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Twin-specific intrauterine 'growth' charts based on cross-sectional birthweight data
Marij Gielen1, Patrick J Lindsey, Catherine Derom
1Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Department of Genetics and Cell Biology, Maastricht University, Maastricht, the Netherlands. marij.gielen@gen.unimaas.nl
Insights
Developing twin-specific intrauterine growth charts is crucial for accurately identifying twins at risk for neonatal death. These charts, considering chorionicity, improve antenatal care assessments compared to singleton charts.
Area of Science:
- Obstetrics and Gynecology
- Perinatology
- Neonatology
Background:
- Fetal growth assessment is vital in antenatal care, particularly for twin pregnancies.
- Existing singleton growth charts may not accurately reflect twin development, potentially missing high-risk cases.
Purpose of the Study:
- To create twin-specific intrauterine growth charts for monochorionic and dichorionic twins.
- To compare the efficacy of twin-specific versus singleton charts in identifying twins at risk for neonatal mortality.
Main Methods:
- Analysis of cross-sectional birthweight data from 8,454 twins and 76,471 singletons in East Flanders, Belgium.
- Utilized nonlinear Gaussian regression for birthweight analysis.
- Compared neonatal mortality rates based on centile placement using twin-specific and singleton charts.
Main Results:
- Twin birthweights deviated from singletons after 33 weeks gestation.
- Monochorionic twin birthweights decreased after 40 weeks, unlike dichorionic twins.
- Neonatal mortality risk significantly increased below the third centile on twin-specific charts, a trend less apparent with singleton charts.
Conclusions:
- Twin-specific growth charts, accounting for chorionicity, are superior for detecting twins at risk of neonatal death.
- The developed charts provide an improved tool for assessing twin fetal growth and optimizing antenatal care.
Abstract:
The assessment of fetal growth is an essential component of good antenatal care, especially for twins. The aims of this study are to develop twin-specific intrauterine 'growth' charts, based on cross-sectional birthweight data, for monochorionic and dichorionic twins according to sex and parity, and to detect twins at risk for neonatal death by comparing the use of twin-specific and singleton charts. The study sample consisted of 76,471 singletons and 8454 twins (4227 pairs) born in East Flanders (Belgium). Birthweights were analyzed using a nonlinear Gaussian regression. After 33 weeks of gestation, the birthweights of twins started to deviate from singletons (difference of 900 grams at 42 weeks). Birthweights of dichorionic twins continued to increase, whereas those of monochorionic twins decreased after week 40 (difference of more than 300 g at 42 weeks). After 31 weeks of gestation, neonatal mortality increased as centile decreased, and was especially high if birthweight was below the twin-specific third centile: .032 (below) versus .007 (above). Using singleton centiles, this was less obvious. In conclusion, twin-specific growth charts, taking chorionicity into account, are more accurate to detect twins at risk for neonatal death. Therefore the presented charts, based on cross-sectional birthweight data, enable an improved assessment of twin growth.
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