Lena H Kim1, Aaron B Caughey2, Lynn M Yee3, Yvonne W Cheng1. 1. Division of Maternal-Fetal Medicine, California Pacific Medical Center, San Francisco, California. 2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon. 3. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Abstract
BACKGROUND: Twin birthweight discordance is associated with adverse outcomes. OBJECTIVE: To determine what degree of twin birthweight discordance is associated with adverse outcomes. STUDY DESIGN: This is a retrospective cohort study of twins with vertex twin A delivered vaginally at 36 to 40 weeks (U.S. Vital Statistics Natality birth certificate registry data 2012-2014). The primary outcome was a composite of neonatal morbidity: 5-minute Apgar < 7, neonatal intensive care unit admission, neonatal mechanical ventilation > 6 hours, neonatal seizure, and/or neonatal transport to a higher level of care. Effect estimates were expressed as incidence rate and adjusted odds ratio (aOR) controlling for confounding using multivariate clustered analysis for between-pair effects, and multilevel random effect generalized estimating equation regressions to account for within-pair effects. We adjusted for sex discordance, breech delivery of the second twin, maternal race/ethnicity, nulliparity, age, marital status, obesity, and socioeconomic status. RESULTS: In comparison to birthweight discordance of ≤20%, aORs with 95% confidence intervals (CIs) by weight discordance of the primary outcome among 27,276 twin deliveries were as follows: 20.01 to 25% (aOR: 1.46 [95% CI: 1.29-1.65]); 25.01 to 30% (aOR: 1.96 [95% CI: 1.68-2.29]); and 30.01 to 60% (aOR: 2.97 [95% CI: 2.52-3.50]). CONCLUSION: Twin birthweight discordance >20% was associated with increased odds of adverse neonatal outcome. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
BACKGROUND: Twin birthweight discordance is associated with adverse outcomes. OBJECTIVE: To determine what degree of twin birthweight discordance is associated with adverse outcomes. STUDY DESIGN: This is a retrospective cohort study of twins with vertex twin A delivered vaginally at 36 to 40 weeks (U.S. Vital Statistics Natality birth certificate registry data 2012-2014). The primary outcome was a composite of neonatal morbidity: 5-minute Apgar < 7, neonatal intensive care unit admission, neonatal mechanical ventilation > 6 hours, neonatal seizure, and/or neonatal transport to a higher level of care. Effect estimates were expressed as incidence rate and adjusted odds ratio (aOR) controlling for confounding using multivariate clustered analysis for between-pair effects, and multilevel random effect generalized estimating equation regressions to account for within-pair effects. We adjusted for sex discordance, breech delivery of the second twin, maternal race/ethnicity, nulliparity, age, marital status, obesity, and socioeconomic status. RESULTS: In comparison to birthweight discordance of ≤20%, aORs with 95% confidence intervals (CIs) by weight discordance of the primary outcome among 27,276 twin deliveries were as follows: 20.01 to 25% (aOR: 1.46 [95% CI: 1.29-1.65]); 25.01 to 30% (aOR: 1.96 [95% CI: 1.68-2.29]); and 30.01 to 60% (aOR: 2.97 [95% CI: 2.52-3.50]). CONCLUSION: Twin birthweight discordance >20% was associated with increased odds of adverse neonatal outcome. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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: Nansi S Boghossian; Shampa Saha; Edward F Bell; Jane E Brumbaugh; Seetha Shankaran; Waldemar A Carlo; Abhik Das Journal: J Perinatol Date: 2019-07-16 Impact factor: 2.521