Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance

Cathrine Vedel; Anna Oldenburg; Katharina Worda; Helle Larsen; Anni Holmskov; Kirsten R. Andreasen; Niels Uldbjerg; Jan Ramb; Birgit Bødker; Lillian Skibsted; Lene Sperling; Stefan Hinterberger; Lone Krebs; Helle Zingenberg; Eva Christine Weiss; Isolde Strobl; Lone Laursen; Jeanette T. Christensen; Vibeke Ersbak; Inger Stornes; Elisabeth Krampl-Bettelheim; Ann Tabor; Line Rode

doi:10.1111/aogs.13062

Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance

Cathrine Vedel^*
, Anna Oldenburg
, Katharina Worda
, Helle Larsen
, Anni Holmskov
, Kirsten R. Andreasen
, Niels Uldbjerg
, Jan Ramb
, Birgit Bødker
, Lillian Skibsted
, Lene Sperling
, Stefan Hinterberger
, Lone Krebs
, Helle Zingenberg
, Eva Christine Weiss
, Isolde Strobl
, Lone Laursen
, Jeanette T. Christensen
, Vibeke Ersbak
, Inger Stornes

Elisabeth Krampl-Bettelheim, Ann Tabor, Line Rode

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

Introduction: The objective was to investigate the association between chorionicity-specific intertwin birthweight discordance and adverse outcomes including long-term follow up at 6, 18, and 48–60 months after term via Ages and Stages Questionnaire. Material and methods: In this secondary analysis of a cohort study (Oldenburg et al., n = 1688) and a randomized controlled trial (PREDICT study, n = 1045) twin pairs were divided into three groups according to chorionicity-specific birthweight discordance: <75th percentile, 75th–90th percentile and >90th percentile. Information on infant mortality, admittance to neonatal intensive care units, and gestational age at delivery was available for all pairs. Detailed neonatal outcomes were available for 656 pairs from PREDICT, of which 567 pairs had at least one Ages and Stages Questionnair follow-up. Logistic regression models were used for dichotomous outcomes. Ages and Stages Questionnair scores were compared using the method of generalized estimating equation to account for the correlation within twins. Results: The 75th and 90th percentiles for birthweight discordance were 14.8 and 21.4% for monochorionic and 16.0 and 23.8% for dichorionic twins. After adjustment for small for gestational age and gender, birthweight discordance >75th and >90th percentile was associated with induced delivery <34 weeks [odds ratio 1.71 (95% confidence interval 1.11–2.65) and odds ratio 2.83 (95% confidence interval 1.73–4.64), respectively]. Discordance >75th-percentile was associated with an increased risk of infant mortality after 28 days [odds ratio 4.69 (95% confidence interval 1.07–20.45)] but not with major neonatal complications or with low mean Ages and Stages Questionnair scores at 6, 18, and 48–60 months after term. Conclusion: Chorionicity-specific intertwin birthweight discordance is a risk factor for induced preterm delivery and infant mortality, but not for lower scores for neurophysiological development at 6, 18, and 48–60 months.

Original language	English
Pages (from-to)	233-242
Number of pages	10
Journal	Acta Obstetricia et Gynecologica Scandinavica
Volume	96
Issue number	2
DOIs	https://doi.org/10.1111/aogs.13062
Publication status	Published - 1 Feb 2017

Funding

Funding for the PREDICT study was provided by The Danish Medical Research Council, The Fetal Medicine Foundation, The Copenhagen University Hospital's Research Fund, The Aase and Ejnar Danielsens Fund, The Augustinus Fund, The Ivan Nielsen Fund, The Doctor Sofus Carl Emil Friis and wife Olga Doris Friis? Fund, The Simon Fougner Hartmanns Family Fund, The Danish Medical Society in Copenhagen, and The A.P. Moeller Foundation. Funding for Oldenburg's study was provided by The Danish Agency for Science, Technology and Innovation.

