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Yang L, Zhou Y, Qiu J, Lin N, Gu N, Dai Y. Birth weight discordance and adverse neonatal outcomes in appropriately grown premature twins. Heliyon 2024; 10:e27057. [PMID: 38463868 PMCID: PMC10920362 DOI: 10.1016/j.heliyon.2024.e27057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/12/2024] Open
Abstract
Objective This study aimed to analyze the clinical characteristics of birth weight discordant twins (BWDT) who were premature and appropriate-for-gestational-age or large-for-gestational-age. Additionally, it assessed the impact of birth weight discordance on the prognosis of appropriately grown premature twins, and investigated the effect of maternal factors on neonatal outcomes. Study design This retrospective cohort study included twins who were born alive after preterm labor at the Nanjing Drum Tower Hospital from January 2018 to December 2021, along with their mothers. Twins were arranged into discordant and concordant groups according to intertwin birth weight discordance, followed by the analysis of the clinical characteristics of mothers and the prognosis of neonates. Results A total of 585 mothers and 1170 neonates were included, with 47 mothers and 94 neonates in the discordant group. The incidence of birth weight discordance was 8.0% (94/1,170) in appropriately grown premature twins. The incidence of complications (43.2% vs. 21.8%) and transfer to the neonatal intensive care unit (NICU) (53.2% vs. 29.2%) was higher in the discordant group than in the concordant group (p < 0.05). Furthermore, the incidence of infectious diseases (36.7% vs. 19.4%), necrotizing enterocolitis (7.6% vs. 1.6%), and oxygen therapy rate (22.8% vs. 12.8%) were statistically significantly higher in the discordant group than in the concordant group (p < 0.05). Conclusion Birth weight discordance remains a high-risk factor for complications and transfer to the NICU in appropriately grown premature twins. It is important to pay attention to birth weight discordance when the outcomes of twins are assessed.
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Affiliation(s)
- Ling Yang
- Department of Neonatology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Yan Zhou
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Jie Qiu
- Department of Neonatology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Nacheng Lin
- Department of Neonatology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Ning Gu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Yimin Dai
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
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李 秋, 张 慧, 陈 倩, 石 碧, 谭 小, 崔 其. [Impact of assisted reproductive technology on birth weight discordance in twins]. Zhongguo Dang Dai Er Ke Za Zhi 2023; 25:1239-1245. [PMID: 38112141 PMCID: PMC10731967 DOI: 10.7499/j.issn.1008-8830.2307034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/23/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES To explore the association between assisted reproductive technology (ART) and birth weight discordance in twins (BWDT). METHODS A retrospective analysis was conducted on twin infants born between January 2011 and December 2020 at the Third Affiliated Hospital of Guangzhou Medical University, with complete basic birth data. The impact of ART on the occurrence of BWDT was identified by the multivariate logistic regression analysis. RESULTS A total of 3 974 pairs of twins were included, with 1 431 conceived naturally and 2 543 through ART. Neonates in the ART group had higher birth weights than those in the naturally conceived group (P<0.001). The incidence of BWDT was lower in the ART group compared to the naturally conceived group (16.17% vs 21.09%, P<0.001). The multivariate logistic regression analysis, adjusting for confounding factors such as maternal age, parity, pre-pregnancy body mass index, gestational diabetes, hypothyroidism, gestational age, and chorionic properties, showed no significant difference in the risk of BWDT between the ART and naturally conceived groups (P>0.05). CONCLUSIONS ART is not associated with the risk of BWDT.
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Rizzini N, Fratelli N, Negri B, Odicino FE, Sartori E, Risso FM, Prefumo F, Fichera A. Chorionicity, birth weight discordance and neonatal morbidity in uncomplicated twin pregnancies delivered from 36 weeks. Eur J Obstet Gynecol Reprod Biol 2022; 271:214-218. [PMID: 35228093 DOI: 10.1016/j.ejogrb.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the association between chorionicity, birth weight discordance and neonatal morbidity in uncomplicated twin pregnancies progressing to at least 36 weeks of gestation. STUDY DESIGN This was a retrospective single centre cohort study of all twin pregnancies referred to our twin clinic between 2011 and 2018. Outcome details were obtained from the computerized maternity and neonatal records. The primary outcome was incidence of composite neonatal morbidity according to chorionicity. We also determined the incidence of composite neonatal morbidity in pregnancies with birth weight discordance. Logistic regression was used to identify and adjust for potential confounders. RESULTS Three hundred and eighty-five twin pregnancies (286 dichorionic, 99 monochorionic) were included. Gestational age at birth was significantly lower in pregnancies complicated by neonatal morbidity (p = 0.013) compared with those which were not. On multivariable logistic regression analysis, gestational age at birth (p = 0.031) and birth weight discordance (p = 0.004), but not chorionicity (p = 0.626) were independently associated with neonatal morbidity. CONCLUSION(S) In uncomplicated twin pregnancies chorionicity is not associated with neonatal morbidity. Gestational age at birth is the major determinant of neonatal outcome while the clinical impact of weight discordance seems marginally significant.
