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Groene SG, Openshaw KM, Jansén-Storbacka LR, Slaghekke F, Haak MC, Heijmans BT, van Klink JMM, Roest AAW, van der Meeren LE, Lopriore E. Impact of placental sharing and large bidirectional anastomoses on birthweight discordance in monochorionic twins: a retrospective cohort study in 449 cases. Am J Obstet Gynecol 2022; 227:755.e1-755.e10. [PMID: 35667417 DOI: 10.1016/j.ajog.2022.05.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND In monochorionic twin pregnancies, the fetuses share a single placenta. When this placenta is unequally shared, a discordant antenatal growth pattern ensues resulting in high rates of perinatal morbidity and mortality. Understanding placental pathophysiology is paramount in devising feasible antenatal management strategies. Unequal placental sharing is not the sole determinant of birthweight discordance as there is no one-to-one relationship with placental share discordance. Placental angioarchitecture, especially the presence of large bidirectional anastomoses, is thought to affect this relationship by allowing for a compensatory intertwin blood flow. OBJECTIVE This study aimed to assess whether placental angioarchitecture can affect birthweight discordance in live-born monochorionic twins, the aim of our study was 2-fold: (1) to assess the relationship between birthweight discordance and placental share discordance and (2) to examine to what extent large bidirectional anastomoses can compensate for the effect of unequal placental sharing on birthweight discordance, with a subgroup analysis for umbilical artery Doppler flow patterns in cases with a birthweight discordance of ≥20%. STUDY DESIGN This was a retrospective cohort study that included monochorionic twin pregnancies observed in our center between March 2002 and June 2021, in which twins with a birthweight discordance of ≥20% were classified according to umbilical artery Doppler flow patterns of the smaller twin. We excluded cases with twin-twin transfusion syndrome and twin anemia polycythemia sequence. Monochorionic placentas of live-born twins were injected with dye, and images were saved for computer measurements of placental sharing and the diameter of anastomoses. Univariate linear regressions of the relationship between placental share discordance and birthweight discordance (both calculated as larger weight or share-smaller weight or share/larger weight or share×100%) and the relationship between arterioarterial and venovenous diameters and birthweight ratio/placental territory ratio were performed. RESULTS A total of 449 placentas were included in the analysis. Placental share discordance was positively correlated with birthweight discordance (β coefficient, 0.325; 95% confidence interval, 0.254-0.397; P<.0001). The arterioarterial diameter was negatively correlated with birthweight ratio/placental territory ratio (β coefficient, -0.041; 95% confidence interval, -0.059 to -0.023; P<.0001), meaning that an increase in arterioarterial diameter leads to less birthweight discordance than expected for the amount of placental share discordance. There was no relationship between venovenous diameter and birthweight ratio/placental territory ratio (β coefficient, -0.007; 95% confidence interval, -0.027 to 0.012; P=.473). CONCLUSION Birthweight discordance in monochorionic twins was strongly associated with placental share discordance. Large arterioarterial anastomoses can mitigate the effect of unequal placental sharing.
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Affiliation(s)
- Sophie G Groene
- Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands; Division of Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | - Femke Slaghekke
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique C Haak
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Bastiaan T Heijmans
- Division of Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanine M M van Klink
- Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Arno A W Roest
- Division of Pediatric Cardiology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
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Jung YM, Lee SM, Oh S, Lyoo SH, Park CW, Lee SD, Park JS, Jun JK. The concordance rate of non-chromosomal congenital malformations in twins based on zygosity: a retrospective cohort study. BJOG 2020; 128:857-864. [PMID: 32783284 DOI: 10.1111/1471-0528.16463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the concordance rate of non-chromosomal congenital malformations in twin pairs based on zygosity. DESIGN Retrospective cohort study. SETTING A tertiary hospital in Korea. POPULATION Twin pairs born at Seoul National University Hospital between 2001 and 2019. METHODS Congenital malformations were diagnosed by postnatal workups of neonates or autopsy in cases of stillborn infants. Zygosity was confirmed by sex, chorionicity and DNA analysis. MAIN OUTCOME MEASURES Concordance rate of congenital malformations in twin pairs based on zygosity. RESULTS In total, 3386 twin pairs were included. The risk of a congenital malformation in the index twin increased significantly if the co-twin had the congenital malformation, and the concordance rate was higher in monozygotic (MZ) than in dizygotic (DZ) twins (37.04 versus 16.77, P < 0.001). An increased risk of a congenital malformation in the presence of the same congenital malformation in the co-twin was observed only for malformations of the nervous system, eye/ear/face/neck, circulatory system, cleft lip/palate, genital organs, urinary system and musculoskeletal system. Significantly higher concordance rates in MZ than in DZ twin pairs were observed only for the nervous system (40.00 versus 0.00, P < 0.001), circulatory system (32.97 versus 19.74, P = 0.021), cleft lip/palate (44.44 versus 0.00, P = 0.017) and urinary system (22.22 versus 0.00, P = 0.004), whereas significant differences were not found for the genital organs or musculoskeletal system. CONCLUSIONS Monozygotic twins had higher concordance rates than DZ twins only in specific organ systems. It may be speculated that nervous system, circulatory system, cleft lip/palate and urinary system are primarily genetically affected. TWEETABLE ABSTRACT Monozygotic twins had higher concordance rates than dizygotic twins only in specific organ systems.
