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Adverse neonatal outcome in twin pregnancy complicated by small-for-gestational age: twin vs singleton reference charts

Briffa, C; Di Fabrizio, C; Kalafat, E; Giorgione, V; Bhate, R; Huddy, C; Richards, J; Shetty, S; Khalil, A (2022) Adverse neonatal outcome in twin pregnancy complicated by small-for-gestational age: twin vs singleton reference charts. Ultrasound Obstet Gynecol, 59 (3). pp. 377-384. ISSN 1469-0705 https://doi.org/10.1002/uog.23764
SGUL Authors: Khalil, Asma

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Abstract

Objective The use of twin-specific vs singleton growth charts in the assessment of twin pregnancy has been controversial. The aim of this study was to assess whether a diagnosis of small-for-gestational age (SGA) made using twin-specific estimated-fetal-weight (EFW) and birth-weight (BW) charts is associated more strongly with adverse neonatal outcomes in twin pregnancies, compared with when the diagnosis is made using singleton charts. Methods This was a cohort study of twin pregnancies delivered at St George's Hospital, London, between January 2007 and May 2020. Twin pregnancies complicated by intrauterine death of one or both twins, fetal aneuploidy or major abnormality, twin–twin transfusion syndrome or twin anemia–polycythemia sequence and those delivered before 32 weeks' gestation, were excluded. SGA was defined as EFW or BW below the 10th centile, and was assessed using both twin-specific and singleton EFW and BW charts. The main study outcome was composite adverse neonatal outcome. Mixed-effects logistic regression analysis with random pregnancy-level intercepts was used to test the association between SGA classified using the different charts and adverse neonatal outcome. Results A total of 1329 twin pregnancies were identified, of which 913 (1826 infants) were included in the analysis. Of these pregnancies, 723 (79.2%) were dichorionic and 190 (20.8%) were monochorionic. Using the singleton charts, 33.3% and 35.7% of pregnancies were classified as SGA based on EFW and BW, respectively. The corresponding values were 5.9% and 5.6% when using the twin-specific charts. Classification as SGA based on EFW using the twin charts was associated significantly with composite adverse neonatal outcome (odds ratio (OR), 4.78 (95% CI, 1.47–14.7); P = 0.007), as compared with classification as appropriate-for-gestational age (AGA). However, classification as SGA based on EFW using the singleton standard was not associated significantly with composite adverse neonatal outcome (OR, 1.36 (95% CI, 0.63–2.88); P = 0.424). Classification as SGA based on EFW using twin-specific standards provided a significantly better model fit than did using the singleton standard (likelihood ratio test, P < 0.001). When twin-specific charts were used, classification as SGA based on BW was associated significantly with a 9.3 times increased odds of composite adverse neonatal outcome (OR, 9.27 (95% CI, 2.86–30.0); P < 0.001). Neonates classified as SGA according to the singleton BW standard but not according to the twin-specific BW standards had a significantly lower rate of composite adverse neonatal outcome than did AGA twins (OR, 0.24 (95% CI, 0.07–0.66); P = 0.009). Conclusions The singleton charts classified one-third of twins as SGA, both prenatally and postnatally. Infants classified as SGA according to the twin-specific charts, but not those classified as SGA according to the singleton charts, had a significantly increased risk of adverse neonatal outcome compared with infants classified as AGA. This study provides further evidence that twin-specific charts perform better than do singleton charts in the prediction of adverse neonatal outcome in twin pregnancies. The use of these charts may reduce misclassification of twins as SGA and improve identification of those that are truly growth restricted.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Briffa, C., Di Fabrizio, C., Kalafat, E., Giorgione, V., Bhate, R., Huddy, C., Richards, J., Shetty, S. and Khalil, A. (2022), Adverse neonatal outcome in twin pregnancy complicated by small-for-gestational age: twin vs singleton reference charts. Ultrasound Obstet Gynecol, 59: 377-384, which has been published in final form at https://doi.org/10.1002/uog.23764. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Keywords: birthweight, chorionicity, estimated fetal weight, neonatal outcomes, reference charts, singleton, specific, twin pregnancy, ultrasound, 1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Ultrasound Obstet Gynecol
ISSN: 1469-0705
Language: eng
Dates:
DateEvent
3 March 2022Published
18 August 2021Published Online
5 August 2021Accepted
Publisher License: Publisher's own licence
PubMed ID: 34405924
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/113579
Publisher's version: https://doi.org/10.1002/uog.23764

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