Abstract
BackgroundThe common use of singleton fetal growth standard to access twin growth might lead to over-monitoring and treatment. We aimed to develop fetal growth standards for Chinese twins based on ultrasound measurements, and compare it with Zhang’s and other twin fetal growth charts.MethodsA cohort of uncomplicated twin pregnancies were prospectively followed in 2014–2017. Smoothed estimates of fetal growth percentiles for both monochorionic (MC) and dichorionic (DC) twins were obtained using a linear mixed model. We also created growth charts for twins using a model-based approach proposed by Zhang et al. Our twin standards were compared with Hadlock’s (singleton) in predicting adverse perinatal outcomes.ResultsA total of 398 twin pregnancies were included, with 214 MC and 582 DC live-born twins. The MC twins were slightly lighter than the DC twins, with small differences throughout the gestation. Our ultrasound-based fetal weight standards were comparable to that using Zhang’s method. Compared with previous references/standards from the US, Brazil, Italy and UK, our twins had very similar 50th percentiles, but narrower ranges between the 5th and 95th or 10th and 90th percentiles. Compared with the Hadlock’s standard, the risks of neonatal death and adverse perinatal outcomes for small for gestational age (SGA) versus non-SGA were substantially elevated using our standards.ConclusionsA normal fetal growth standard for Chinese twins was created. The differences between MC and DC twins were clinically insignificant. The 50th weight percentiles of the Chinese twins were identical to those in other races/ethnicities but the ranges were markedly narrower. Our standard performed much better than the Hadlock’s in predicting low birth weight infants associated with adverse perinatal outcomes in twin pregnancies. The present study also indicated that Zhang’s method is applicable to Chinese twins, and other areas may use Zhang’s method to generate their own curves for twins if deemed necessary.
Highlights
The common use of singleton fetal growth standard to access twin growth might lead to over-monitoring and treatment
It is a common clinical practice to evaluate twin growth status using a fetal growth chart that was developed for singleton pregnancies
Ultrasound-estimated gestational age (Us-GA) was calculated based on the fetal crown-rump length of the larger twin using the formula by Robinson and Fleming: Us-GA = (8.052*√CRL+23.73)/7 [23], and chorionicity was determined by the presence of T sign or λ sign at the junction site of intertwin membrane with the placenta
Summary
The common use of singleton fetal growth standard to access twin growth might lead to over-monitoring and treatment. It is a common clinical practice to evaluate twin growth status using a fetal growth chart that was developed for singleton pregnancies. Whether the growth difference between singletons and twins is a pathological consequence(real growth problem) or a physiological adaption remains controversial. It has been well-recognized that the growth of twins lags behind that of singletons especially at late gestation. Using singleton standards for twins may identify more SGA fetuses especially at late gestation, leading to over-monitoring and treatment, and increasing medical burden and costs. It is widely acknowledged that singletons and twins need separate growth charts to assess their growth accurately [9]
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