for 3% of all births in the United States but are disproportionately responsible for larger rates of prematurity and significant neonatal morbidity. The mean birth age for most multi-fetal pregnancies occurs during the late preterm period when both spontaneous preterm labor and iatrogenic premature birth because of obstetrical or maternal complications are common. Multiples pose numerous unique challenges, emphasizing the significant impact of plurality on late preterm births.
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Affiliation(s)
- Young Mi Lee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Columbia University Medical Center, New York, NY 10032, USA.
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