First-Trimester Growth Rate in Relation to Selective Fetal Growth Restriction in Monochorionic Twins

Area of Science:

• Maternal-Fetal Medicine
• Twin Gestation Research
• Prenatal Diagnostics

Background:

• Selective fetal growth restriction (sFGR) in monochorionic (MC) twins poses significant risks.
• Crown-rump length discrepancy (CRLd) is a current, but limited, predictor of sFGR.
• Early identification of sFGR is crucial for timely intervention and improved outcomes.

Purpose of the Study:

• To investigate the association between first-trimester fetal growth rate (GR) and the development of sFGR in MC twins.
• To compare the predictive value of first-trimester GR with CRLd for sFGR.
• To determine if a combination of GR and CRLd improves sFGR prediction.

Main Methods:

• Retrospective cohort study of MC twin pregnancies with first-trimester ultrasound data.
• Calculation of CRLd and GR for each fetus.
• Statistical analysis using generalized estimating equations to assess independent associations with sFGR.

Main Results:

• A total of 335 MC twin pregnancies were analyzed, with 100 (29.85%) diagnosed with sFGR.
• Lower first-trimester GR was observed in pregnancies that developed sFGR.
• Both reduced GR and increased CRLd were independently associated with a higher likelihood of sFGR.

Conclusions:

• Reduced first-trimester GR is an independent early predictor of sFGR in MC twins.
• Increased CRLd also remains an independent predictor of sFGR.
• The combined assessment of first-trimester GR and CRLd provides the most robust model for predicting sFGR.