Donor catch-up growth after laser surgery for twin-twin transfusion syndrome
Ramen H Chmait1, Andrew H Chon2, Sheree M Schrager3
1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, United States.
Insights
Donor twins treated for twin-to-twin transfusion syndrome (TTTS) with laser surgery show significant catch-up growth by age two. This study tracked fetal growth, birth weight, and growth to two years, demonstrating improved weight percentiles for donor twins.
Area of Science:
- Fetal Medicine
- Neonatalogy
- Pediatric Growth Studies
Background:
- Twin-to-twin transfusion syndrome (TTTS) poses significant risks to fetal growth and development.
- Laser surgery is a common intervention for TTTS, but its long-term effects on growth require assessment.
Purpose of the Study:
- To evaluate fetal growth patterns in children treated for TTTS with laser surgery.
- To compare growth trajectories of donor and recipient twins from prenatal diagnosis through two years of age.
Main Methods:
- Retrospective analysis of growth data (fetal, birth, 2-year corrected age) from 99 children treated for TTTS between 2007-2010.
- Utilized ultrasound for fetal weight, institutional records for birth weight, and neurodevelopmental testing for 2-year weight.
- Employed multilevel latent growth curve models and repeated measures ANOVA to analyze weight change and discordance over time, considering donor status.
Main Results:
- Growth restriction was prevalent prenatally (56% donors vs. 2% recipients) and at birth (35% vs. 10%), decreasing significantly by age two (6% vs. 0%).
- Donor twins demonstrated substantial catch-up growth, with significant increases in weight percentile (B=13.1, p<0.001) and reduced growth restriction rates over time (B=-1.6, p<0.001).
- Weight discordance between donor and recipient twins significantly decreased post-intervention (linear F(1,42)=54.34, p<0.001).
Conclusions:
- Laser surgery for TTTS facilitates significant catch-up growth in donor twins by two years of age.
- Post-intervention growth trajectories show a marked improvement for donor twins, reducing initial growth disparities.
Objective:
To assess fetal growth after laser surgery for TTTS at the time of prenatal diagnosis, birth, and at 2years of age.
Design/Methods:
Growth data were collected from surviving children treated between 2007 and 2010 as part of a study to assess neurodevelopment at 24months (±6weeks) corrected age. Fetal weights were obtained via ultrasound using Hadlock's formula at the time of preoperative assessment for laser surgery. Birth weights were recorded by the staff at the delivering institutions. Weights at 2years corrected age were recorded at the time of neurodevelopmental testing. Weights were converted into percentiles according to standard growth curves. Growth restriction was defined as <10th percentile for given age. Multilevel latent growth curve models in Mplus (twins nested in families) examined weight change over time as a function of donor status, and repeated measures ANOVA was utilized to assess in donor-recipient weight discordance over time for twin pairs.
Results:
99 of 206 children (56 of 130 families) were studied. There were no differences between enrolled and non-enrolled patients in donor/recipient status and survival rates, fetal demise, intrauterine growth restriction, Quintero stage, and gestational age of surgery or delivery. 48.5% were donors. The median fetal, birth, and 2-year weights for all twins were 288g, 1.9kg, and 11.8kg, respectively, and the overall prevalence of growth restriction was 28%, 22%, and 3%, respectively. Growth restriction rates at prenatal diagnosis were 56% in donors vs. 2% in recipients (OR=64.3, p<0.001); at birth, 35% vs. 10% (OR=5.0, p<0.01); and at 2years, 6% vs. 0%. Donors showed significant gains in weight percentile (B=13.1, p<0.001) and a significant decrease in growth restriction rates over time (B=-1.6, p<0.001). Weight discordance between donor and recipient pairs also significantly decreased over time (linear F(1,42)=54.34, p<0.001).
Conclusions:
After laser surgery for TTTS, donor twins exhibit significant catch-up growth by two years of age.
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