Keywords

Ages and Stages Questionnaire
birthweight discordance
Chorionicity
neonatal complications
twins

Access to Document

10.1111/aogs.13062

Cite this

Vedel, C., Oldenburg, A., Worda, K., Larsen, H., Holmskov, A., Andreasen, K. R., Uldbjerg, N., Ramb, J., Bødker, B., Skibsted, L., Sperling, L., Hinterberger, S., Krebs, L., Zingenberg, H., Weiss, E. C., Strobl, I., Laursen, L., Christensen, J. T., Ersbak, V., ... Rode, L. (2017). Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance. Acta Obstetricia et Gynecologica Scandinavica, 96(2), 233-242. https://doi.org/10.1111/aogs.13062

@article{838c99a068e645cd827944ec9bee8b64,

title = "Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance",

abstract = "Introduction: The objective was to investigate the association between chorionicity-specific intertwin birthweight discordance and adverse outcomes including long-term follow up at 6, 18, and 48–60 months after term via Ages and Stages Questionnaire. Material and methods: In this secondary analysis of a cohort study (Oldenburg et al., n = 1688) and a randomized controlled trial (PREDICT study, n = 1045) twin pairs were divided into three groups according to chorionicity-specific birthweight discordance: <75th percentile, 75th–90th percentile and >90th percentile. Information on infant mortality, admittance to neonatal intensive care units, and gestational age at delivery was available for all pairs. Detailed neonatal outcomes were available for 656 pairs from PREDICT, of which 567 pairs had at least one Ages and Stages Questionnair follow-up. Logistic regression models were used for dichotomous outcomes. Ages and Stages Questionnair scores were compared using the method of generalized estimating equation to account for the correlation within twins. Results: The 75th and 90th percentiles for birthweight discordance were 14.8 and 21.4\% for monochorionic and 16.0 and 23.8\% for dichorionic twins. After adjustment for small for gestational age and gender, birthweight discordance >75th and >90th percentile was associated with induced delivery <34 weeks [odds ratio 1.71 (95\% confidence interval 1.11–2.65) and odds ratio 2.83 (95\% confidence interval 1.73–4.64), respectively]. Discordance >75th-percentile was associated with an increased risk of infant mortality after 28 days [odds ratio 4.69 (95\% confidence interval 1.07–20.45)] but not with major neonatal complications or with low mean Ages and Stages Questionnair scores at 6, 18, and 48–60 months after term. Conclusion: Chorionicity-specific intertwin birthweight discordance is a risk factor for induced preterm delivery and infant mortality, but not for lower scores for neurophysiological development at 6, 18, and 48–60 months.",

keywords = "Ages and Stages Questionnaire, birthweight discordance, Chorionicity, neonatal complications, twins",

author = "Cathrine Vedel and Anna Oldenburg and Katharina Worda and Helle Larsen and Anni Holmskov and Andreasen, \{Kirsten R.\} and Niels Uldbjerg and Jan Ramb and Birgit B{\o}dker and Lillian Skibsted and Lene Sperling and Stefan Hinterberger and Lone Krebs and Helle Zingenberg and Weiss, \{Eva Christine\} and Isolde Strobl and Lone Laursen and Christensen, \{Jeanette T.\} and Vibeke Ersbak and Inger Stornes and Elisabeth Krampl-Bettelheim and Ann Tabor and Line Rode",

year = "2017",

month = feb,

day = "1",

doi = "10.1111/aogs.13062",

language = "English",

volume = "96",

pages = "233--242",

journal = "Acta Obstetricia et Gynecologica Scandinavica",

issn = "0001-6349",

publisher = "Wiley-Blackwell",

number = "2",

}

Vedel, C, Oldenburg, A, Worda, K, Larsen, H, Holmskov, A, Andreasen, KR, Uldbjerg, N, Ramb, J, Bødker, B, Skibsted, L, Sperling, L, Hinterberger, S, Krebs, L, Zingenberg, H, Weiss, EC, Strobl, I, Laursen, L, Christensen, JT, Ersbak, V, Stornes, I, Krampl-Bettelheim, E, Tabor, A & Rode, L 2017, 'Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance', Acta Obstetricia et Gynecologica Scandinavica, vol. 96, no. 2, pp. 233-242. https://doi.org/10.1111/aogs.13062

TY - JOUR

T1 - Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance

AU - Vedel, Cathrine

AU - Oldenburg, Anna

AU - Worda, Katharina

AU - Larsen, Helle

AU - Holmskov, Anni

AU - Andreasen, Kirsten R.

AU - Uldbjerg, Niels

AU - Ramb, Jan

AU - Bødker, Birgit

AU - Skibsted, Lillian

AU - Sperling, Lene

AU - Hinterberger, Stefan

AU - Krebs, Lone

AU - Zingenberg, Helle

AU - Weiss, Eva Christine

AU - Strobl, Isolde

AU - Laursen, Lone

AU - Christensen, Jeanette T.

