OBJECTIVE: To establish the level of birth weight discordance at which perinatal morbidity increases in monochorionic and dichorionic twin pregnancy. METHODS: This prospective multicenter cohort study included 1,028 unselected twin pairs recruited over a 2-year period. Participants underwent two weekly ultrasonographic surveillance from 24 weeks of gestation with surveillance of monochorionic twins two-weekly from 16 weeks. Analysis using Cox proportional hazards compared a composite measure of perinatal morbidity (including any of the following: mortality, respiratory distress syndrome, hypoxic-ischemic encephalopathy, periventricular leukomalacia, necrotizing enterocolitis, or sepsis) at different degrees of birth weight discordance with adjustment for chorionicity, gestational age, twin-twin transfusion syndrome, birth order, gender, and growth restriction. RESULTS: Perinatal outcome data were recorded for 977 patients (100%) who continued the study with both fetuses alive beyond 24 weeks, including 14 cases of twin-twin transfusion syndrome. Adjusting for gestation at delivery, twin order, gender, and growth restriction, perinatal mortality, individual morbidity, and composite perinatal morbidity were all seen to increase with birth weight discordance exceeding 18% for dichorionic pairs (hazard ratio 2.2, 95% confidence interval [CI] 1.6-2.9, P<.001) and 18% for monochorionic twins without twin-twin transfusion syndrome (hazard ratio 2.6, 95% CI 1.6-4.3, P<.001). A minimum twofold increase in risk of perinatal morbidity persisted even when both twin birth weights were appropriate for gestational age. CONCLUSION: : The threshold for birth weight discordance established by this prospective study is 18% both for dichorionic twin pairs and for monochorionic twins without twin-twin transfusion syndrome. This threshold is considerably lower than that defined by many retrospective series as pathologic. We suggest that an anticipated difference of 18% in birth weight should prompt more intensive fetal monitoring.
OBJECTIVE: To establish the level of birth weight discordance at which perinatal morbidity increases in monochorionic and dichorionic twin pregnancy. METHODS: This prospective multicenter cohort study included 1,028 unselected twin pairs recruited over a 2-year period. Participants underwent two weekly ultrasonographic surveillance from 24 weeks of gestation with surveillance of monochorionic twins two-weekly from 16 weeks. Analysis using Cox proportional hazards compared a composite measure of perinatal morbidity (including any of the following: mortality, respiratory distress syndrome, hypoxic-ischemicencephalopathy, periventricular leukomalacia, necrotizing enterocolitis, or sepsis) at different degrees of birth weight discordance with adjustment for chorionicity, gestational age, twin-twin transfusion syndrome, birth order, gender, and growth restriction. RESULTS: Perinatal outcome data were recorded for 977 patients (100%) who continued the study with both fetuses alive beyond 24 weeks, including 14 cases of twin-twin transfusion syndrome. Adjusting for gestation at delivery, twin order, gender, and growth restriction, perinatal mortality, individual morbidity, and composite perinatal morbidity were all seen to increase with birth weight discordance exceeding 18% for dichorionic pairs (hazard ratio 2.2, 95% confidence interval [CI] 1.6-2.9, P<.001) and 18% for monochorionic twins without twin-twin transfusion syndrome (hazard ratio 2.6, 95% CI 1.6-4.3, P<.001). A minimum twofold increase in risk of perinatal morbidity persisted even when both twin birth weights were appropriate for gestational age. CONCLUSION: : The threshold for birth weight discordance established by this prospective study is 18% both for dichorionic twin pairs and for monochorionic twins without twin-twin transfusion syndrome. This threshold is considerably lower than that defined by many retrospective series as pathologic. We suggest that an anticipated difference of 18% in birth weight should prompt more intensive fetal monitoring.
Authors: Cecilie Halling; Fergal D Malone; Fionnuala M Breathnach; Moira C Stewart; Fionnuala M McAuliffe; John J Morrison; Patrick Dicker; Fiona Manning; John David Corcoran Journal: Eur J Pediatr Date: 2015-10-21 Impact factor: 3.183
Authors: Melissa M Amyx; Paul S Albert; Alaina M Bever; Stefanie N Hinkle; John Owen; William A Grobman; Roger B Newman; Edward K Chien; Robert E Gore-Langton; Germaine M Buck Louis; Katherine L Grantz Journal: Am J Obstet Gynecol Date: 2019-08-24 Impact factor: 8.661
Authors: Liberty G Reforma; Daniela Febres-Cordero; Alyssa Trochtenberg; Anna M Modest; Ai-Ris Y Collier; Melissa H Spiel Journal: Am J Obstet Gynecol Date: 2021-11-26 Impact factor: 10.693
Authors: Melissa M Amyx; Paul S Albert; Alaina M Bever; Stefanie N Hinkle; John Owen; William A Grobman; Roger B Newman; Edward K Chien; Robert E Gore-Langton; Germaine M Buck Louis; Katherine L Grantz Journal: Paediatr Perinat Epidemiol Date: 2019-09-03 Impact factor: 3.103
Authors: Nasim C Sobhani; Teresa N Sparks; Kristen A Gosnell; Larry Rand; Juan M Gonzalez; Vickie A Feldstein Journal: Am J Perinatol Date: 2020-12-15 Impact factor: 3.079
Authors: Amira S Egic; Donka V Mojovic; Zagorka M Milovanovic; Aleksandar B Jurisic; Ljubomir P Srbinovic; Suzana P Krsmanovic; Natasa T Karadzov-Orlic Journal: Obstet Gynecol Int Date: 2014-07-07