Birthweight Discordance in Twins and the Risk of Being Heavier for Respiratory Distress Syndrome

Canpolat, Fuat Emre; Yurdakök, Murat; Korkmaz, Ayşe; Yiğit, Şule; Tekinalp, Gülsevin

doi:10.1375/183242706778553372

Cited by 7 publications

(8 citation statements)

References 17 publications

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“…Preterm, 56-60 small for gestational age, 59 low birth weight, 61,62 and discordant twin neonates 63,64 are at highest risk for hypoglycemia. Minimal glycogen and fat stores impair the preterm neonate's ability to maintain adequate BG levels.…”

Section: Risk Factors For Hypoglycemiamentioning

confidence: 99%

Hypoglycemia in Critically Ill Children

Faustino

Hirshberg

Bogue

2012

J Diabetes Sci Technol

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Section: Risk Factors For Hypoglycemiamentioning

confidence: 99%

Hypoglycemia in Critically Ill Children

Faustino

Hirshberg

Bogue

2012

J Diabetes Sci Technol

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“…Although it may represent a normal physiological variation, high degrees of discrepancy in fetal growth have been associated with poor perinatal outcome. In view of this association, clinicians commonly report the degree of estimated weight discordance detected on ultrasound …”

Section: Introductionmentioning

confidence: 99%

“…In a recent systematic review, we reported that both dichorionic (DC) and MC twin pregnancies discordant for fetal growth are at higher risk of intrauterine death, especially as a result of growth restriction . Besides mortality, BW discordance has also been reported to be associated with an increased risk of neonatal morbidity such as respiratory distress syndrome, sepsis, intraventricular hemorrhage and admission to neonatal intensive care unit . Despite this, small sample size of previously published studies, inclusion of cases affected by fetal anomalies, or TTTS, heterogeneity in prenatal management, and outcome measures do not allow extrapolation of robust evidence on the strength of association between discordant weight and morbidity.…”

Section: Introductionmentioning

confidence: 99%

“…Although it may represent a normal physiological variation, high degrees of discrepancy in fetal growth have been associated with poor perinatal outcome. [3][4][5][6][7][8][9][10][11][12][13] In view of this association, clinicians commonly report the degree of estimated weight discordance detected on ultrasound. 8 In a recent systematic review, we reported that both dichorionic (DC) and MC twin pregnancies discordant for fetal growth are at higher risk of intrauterine death, especially as a result of growth restriction.…”

Section: Introductionmentioning

confidence: 99%

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Birthweight discordance and neonatal morbidity in twin pregnancies: A systematic review and meta‐analysis

Mascio

Acharya

Khalil

et al. 2019

Acta Obstet Gynecol Scand

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Introduction The aim of this systematic review was to quantify the association between birthweight discordance and neonatal morbidity in twin pregnancies. Material and methods MEDLINE, Embase and Cinahl databases were searched. Studies reporting the occurrence of morbidity in twins affected compared with those not affected by birthweight discordance were included. The primary outcome was composite neonatal morbidity (including neurological, respiratory, infectious morbidities, abnormal acid‐base status and necrotizing enterocolitis). The secondary outcomes were the individual morbidities. Sub‐group analysis according to chorionicity, gestational age at birth and fetal weight (smaller vs larger twin) was also performed. Random‐effect head‐to‐head meta‐analyses were used to analyze the data. Results Twenty studies (10 851 twin pregnancies) were included. The risk of composite morbidity was significantly higher in the pregnancies with birthweight discordance ≥15% (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.0‐1.9), ≥20% (OR 2.2, 95% CI 1.40‐3.45), ≥25% (OR 2.5, 95% CI 1.8‐3.6), and ≥30% (OR 3.4, 95% CI 2.2‐3.2). In dichorionic twins, birthweight discordance ≥15% (OR 2.4, 95% CI 1.65‐3.46), ≥20% (OR 2.2, 95% CI 1.3‐3.8), ≥25% (OR 2.7, 95% CI 1.4‐5.1) and ≥30% (OR 3.6, 95% CI 2.3‐5.7) were all significantly associated with composite neonatal morbidity. Analysis of monochorionic twins was hampered by the very small number of included studies, which precluded adequate statistical power. Monochorionic twins with a birthweight discordance ≥20% were at significantly higher risk of composite neonatal morbidity (OR 2.2, 95% CI 1.1‐4.9) compared with those presenting with lesser degree of discordance. When stratifying the analysis according to gestational age at birth and fetal size, twins with birthweight discordance ≥15%, 20%, 25% and 30% delivered at ≥34 weeks were at higher risk of neonatal morbidity compared with controls, but there was no difference in the risk of morbidity between the larger and the smaller twin in the discordant pair. Conclusions Birthweight discordance is associated with neonatal morbidity in twin pregnancies. The strength of this association persists for dichorionic twins. It was not possible to extrapolate robust evidence on monochorionic twins due to the low power of the analysis due to the small number of included studies.

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“…Our findings demonstrate that the larger infant had increased signs of respiratory distress and required early invasive respiratory support are consistent with those of 2 prior studies that identified the same difference. 37,38 If the increased lung maturation of the growth-restricted twin played a role in the immediate respiratory picture, it is likely that the larger twin was not exposed to the same in utero stress and, therefore, was born with increased lung immaturity. Once born and given time to establish functional residual capacity, produce or receive surfactant, and establish a mature respiratory pattern, the larger twins improved fairly quickly from the initial respiratory compromise.…”

Section: Figurementioning

confidence: 99%