Twin chorionicity‐specific population birth‐weight charts adjusted for estimated fetal weight

Briffa, C.; Stirrup, Oliver; Huddy, Charlotte; Richards, Justin; Shetty, Sandeep; Reed, Keith; Khalil, Asma

doi:10.1002/uog.23606

Cited by 11 publications

(13 citation statements)

References 34 publications

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“…while birth‐weight centiles were assessed using the singleton standard reported by Nicolaides et al 14 . and twin chorionicity‐specific reference standards reported by Briffa et al 12 …”

Section: Methodsmentioning

confidence: 99%

“…EFW was calculated using Hadlock's formula, including the following biometric parameters: head circumference, biparietal diameter, abdominal circumference and femur length 19 . EFW centiles were calculated using the singleton chart of Nicolaides et al 14 and the twin chorionicity-specific charts of Stirrup et al 13 , while birth-weight centiles were assessed using the singleton standard reported by Nicolaides et al 14 and twin chorionicity-specific reference standards reported by Briffa et al 12 . Fetuses with EFW less than the 10 th centile and neonates with birth weight less than the 10 th centile were defined as SGA.…”

Section: Study Population and Data Variablesmentioning

confidence: 99%

“…The objective of this study was to compare the performance of recently published twin estimated-fetal-weight (EFW) and birth-weight charts 12,13 with previously published modern singleton reference charts 14 in identifying SGA twins at increased risk of neonatal morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Methodsmentioning

confidence: 99%

Section: Study Population and Data Variablesmentioning

confidence: 99%

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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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“…The centiles of EFW were calculated adopting the singleton chart by Nicolaides et al [17] and the twin charts by Stirrup et al [9]. The BW centiles were assessed using the singleton standard reported by Nicolaides et al [17] and twin chorionicity-specific reference standards reported by Briffa et al [24]. Fetuses with EFW less than 10th centile and newborns with BW less than 10th centile were considered SGA.…”

Section: Study Variables and Outcomesmentioning

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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“…Twins are known to have lower birth weight than singletons 24 , and due to their higher risk of perinatal complications, in particular FGR, more stringent surveillance using ultrasound is required 25,26 . Recent research has found that twins have a different growth trajectory than singletons, with growth being lower from 30 weeks in DC twins compared to singletons, and MC twins being generally smaller than both DC twins and singletons throughout gestation 27,28 . Yet, current practice continues to use singleton growth charts in twins, which can lead to overdiagnosis of FGR and unnecessary iatrogenic preterm delivery.…”

Section: Assessment Of Fetal Growthmentioning

confidence: 99%

Controversies in the management of twin pregnancy

Khalil

Liu

2021

Ultrasound in Obstet & Gyne

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Despite many advances in antenatal care, twin pregnancies still experience more adverse outcomes, in particular higher perinatal mortality and morbidity. They also pose a multitude of challenges and controversies as outlined in this paper. Moreover, they are less likely to be included in clinical trials. Many issues on classification and management remain under debate. Efforts on standardising diagnostic criteria, monitoring protocols, management and outcome reporting are likely to reduce their perinatal risks. The top 10 most important research uncertainties related to multiple pregnancies have been identified by both clinicians and patients. More robust research in the form of randomised trials and large well-conducted prospective cohort studies are needed to address these controversies.

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Twin chorionicity‐specific population birth‐weight charts adjusted for estimated fetal weight

Abstract: Twin chorionicity-specific population birth-weight charts developed with adjustment for estimated fetal weight

Cited by 11 publications

References 34 publications

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

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

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

Controversies in the management of twin pregnancy

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