Introduction: To identify the optimal cut-off that should define discordance in dichorionic twin gestations through correlation with abnormal placental pathology as a specific measure of fetal growth restriction of the smaller twin.
Methods: We performed a retrospective cohort study of all women with dichorionic twin pregnancies who gave birth in a single center between 2002-2015. We investigated the association between the level of growth discordance and maternal vascular malperfusion (MVM) pathology in the placenta of the smaller twin, with and without adjustment for whether the smaller twin is small for gestational age (SGA).
Results: A total of 1,198 women with dichorionic twin gestation met the study criteria. The rate of MVM pathology in the placenta of the smaller twin increased with the level of discordance and was most obvious for discordance ≥25% (rate of MVM 12.0% compared with 2.8% in cases with discordance <10%, aRR 3.71, 95%-CI 1.97-6.99). When the analysis was adjusted for SGA of the smaller twin, discordance was independently associated with MVM pathology only when growth discordance was ≥25% (aRR 2.18, 95%-CI 1.01-4.93), while SGA was strongly associated with MVM pathology irrespective of the level of discordance.
Conclusion: Our findings suggest that discordant growth in dichorionic twins should raise the concern of fetal growth restriction of the smaller twin, irrespective of whether the smaller twin is SGA, only when the discordance s ≥25%. The association of lower levels of discordance with abnormal placental pathology is mainly driven by the confounding effect of SGA of the smaller twin.
Liran Hiersch– MFM Fellow, Sunnybrook Health Sciences Centre, University of Toronto
Amir Aviram– MFM Specialist, Sunnybrook Health Sciences Centre
Arthur Zaltz– Obstetrician, Sunnybrook Health Sciences Centre, Univeristy of Toronto
howard Berger– associated professor, university of Toronto
John Kingdom– Obstetrician, Maternal-Fetal Medicine, Mount Sinai Hospital and Obstetrics and Gynaecology, University of Toronto
Jon Barrett– Chief of Maternal-Fetal Medicine at Sunnybrook Health Sciences Centre, Sunnybrook Health Sciences Centre, University of Toronto
Nir melamed– MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N3M5