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Comparative Study
. 2014 May 5:40:43.
doi: 10.1186/1824-7288-40-43.

Intrauterine growth pattern and birthweight discordance in twin pregnancies: a retrospective study

Giuseppe Puccio  1 , Mario Giuffré, Maria Piccione, Ettore Piro, Valentina Malerba, Giovanni Corsello
Affiliations
Comparative Study

Intrauterine growth pattern and birthweight discordance in twin pregnancies: a retrospective study

Giuseppe Puccio et al. Ital J Pediatr. .

Abstract

Background: Twins, compared to singletons, have an increased risk of perinatal mortality and morbidity, due mainly to a higher prevalence of preterm birth and low birthweight. Intrauterine growth restriction (IUGR) is also common and can affect one or both fetuses. In some cases, however, one twin is much smaller than the other (growth discordance). Usually, high birthweight discordance is associated with increased perinatal morbidity. The aim of this study is to describe the epidemiological features of a population of twins at birth, with particular reference to the interpretation and clinical effects of birthweight discordance.

Methods: We evaluated retrospectively the clinical features of 70 infants born from twin pregnancies and assessed birthweight discordance in 31 pregnancies where both twins were followed at our institution. Discordance was treated both as a continuous and a categorical variable, using a cutoff of 18%. Possible relationships between birthweight discordance and other variables, such as maternal age, gestational age, birthweight percentile, number of SGA newborns in the pair, Hematocrit (Ht) discordance and neonatal anemia, prevalence of malformations, neonatal morbidity and death, were analyzed.

Results: In our cohort birthweight percentile decreased slightly with increasing gestational age. Birthweight discordance, on the contrary, increased slightly with the increase of gestational age.A high discordance is associated to the presence of one SGA twin, with the other AGA or LGA. In our population, all 6 pregnancies in which discordance exceeded 18% belonged to this category (one SGA twin).Ht discordance at birth is associated to the presence of neonatal anemia in a twin, but it is not significantly related to weight discordance.Finally, in our case history, weight discordance is not associated in any way with the prevalence of malformations, morbidity and mortality.

Conclusions: Birthweight discordance is an important indicator of complications that act asymmetrically on the two fetuses, affecting intrauterine growth in one of them, and usually determining the birth of a SGA infant.Our case history shows a significant statistical association between pair discordance and IUGR in one of the twins, but we could not demonstrate any relationship between discordance and the prevalence of malformations, morbidity and mortality.

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Figures

Figure 1
Figure 1
Distribution of birthweight and gestational age according to weight class calculated with Ines percentiles.
Figure 2
Figure 2
Distribution of birthweight percentiles for gestational age.
Figure 3
Figure 3
Scatterplot of birthweight percentile and weight discordance, considering separately the larger twins and the smaller twins.
Figure 4
Figure 4
Scatterplot of birthweight percentile and weight discordance, highlighting the behavior of individual pairs. Blue rectangle: SGA babies in twin pairs with low discordance. Yellow rectangle: SGA babies in twin pairs with high discordance.
Figure 5
Figure 5
Distribution of Ht discordance according to weight discordance.
Figure 6
Figure 6
Ht values, Ht discordance and anemia.
See this image and copyright information in PMC

References

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