Developmental and behavioral outcomes of uncomplicated monochorionic diamniotic twins born in the third trimester

Abstract

BackgroundRelatively little is known about the neurodevelopmental and behavioral outcomes of monochorionic diamniotic (MCDA) twin pregnancies where there are no antenatal complications peculiar to monochorionicity or prematurity.MethodsTwenty-two MCDA twins (44 children) with an average age of 4.3 years, and with no antenatal complications detected by 28 weeks of gestation, were recruited from a feto-maternal unit database. Parents completed a battery of neurodevelopmental and behavioral assessment questionnaires.ResultsEighteen children (41%) were identified as having developmental or behavioral concerns, predominantly of mild severity, which in turn were associated with a lower birth weight of medium effect size (Cohen’s d=0.59).ConclusionMCDA twins delivered in the third trimester with no antenatal monochorionic complications in the first two trimesters appear to be at risk for subtle neurodevelopmental difficulties, associated with a lower birth weight. Ongoing developmental surveillance of these children during preschool-age is indicated for early identification and intervention.

Long-Term Neurodevelopmental Outcome of Monochorionic Twins after Laser Therapy or Umbilical Cord Occlusion for Twin-Twin Transfusion Syndrome

“…Although it was excluded from our overall analysis, we report this outcome, since it adds important information on possible long-term behavioral difficulties in these children, as mentioned by others [15,21]. It should be noted that the interviews were performed in a small selected group of children lost to follow-up by the ASQ, hypothetically due to the lack of skills expected for their age [15,36,37].…”

“…Severe neurodevelopmental impairment (NDI) is reported to occur in 8-15% [11,15,17,18] of children after fetoscopic laser surgery or selective feticide and is believed to be influenced by TTTS itself [19], gestational age (GA) at delivery, and birthweight [20]. Some studies suggest that twinning and monochorionicity may increase the risk of neurologic disabilities [21][22][23]. The aim of this study was to assess the risk of severe NDI in MC twins treated for TTTS by either fetoscopic selective laser coagulation (FSLC) or selective feticide by ultrasound-guided umbilical cord occlusion (UCO) in a consecutive Danish national cohort and to compare the incidence of severe NDI with a control group of MC twins from uncomplicated pregnancies.…”

The Influence of Time of Diagnosis on Neurodevelopmental Outcomes of Complicated Monochorionic Pregnancies

“…44 Poor results in an 8 month or 2 year 'concerning' was defined as a score that was below 75 for the BSID-III, or equivalent neurodevelopmental assessment does not necessarily mean that the child will have poor outcomes when they are older, but it does indicate that they will need more intensive support and possible intervention. That is why these neurodevelopmental tests are important, especially in twins affected by monochorionic complications [14,39,41].…”

“…According to a cohort study, 41% of monochorionic pregnancies had neurodevelopmental concerns [14] with no pre-natal complications identified and who delivered in the 3 rd trimester. The factors referenced as an explanation were very low birth weight, monochorionic complications, antenatal and postnatal injury and prematurity [7,10,15].…”

The Influence of Time of Diagnosis on Neurodevelopmental Outcomes of Complicated Monochorionic Pregnancies

“…According to a cohort study, 41% of monochorionic pregnancies had neurodevelopmental concerns [14] with no pre-natal complications identified and who delivered in the 3 rd trimester. The factors referenced as an explanation were very low birth weight, monochorionic complications, antenatal and postnatal injury and prematurity [7,10,15].…”