The Association Between Hypertension in Pregnancy and Preterm Birth with Fetal Growth Restriction in Singleton and Twin Pregnancy: Use of Twin Versus Singleton Charts

Kalafat, Erkan; Abiola, Aisha; Thilaganathan, B.; Bhide, A.; Khalil, Asma

doi:10.3390/jcm9082518

Cited by 17 publications

(19 citation statements)

References 25 publications

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“…Recent studies have also proven that adjusted EFW reference charts for twins reduce the number of twins labelled as SGA and still identify a similar proportion of stillbirth cases [ 7 ]. Furthermore, published studies have highlighted that twin-specific birthweight charts were more strongly associated with HDP and PTB than the singleton charts [ 27 , 28 , 29 ]. Our results reveal a similar trend, suggesting that SGA defined using twin-specific charts, both EFW and BW, had a stronger association between those labelled as SGA and those at risk of adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

Giorgione

Briffa

Fabrizio

et al. 2021

JCM

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Twin pregnancies are commonly assessed using singleton growth and birth weight reference charts. This practice has led to a significant number of twins labelled as small for gestational age (SGA), causing unnecessary interventions and increased risk of iatrogenic preterm birth. However, the use of twin-specific charts remains controversial. This study aims to assess whether twin-specific estimated fetal weight (EFW) and birth weight (BW) charts are more predictive of adverse outcomes compared to singleton charts. Centiles of EFW and BW were calculated using previously published singleton and twin charts. Categorical data were compared using Chi-square or McNemar tests. The study included 1740 twin pregnancies, with the following perinatal adverse outcomes recorded: perinatal death, preterm birth <34 weeks, hypertensive disorders of pregnancy (HDP) and admissions to the neonatal unit (NNU). Twin-specific charts identified prenatally and postnatally a smaller proportion of infants as SGA compared to singleton charts. However, twin charts showed a higher percentage of adverse neonatal outcomes in SGA infants than singleton charts. For example, perinatal death (SGA 7.2% vs. appropriate for gestational age (AGA) 2%, p < 0.0001), preterm birth <34 weeks (SGA 42.1% vs. AGA 16.4%, p < 0.0001), HDP (SGA 21.2% vs. AGA 13.5%, p = 0.015) and NNU admissions (SGA 69% vs. AGA 24%, p < 0.0001), when compared to singleton charts (perinatal death: SGA 2% vs. AGA 1%, p = 0.029), preterm birth <34 weeks: (SGA 20.6% vs. AGA 17.4%, p = 0.020), NNU admission: (SGA 34.5% vs. AGA 23.9%, p < 0.000). There was no significant association between HDP and SGA using the singleton charts (p = 0.696). In SGA infants, according to the twin charts, the incidence of abnormal umbilical artery Doppler was significantly more common than in SGA using the singleton chart (27.0% vs. 8.1%, p < 0.001). In conclusion, singleton charts misclassify a large number of twins as at risk of fetal growth restriction. The evidence suggests that the following twin-specific charts could reduce unnecessary medical interventions prenatally and postnatally.

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Section: Discussionmentioning

confidence: 99%

Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

Giorgione

Briffa

Fabrizio

et al. 2021

JCM

Self Cite

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“…It is common practice to assess the growth of twins using population-based singleton growth charts. However, recent evidence suggests that twin-specific growth charts may be more accurate, as singleton standards label a large proportion of twin pregnancies as SGA owing to the differences in growth trajectory between twins and singletons 4 . Overestimating the risk of morbidity and mortality potentially leads to increased iatrogenic intervention and subsequent risks associated with preterm birth, as well as increased maternal anxiety 1,5,6 .…”

Section: Introductionmentioning

confidence: 99%

Adverse neonatal outcome in twin pregnancy complicated by small‐for‐gestational age: twin vs singleton reference charts

