Uncomplicated monochorionic twins: neurodevelopmental insights and implications.

Area of Science:

• Perinatology
• Developmental Pediatrics
• Twin Research

Background:

• Monochorionic diamniotic (MCDA) twins exhibit unique physiological adaptations due to their shared placenta.
• Long-term neurodevelopmental outcomes in uncomplicated MCDA twins require further investigation.
• Early identification of neurodevelopmental risks is vital for timely interventions.

Purpose of the Study:

• To assess neurodevelopmental outcomes in uncomplicated MCDA twins up to three years of age.
• To identify risk factors associated with neurodevelopmental impairment (NDI) in this population.
• To propose recommendations for future research and follow-up protocols.

Main Methods:

• Observational cohort study of uncomplicated MCDA twins (n=138) born between 34 weeks gestation.
• Neurodevelopmental assessments using Bayley Scales and neurological evaluations at 1, 2, and 3 years.
• Multivariable logistic regression models to analyze associations between NDI and perinatal/environmental factors.

Main Results:

• Mean Bayley scores were comparable to singletons; however, 29.0% had mild NDI and 5.8% had severe NDI.
• Behavioral disorders, including autism spectrum disorder (ASD), were diagnosed in 11.6% of infants.
• Respiratory distress syndrome predicted mild NDI, while female sex, higher maternal age, and higher sociocultural status were protective.

Conclusions:

• Mild neurodevelopmental impairment and higher ASD incidence are common in uncomplicated MCDA twins.
• Early detection of NDI is critical for mitigating long-term effects.
• A standardized neurodevelopmental follow-up protocol through school age is recommended for MCDA twins.