Predictive Accuracy of Singleton Versus Customized Twin Growth Chart for Adverse Perinatal Outcome: A Cohort Study.

Urszula Nowacka,Paweł Krajewski,Katarzyna Kosińska-Kaczyńska,Aleksandra Saletra-Bielińska,Iwona Szymusik,Izabela Walasik

doi:10.3390/ijerph18042016

Urszula Nowacka, Paweł Krajewski + Show 4 more

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https://doi.org/10.3390/ijerph18042016

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Abstract

Background: Fetal growth of twins differs from singletons. The objective was to assess the fetal growth in twin gestations in relation to singleton charts and customized twin charts, respectively, followed by a comparison of the frequency of neonatal complications in small-for-gestational-age (SGA) twins. Methods: We performed an analysis of twin pregnancies with established chorionicity with particular emphasis on postnatal adverse outcomes in newborns classified as SGA. Neonatal birth weight was comparatively assessed using both singleton and twin growth charts with following percentile estimation. Using a statistical model, we established the prediction strength of neonatal complications in SGA twins for both methods. Results: The dataset included 322 twin pairs (247 cases of dichorionic and 75 cases of monochorionic diamniotic gestations). Utilization of twin-specific normograms was less likely to label twins as SGA—nevertheless, this diagnosis strongly correlated with risk of observing adverse outcomes. Using a chart dedicated for twin pregnancies predicted newborn complications in the SGA group with higher sensitivity and had better positive predictive value regarding postnatal morbidity. Conclusions: Estimating twin growth with customized charts provides better prognosis of undesirable neonatal events in the SGA group comparing to singleton nomograms and consequently might determine neonatal intensive care prenatal approach.

Highlights

Introduction published maps and institutional affilSmall-for-gestational age (SGA) describes a fetus/neonate with an estimated/actual birth weight less than the 10th centile for the corresponding gestational age
The objective of our study was to determine whether singleton or twin growth charts predict neonatal adverse outcomes in the SGA group more precisely
Pregnancies complicated by one or two fetal demises, genetic or major anatomical abnormalities, twin to twin transfusion syndrome (TTTS), twin anemiapolycythemia sequence (TAPS), twin reversed arterial perfusion syndrome (TRAP), as well as monochorionic monoamniotic pregnancies were excluded from the study

Summary

Introduction

Small-for-gestational age (SGA) describes a fetus/neonate with an estimated/actual birth weight less than the 10th centile for the corresponding gestational age. Fetal growth restriction (FGR) is an implication of a pathological retardation of genetic growth potential, which may result in fetal compromise (abnormal Doppler studies, reduced amniotic fluid volume); FGR is not synonymous with SGA [1,2]. Implementation of centiles customized for maternal characteristics, gestational age, and infant gender identifies neonates at high risk of morbidity and mortality better than populational centiles [3]. Selecting SGA fetuses in singleton pregnancies has a major influence on the level of provided perinatal care. In comparison to appropriate for gestational age (AGA) newborns, SGA babies are at increased risk of morbidity (OR 2.26, 95% CI 1.04–4.39) [4] and unfavorable neurodevelopmental outcome at the age of 24 months

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