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Affiliation(s)
- Y M Jung
- Department of Obstetrics and Gynaecology, Seoul National University College of Medicine, Seoul, Korea
| | - S M Lee
- Department of Obstetrics and Gynaecology, Seoul National University College of Medicine, Seoul, Korea
| | - S Oh
- Department of Biostatistics, Seoul National University Seoul Metropolitan Government Boramae Medical Centre, Seoul, Korea
| | - S H Lyoo
- Institute of Forensic and Anthropological Science, Medical Research Centre, Seoul National University, Seoul, Korea
| | - C-W Park
- Department of Obstetrics and Gynaecology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Reproductive Medicine and Population, Medical Research Centre, Seoul National University, Seoul, Korea
| | - S D Lee
- Institute of Forensic and Anthropological Science, Medical Research Centre, Seoul National University, Seoul, Korea.,Department of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - J S Park
- Department of Obstetrics and Gynaecology, Seoul National University College of Medicine, Seoul, Korea
| | - J K Jun
- Department of Obstetrics and Gynaecology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Reproductive Medicine and Population, Medical Research Centre, Seoul National University, Seoul, Korea
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Nunes JS, Sousa M, Montenegro N, Matias A. Twin Pregnancies, Crown-rump Length and Birthweight Discordancy: The Influence of Chorionicity. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:529-534. [PMID: 32559796 PMCID: PMC10309241 DOI: 10.1055/s-0040-1712128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The purpose of the present study was to analyze the influence of chorionicity in the biometric parameters crown-rump length (CRL), birthweight (BW), crown-rump length discordancy (CRLD) and birthweight discordancy (BWD), determine the correlation between these latter two in cases of intertwin discordancy, and to analyze the influence of chronicity in the presence of these discordancies with clinical relevance (> 10% and > 15%, respectively). METHODS The present study was a retrospective study based on the twin pregnancy database of the Centro Hospitalar S. João (2010-2015), including 486 fetuses among 66 monochorionic (MC) and 177 dichorionic gestations (DC). The inclusion criteria were multiple pregnancies with 2 fetuses and healthy twin gestations. The exclusion criteria were trichorionic gestations and pregnancies with inconclusive chorionicity, multiple pregnancy with ≥ 3 fetuses and pathological twin gestations. RESULTS No statistically significant difference was found in BW (p = 0.09) and in its discordancy (p = 0.06) nor in CRL (p = 0.48) and its discordancy (p = 0.74) between MCs and DCs. Crown-rump length discordancy and birthweight discordancy were correlated by the regression line "BWD = 0.8864 x CRLD + 0.0743," with r2 = 0.1599. Crown-rump length discordancy > 10% was found in 7.58% of monochorionic and in 13.56% of dichorionic twins. Birthweight discordancy > 15% was detected in 16.67% of monochorionic and in 31.64% of dichorionic twins. CONCLUSION No statistically significant influence of chorionicity was identified in both birthweight and birthweight discordancy, as in crown-rump length and crown-rump length discordancy. Birthweight discordancy was correlated to crown-rump length discordancy in 20% of cases.