Briffa

Fabrizio

Kalafat

et al. 2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?We present a comparison of the ability of twin-specific vs singleton estimated-fetal-weight and birth-weight reference charts to predict adverse neonatal outcome in small-for-gestational-age (SGA) twins. Infants classified as SGA according to the twin-specific charts, but not those classified as SGA according to the singleton charts, had a significantly increased risk of adverse neonatal outcome compared with appropriate-for-gestational-age infants. What are the clinical implications of this work?This study presents further evidence that twin-specific charts perform better than singleton charts in the prediction of adverse neonatal outcome in twin pregnancies. The use of twin-specific charts may reduce misclassification and improve identification of infants who may not be at increased risk of adverse outcome despite being labeled as SGA using singleton standards.

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“…The definition of FGR in twin pregnancies is inconsistent in the literature, and two separate criteria have been applied: at least one fetus with a birth weight < the 10th percentile ( 4 , 26 , 27 ), or at least one fetus with a birth weight < the 3rd percentile ( 28 – 30 ). Based on the definition of selective fetal growth restriction (sFGR) in the recent Delphi Consensus Statement, we adapted the antenatal criteria of one of the following: (1) one twin with a birth weight < the 10th centile and a birth weight discordance of >25%, or (2) the solitary criterion of one twin with a birth weight < the 3rd percentile ( 28 , 30 , 31 ). Singleton reference charts were used to assess birth weight centiles ( 28 ).…”

Section: Methodsmentioning

confidence: 99%

Twin Growth Discordance and Risk of Postpartum Hemorrhage: A Retrospective Cohort Study

et al. 2022

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BackgroundIn recent years, the incidence of postpartum hemorrhage has increased globally. Multiple pregnancies and cesarean sections are well-known risk factors for postpartum hemorrhage. No studies have evaluated the associations between fetal growth anomalies and postpartum hemorrhage in women with twin pregnancies undergoing cesarean section. This study aimed to identify the relationship between fetal growth anomalies and postpartum hemorrhage in women with twin pregnancies undergoing cesarean section.MethodsThis retrospective single-center study included 3,180 women with twin pregnancies at a tertiary hospital between August 2013 and July 2020. Singleton reference charts were used to assess fetal growth restriction at birth. Discordant growth was defined as an intertwin birth weight difference of ≥20%. Logistic regression analyses were used to evaluate the association between fetal growth anomalies and postpartum hemorrhage. Additionally, sensitivity analysis of abnormal placenta and stratification by twin chorionicity were conducted.ResultsThe overall incidence of postpartum hemorrhage was 4.3%. Twin growth discordance, especially with fetal growth restriction, was associated with an increased risk of postpartum hemorrhage (adjusted odds ratio [AOR] = 1.62, 95% confidence interval [CI], 1.05–2.51, P = 0.031; AOR = 1.71; 95% CI, 1.08–2.70, P = 0.022; AOR = 1.98, 95% CI, 1.21–3.25, P = 0.006, respectively). After stratification, this relationship persisted in dichorionic twins (OR = 1.71, 95% CI, 1.04–2.82, P = 0.036; OR = 1.90, 95% CI, 1.13–3.21, P = 0.016; OR = 2.48, 95% CI, 1.41–4.38, P = 0.002, respectively). However, no significant association was observed in monochorionic twin pregnancies.ConclusionGrowth discordance, especially complicated by fetal growth restriction, was associated with an increased risk of postpartum hemorrhage in women with twin pregnancies undergoing cesarean section, and was more evident in patients with dichorionic twins.

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The Association Between Hypertension in Pregnancy and Preterm Birth with Fetal Growth Restriction in Singleton and Twin Pregnancy: Use of Twin Versus Singleton Charts

Cited by 17 publications

References 25 publications

Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

Adverse neonatal outcome in twin pregnancy complicated by small‐for‐gestational age: twin vs singleton reference charts

Twin Growth Discordance and Risk of Postpartum Hemorrhage: A Retrospective Cohort Study

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