AU - Ersbak, Vibeke

AU - Stornes, Inger

AU - Krampl-Bettelheim, Elisabeth

AU - Tabor, Ann

AU - Rode, Line

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Introduction: The objective was to investigate the association between chorionicity-specific intertwin birthweight discordance and adverse outcomes including long-term follow up at 6, 18, and 48–60 months after term via Ages and Stages Questionnaire. Material and methods: In this secondary analysis of a cohort study (Oldenburg et al., n = 1688) and a randomized controlled trial (PREDICT study, n = 1045) twin pairs were divided into three groups according to chorionicity-specific birthweight discordance: <75th percentile, 75th–90th percentile and >90th percentile. Information on infant mortality, admittance to neonatal intensive care units, and gestational age at delivery was available for all pairs. Detailed neonatal outcomes were available for 656 pairs from PREDICT, of which 567 pairs had at least one Ages and Stages Questionnair follow-up. Logistic regression models were used for dichotomous outcomes. Ages and Stages Questionnair scores were compared using the method of generalized estimating equation to account for the correlation within twins. Results: The 75th and 90th percentiles for birthweight discordance were 14.8 and 21.4% for monochorionic and 16.0 and 23.8% for dichorionic twins. After adjustment for small for gestational age and gender, birthweight discordance >75th and >90th percentile was associated with induced delivery <34 weeks [odds ratio 1.71 (95% confidence interval 1.11–2.65) and odds ratio 2.83 (95% confidence interval 1.73–4.64), respectively]. Discordance >75th-percentile was associated with an increased risk of infant mortality after 28 days [odds ratio 4.69 (95% confidence interval 1.07–20.45)] but not with major neonatal complications or with low mean Ages and Stages Questionnair scores at 6, 18, and 48–60 months after term. Conclusion: Chorionicity-specific intertwin birthweight discordance is a risk factor for induced preterm delivery and infant mortality, but not for lower scores for neurophysiological development at 6, 18, and 48–60 months.

AB - Introduction: The objective was to investigate the association between chorionicity-specific intertwin birthweight discordance and adverse outcomes including long-term follow up at 6, 18, and 48–60 months after term via Ages and Stages Questionnaire. Material and methods: In this secondary analysis of a cohort study (Oldenburg et al., n = 1688) and a randomized controlled trial (PREDICT study, n = 1045) twin pairs were divided into three groups according to chorionicity-specific birthweight discordance: <75th percentile, 75th–90th percentile and >90th percentile. Information on infant mortality, admittance to neonatal intensive care units, and gestational age at delivery was available for all pairs. Detailed neonatal outcomes were available for 656 pairs from PREDICT, of which 567 pairs had at least one Ages and Stages Questionnair follow-up. Logistic regression models were used for dichotomous outcomes. Ages and Stages Questionnair scores were compared using the method of generalized estimating equation to account for the correlation within twins. Results: The 75th and 90th percentiles for birthweight discordance were 14.8 and 21.4% for monochorionic and 16.0 and 23.8% for dichorionic twins. After adjustment for small for gestational age and gender, birthweight discordance >75th and >90th percentile was associated with induced delivery <34 weeks [odds ratio 1.71 (95% confidence interval 1.11–2.65) and odds ratio 2.83 (95% confidence interval 1.73–4.64), respectively]. Discordance >75th-percentile was associated with an increased risk of infant mortality after 28 days [odds ratio 4.69 (95% confidence interval 1.07–20.45)] but not with major neonatal complications or with low mean Ages and Stages Questionnair scores at 6, 18, and 48–60 months after term. Conclusion: Chorionicity-specific intertwin birthweight discordance is a risk factor for induced preterm delivery and infant mortality, but not for lower scores for neurophysiological development at 6, 18, and 48–60 months.

KW - Ages and Stages Questionnaire

KW - birthweight discordance

KW - Chorionicity

KW - neonatal complications

KW - twins

UR - https://www.scopus.com/pages/publications/85009456827

U2 - 10.1111/aogs.13062

DO - 10.1111/aogs.13062

M3 - Article

C2 - 27861703

AN - SCOPUS:85009456827

SN - 0001-6349

VL - 96

SP - 233

EP - 242

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 2

ER -

Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance

Abstract

Funding

Keywords

Access to Document

Other files and links

Fingerprint

Cite this