Genome-wide epigenetic study in monochorionic(MC) twins after fetoscopic laser photocoagulation(FLP) at birth
Placenta(2013)
摘要
We sought to determine the perinatal risks associated with growth discordance in appropriately grown twin gestations.We conducted a retrospective cohort study of all twin gestations excluding those complicated by monoamnionicity, twin-twin transfusion syndrome, structural anomalies, selective reduction, or a birthweight <10th percentile. Growth discordance was defined as ≥20%. Outcomes considered were stillbirth, preterm delivery <34 weeks and <28 weeks, and admission to the neonatal intensive care unit. Analyses were stratified by chorionicity.Of 895 included dichorionic pregnancies, 63 (7.0%) were discordant. Discordant dichorionic twins were not at increased risk of preterm delivery <34 weeks (34.9% vs 25.6%; relative risk [RR], 1.4; 95% confidence interval [CI], 1.0−1.9), preterm delivery <28 weeks (3.2% vs 2.8%; RR, 1.1; 95% CI, 0.3−4.8), or admission to intensive care (26.9% vs 23.5%; RR, 1.5; 95% CI, 1.0−2.3). We had >90% power to detect a 2.5-fold increase in preterm delivery and admission to the neonatal intensive care unit in dichorionic twins. Of 250 monochorionic pregnancies, 23 (9.2%) were discordant. Monochorionic twin pregnancies were at increased risk of preterm delivery <34 weeks (65.2% vs 26.4%; RR, 2.5; 95% CI, 1.7−3.6), preterm delivery <28 weeks (34.8% vs 4.0%; RR, 8.8; 95% CI, 3.7−20.5), and admission to intensive care (68.2% vs 23.3%; RR, 2.9; 95% CI, 2.0−4.3).In appropriately grown twins, growth discordance is a risk factor for adverse perinatal outcomes in monochorionic, but not dichorionic, twins. Discordant monochorionic twins may benefit from increased antenatal surveillance.
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关键词
twins,genome-wide
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