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Affiliation(s)
- Nicoletta Rizzini
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Nicola Fratelli
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Beatrice Negri
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco E Odicino
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Enrico Sartori
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco M Risso
- Neonatalogy and Neonatal Intensive Care Unit, ASST Spedali Civili, Brescia, Italy
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Anna Fichera
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Groene SG, Tollenaar LSA, Slaghekke F, Middeldorp JM, Haak M, Oepkes D, Lopriore E. Placental characteristics in monochorionic twins with selective intrauterine growth restriction in relation to the umbilical artery Doppler classification. Placenta 2018; 71:1-5. [PMID: 30415741 DOI: 10.1016/j.placenta.2018.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/23/2018] [Accepted: 09/17/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the placental characteristics of monochorionic twin pregnancies with selective intrauterine growth restriction (sIUGR) classified according to the Gratacós classification based on umbilical artery Doppler measurements. METHODS All consecutive placentas from monochorionic twin pregnancies with sIUGR, (defined as a birthweight discordance > 25% and/or an estimated fetal weight in one twin <10th centile) examined between May 2002 and February 2018 were included in the study. Each placenta was injected with colored dye to study the angioarchitecture. Primary outcomes were placental share discordance and diameter of the arterio-arterial anastomoses in relation to the umbilical artery Doppler types of sIUGR (Gratacós classification). RESULTS Of the 83 sIUGR twins included, 27 were classified as Gratacós type I, 24 as type II and 32 as type III. The median gestational age at delivery was 34.3 weeks for type I, compared to 31.2 weeks and 31.6 weeks for type II and type III respectively. A trend towards a higher placental share discordance in type III sIUGR was observed. The median arterio-arterial diameter was 1.7 mm (0.8-2.6) in type I, 1.7 mm (1.2-2.2) in type II and 2.8 (2.0-3.5) mm in type III (p < 0.01). DISCUSSION Type III sIUGR placentas appear to be characterized by a larger diameter of the arterio-arterial anastomoses and a larger placental share discordance compared to type I and II sIUGR. The insights in the placental architecture of sIUGR placentas may offer new views on the pathophysiology of the disease.
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Affiliation(s)
- S G Groene
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, the Netherlands.
| | - L S A Tollenaar
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, the Netherlands
| | - F Slaghekke
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, the Netherlands
| | - J M Middeldorp
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, the Netherlands
| | - M Haak
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, the Netherlands
| | - D Oepkes
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, the Netherlands
| | - E Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, the Netherlands
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Abstract
OBJECTIVE Our purpose was to examine the association between discordant growth and perinatal mortality and morbidity among twins with careful adjustment for maternal confounding factors. STUDY DESIGN Two cohorts with and without chorionicity data were compared using generalized estimating modeling. RESULTS Our population-based dataset consisted of 12,656 individual twins from whom 4% (452/12,656) had≥30% growth discordance. A subgroup of this population with chorionicity information had an incidence of 7.3%≥30% growth discordance. In growth-discordant twins, perinatal mortality and morbidity were higher than concordant pairs (P<0.01). Low Apgar score and perinatal mortality were more frequent in growth-discordant twins compared with growth-concordant ones (all P<0.01). CONCLUSION Birth weight discordance (BWD) places twins at increased risk of perinatal mortality. Growth discordance was also an independent risk factor for lower Apgar score of 5 min less than 5.
