Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance

TY - JOUR

T1 - Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance

AU - Vedel, Cathrine

AU - Oldenburg, Anna

AU - Worda, Katharina

AU - Larsen, Helle

AU - Holmskov, Anni

AU - Andreasen, Kirsten R

AU - Uldbjerg, Niels

AU - Ramb, Jan

AU - Bødker, Birgit

AU - Skibsted, Lillian

AU - Sperling, Lene

AU - Hinterberger, Stefan

AU - Krebs, Lone

AU - Zingenberg, Helle

AU - Weiss, Eva-Christine

AU - Strobl, Isolde

AU - Laursen, Lone

AU - Christensen, Jeanette Tranberg

AU - Ersbak, Vibeke

AU - Stornes, Inger

AU - Krampl-Bettelheim, Elisabeth

AU - Tabor, Ann

AU - Rode, Line

N1 - © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - INTRODUCTION: The objective was to investigate the association between chorionicity-specific intertwin birthweight discordance and adverse outcomes including long-term follow up at 6, 18, and 48-60 months after term via Ages and Stages Questionnaire.MATERIAL AND METHODS: In this secondary analysis of a cohort study (Oldenburg et al., n = 1688) and a randomized controlled trial (PREDICT study, n = 1045) twin pairs were divided into three groups according to chorionicity-specific birthweight discordance: <75th percentile, 75th-90th percentile and >90th percentile. Information on infant mortality, admittance to neonatal intensive care units, and gestational age at delivery was available for all pairs. Detailed neonatal outcomes were available for 656 pairs from PREDICT, of which 567 pairs had at least one Ages and Stages Questionnair follow-up. Logistic regression models were used for dichotomous outcomes. Ages and Stages Questionnair scores were compared using the method of generalized estimating equation to account for the correlation within twins.RESULTS: The 75th and 90th percentiles for birthweight discordance were 14.8 and 21.4% for monochorionic and 16.0 and 23.8% for dichorionic twins. After adjustment for small for gestational age and gender, birthweight discordance >75th and >90th percentile was associated with induced delivery <34 weeks [odds ratio 1.71 (95% confidence interval 1.11-2.65) and odds ratio 2.83 (95% confidence interval 1.73-4.64), respectively]. Discordance >75th-percentile was associated with an increased risk of infant mortality after 28 days [odds ratio 4.69 (95% confidence interval 1.07-20.45)] but not with major neonatal complications or with low mean Ages and Stages Questionnair scores at 6, 18, and 48-60 months after term.CONCLUSION: Chorionicity-specific intertwin birthweight discordance is a risk factor for induced preterm delivery and infant mortality, but not for lower scores for neurophysiological development at 6, 18, and 48-60 months.

AB - INTRODUCTION: The objective was to investigate the association between chorionicity-specific intertwin birthweight discordance and adverse outcomes including long-term follow up at 6, 18, and 48-60 months after term via Ages and Stages Questionnaire.MATERIAL AND METHODS: In this secondary analysis of a cohort study (Oldenburg et al., n = 1688) and a randomized controlled trial (PREDICT study, n = 1045) twin pairs were divided into three groups according to chorionicity-specific birthweight discordance: <75th percentile, 75th-90th percentile and >90th percentile. Information on infant mortality, admittance to neonatal intensive care units, and gestational age at delivery was available for all pairs. Detailed neonatal outcomes were available for 656 pairs from PREDICT, of which 567 pairs had at least one Ages and Stages Questionnair follow-up. Logistic regression models were used for dichotomous outcomes. Ages and Stages Questionnair scores were compared using the method of generalized estimating equation to account for the correlation within twins.RESULTS: The 75th and 90th percentiles for birthweight discordance were 14.8 and 21.4% for monochorionic and 16.0 and 23.8% for dichorionic twins. After adjustment for small for gestational age and gender, birthweight discordance >75th and >90th percentile was associated with induced delivery <34 weeks [odds ratio 1.71 (95% confidence interval 1.11-2.65) and odds ratio 2.83 (95% confidence interval 1.73-4.64), respectively]. Discordance >75th-percentile was associated with an increased risk of infant mortality after 28 days [odds ratio 4.69 (95% confidence interval 1.07-20.45)] but not with major neonatal complications or with low mean Ages and Stages Questionnair scores at 6, 18, and 48-60 months after term.CONCLUSION: Chorionicity-specific intertwin birthweight discordance is a risk factor for induced preterm delivery and infant mortality, but not for lower scores for neurophysiological development at 6, 18, and 48-60 months.

KW - Birth Weight

KW - Body Mass Index

KW - Cohort Studies

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Infant

KW - Infant Mortality

KW - Infant, Newborn

KW - Infant, Newborn, Diseases

KW - Infant, Small for Gestational Age

KW - Intensive Care Units, Neonatal

KW - Labor, Induced

KW - Patient Admission

KW - Pregnancy

KW - Pregnancy, Twin

KW - Premature Birth

KW - Randomized Controlled Trials as Topic

KW - Retrospective Studies

KW - Risk Factors

KW - Smoking

KW - Journal Article

U2 - 10.1111/aogs.13062

DO - 10.1111/aogs.13062

M3 - Journal article

C2 - 27861703

SN - 0001-6349

VL - 96

SP - 233

EP - 242

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 2

ER -