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Affiliation(s)
- Joana Sousa Nunes
- Obstetrics & Gynecology Department, Senhora da Oliveira Hospital, Guimarães, Portugal.,Obstetrics & Gynecology Department, Faculty of Medicine, Minho University, Braga, Portugal
| | - Mário Sousa
- Laboratory of Cell Biology, Microscopy Department, Porto Hospital Centre, Institute of Biomedical Sciences Abel Salazar, Porto University, Porto, Portugal
| | - Nuno Montenegro
- Obstetrics & Gynecology Department, São João Hospital & University Centre, Porto, Portugal
| | - Alexandra Matias
- Obstetrics & Gynecology Department, São João Hospital & University Centre, Porto, Portugal
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Genotyping of STR and DIP-STR Markers in Plasma Cell-Free DNA for Simple and Rapid Noninvasive Prenatal Diagnosis of Zygosity of Twin Pregnancies. Twin Res Hum Genet 2019; 22:321-329. [PMID: 31619303 DOI: 10.1017/thg.2019.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Due to the high rate of complications, special medical care must be provided especially for monozygotic twin pregnancies, which are characterized as having 2.5 times higher mortality of fetuses. In recent years, examination of cell-free DNA (cfDNA) circulating in maternal plasma has become a useful noninvasive method of prenatal diagnosis. However, fetal DNA constitutes only 3-20% of plasma cfDNA during pregnancy. Short tandem repeats (STRs) are routinely used in forensic examination of DNA mixtures and are able to identify 5% minority components. Haplotypes of deletion/insertion polymorphisms and STRs (DIP-STRs) are able to detect even 0.1% minority components of DNA mixtures. Thus, STRs and DIP-STRs seem to be a perfect tool for detection of fetal alleles in DNA isolated from maternal plasma. Here, we present a novel noninvasive prenatal diagnosis technique of determination of pregnancy zygosity based on examination of feto-maternal microchimerism of plasma cfDNA with the use of STRs and DIP-STRs. Our preliminary results based on 22 STR loci showed 67% sensitivity, 100% specificity and 82% accuracy for prenatal detection of twin dizygosity. The corresponding values for seven DIP-STRs were 13%, 100% and 54%, respectively. Owing to assay performance, low DNA input requirements, low costs (below 10 USD per patient) and simplicity of analysis, genotyping of STR/DIP-STR markers in maternal plasma cfDNA may become a useful supplementary test for noninvasive prenatal diagnosis of twin zygosity in cases when chorionicity and zygosity cannot be reliably determined by ultrasound examination and prognostic value may be provided by a DNA test determining pregnancy zygosity.
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Zou Z, Huang L, Lin S, He Z, Luo Y. Unusual twinning: Additional findings during prenatal diagnosis of twin zygosity by single nucleotide polymorphism (SNP) array. Prenat Diagn 2018; 38:428-434. [PMID: 29569732 DOI: 10.1002/pd.5255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Zhiyong Zou
- Department of Obstetrics & Gynecology; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Linhuan Huang
- Department of Obstetrics & Gynecology; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Shaobin Lin
- Department of Obstetrics & Gynecology; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Zhiming He
- Department of Obstetrics & Gynecology; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Yanmin Luo
- Department of Obstetrics & Gynecology; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
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Zhang Y, Huang L, Huang X, He Z, Lin S, Wang Y, Li L, Luo Y, Fang Q. Chromosomal aberrations and CNVs in twin fetuses with cardiovascular anomalies: Comparison between monochorionic diamniotic and dichorionic diamniotic twins. Prenat Diagn 2018; 38:318-327. [PMID: 29460287 DOI: 10.1002/pd.5238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Yi Zhang
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Linhuan Huang
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Xuan Huang
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Zhiming He
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Shaobin Lin
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Ye Wang
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Lin Li
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Yanmin Luo
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Qun Fang
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
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Does multiple gestation impact birthweight deficit from smoking? J Perinatol 2014; 34:112-5. [PMID: 24310445 DOI: 10.1038/jp.2013.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/19/2013] [Accepted: 10/18/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To test the hypothesis that the combined birthweight deficit from smoking in twin gestation is significantly greater than previously described for singletons. STUDY DESIGN Retrospective cohort study of White/Black live-born twins, 32 to 40 weeks of gestation, 1990 to 2005, Kansas City, MO. Data were analyzed by t-test, χ(2), linear and linear regression analyses. RESULT The cohort comprised 1190 twin pairs, 58% Whites and 55% ≥37 weeks. Smoking rate was 14.5% and similar by race (14.2% White vs 14.8%, P=0.772). The aggregate birthweight of twins of nonsmokers was greater, 5116 g ± 25 g vs 4870 g ± 59 g, P<0.001 (mean±s.d.) and the difference was 264 g (95% confidence interval, 156 to 372 g) after adjusting for other variables in linear regression analyses. CONCLUSION Smoking-associated growth restriction in twins is quantitatively similar to that of singletons. This finding is suggestive of dissipation or a ceiling effect to the growth-restricting effect of cigarette smoking.
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Abstract
The incidence of monozygotic twinning in pregnancies achieved with assisted reproductive technologies (ART) is significantly higher than spontaneously conceived pregnancies. The factors associated with ART that predispose the embryos to splitting are not well-characterized. Assisted hatching and extended embryo culture are two ART laboratory methods that have been risk factors for monozygotic twinning. The methods and strategies that may be employed to avoid monozygotic twinning are discussed in this chapter.
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Affiliation(s)
- Amy E Sparks
- IVF and Reproductive Testing Laboratories, Department of Obstetrics and Gynecology, Center for Advanced Reproductive Care, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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