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Cambiaso O, Zhao DP, Abasolo JI, Aiello HA, Oepkes D, Lopriore E, Otaño L. Discordance of cord insertions as a predictor of discordant fetal growth in monochorionic twins. Placenta 2016; 47:81-85. [PMID: 27780543 DOI: 10.1016/j.placenta.2016.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The type of cord insertion within monochorionic twin pairs could be different. The purpose of study is to evaluate the association of different combinations of placental umbilical cord insertions with birth weight discordance in a large cohort of monochorionic twins. METHODS All consecutive monochorionic placentas from either uncomplicated twin pregnancies or with fetal weight discordance examined and injected with color dye at our centers were included in this study (n = 374). Marginal or velamentous cord insertions were defined as abnormal. Placentas were categorized as concordant when the cord insertions of both fetuses were either normal-normal or abnormal-abnormal, and as discordant when they were normal-abnormal. Birth weight discordance was defined as a difference in birth weight of each twin ≥25%. The association of different cord insertion combinations with birth weight discordance was analyzed. RESULTS The rate of discordant cord insertions was 55% (204/374) in monochorionic twins. A highly significant association between discordant cord insertions and discordant birth weight was observed (p < 0.01). The odds ratios (OR) for birth weight discordance in the discordant cord insertion group compared with the concordant group were 2.3 (95% CI: 1.2-4.4) for the normal-marginal and 5.9 (95% CI: 3.8-10.4) for the normal-velamentous cord insertion subgroup. Discordant cord insertions are associated with the occurrence of unequal placental sharing (OR 4.3, 95%CI 2.7-6.9). DISCUSSION Discordance of cord insertions is associated with discordance of birth weight and may therefore be an important indicator of adverse outcome in monochorionic twins.
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Affiliation(s)
| | - De-Peng Zhao
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China; Leiden University Medical Center, Leiden, Netherlands.
| | - Jose I Abasolo
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Dick Oepkes
- Leiden University Medical Center, Leiden, Netherlands
| | | | - Lucas Otaño
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Mottet N, Guillaume M, Martin A, Ramanah R, Riethmuller D. [ Birth weight discordance in dichorionic twins: diagnosis, obstetrical and neonatal prognosis]. Gynecol Obstet Fertil 2014; 42:572-8. [PMID: 25153442 DOI: 10.1016/j.gyobfe.2014.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/22/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe neonatal and obstetrical prognosis in dichorionic (DC) twins with a birth weight discordance under 20% and evaluate the influence of intrauterine growth restriction on the management. PATIENTS AND METHODS We studied retrospectively 67 DC twins birth between July 2002 and July 2012 at our university labour ward. Birth weight discordance was considered slight between 20-25%, moderate between 25-30%, and severe over 30%. RESULTS Prevalence of birth weight discordance in DC twins is estimated at 11.4% in our study. Eighty percent of severe discordance was diagnosed before delivery, 41% for moderate discordance and 20% for slight discordance. We note 30% of pre eclampsia in our population with 44% in the severe discordance group. Mean gestational age was 35.1 weeks for slight and moderate discordances, and 33 weeks for severe discordance. Caesarean section rate was 48% for severe discordance and only 36% for slight discordance. Vaginal delivery rate is 56.7%. More than half of patient with a severe discordance gave birth vaginally. Intrauterine growth restriction rate under the 10th percentile was 18.7%. Prevalence of IUGR was 24% in sever discordance group, 23.5% in the moderate discordance group and 10% in the slight group. Neonatal morbidity rate was 20.8% mainly in children with IUGR. DISCUSSION AND CONCLUSION Neonatal mortality and morbidity rate are mainly increased in severe discordant twins. These pregnancies are at high risk of maternal morbidity. Vaginal delivery must be preferred for slight and moderate discordances. In case of severe discordance, vaginal delivery should be considered depending on the degree of intrauterine growth retardation.
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Affiliation(s)
- N Mottet
- Service de gynécologie-obstétrique, CHRU Jean-Minjoz, boulevard Fleming, 25000 Besançon, France
| | - M Guillaume
- Service de gynécologie-obstétrique, CHRU Jean-Minjoz, boulevard Fleming, 25000 Besançon, France
| | - A Martin
- Service de gynécologie-obstétrique, CHRU Jean-Minjoz, boulevard Fleming, 25000 Besançon, France
| | - R Ramanah
- Service de gynécologie-obstétrique, CHRU Jean-Minjoz, boulevard Fleming, 25000 Besançon, France
| | - D Riethmuller
- Service de gynécologie-obstétrique, CHRU Jean-Minjoz, boulevard Fleming, 25000 Besançon, France.
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