Growth patterns and associated risk factors of congenital malformations in twins

Abstract

Background: The rate of twinning continues to increase due to the combined effect of a rise in parental age and increased use of assisted reproductive technology. The risk of congenital anomalies in twins is higher than in singletons, but it is less well reported in relation to growth patterns. We focused to the auxological outcome of twin pregnancies when one or both of twins are affected by one or more malformations. Methods: We conducted a retrospective observational study reviewing the clinical charts of twins admitted in the period between January 2003 and December 2018 at the University Hospital of Palermo. The associations between malformations and anthropometric variables at birth were analyzed by comparison within each twin pair and regarding each variable as ordered difference between the two twins. Results: We studied data of 488 neonates (52% females) from 244 pregnancies. The rate of major congenital anomalies was 11%, affecting significantly the smaller twin (p = .00018; Odds ratio 3.21; 95% CI 1.65 6.59). Malformation class distribution was as following: genitourinary (24%), gastrointestinal (20%), cardiovascular (18.5%), musculoskeletal (11%), central nervous system (9%), syndromic (9%), ocular (5.5%) and diaphragmatic hernia (2%). The most predictive value, the Birthweight (BW) difference mean ratio in malformed versus not malformed neonates (− 0.31 vs 0.02; p = .0016) was distributed equally lower than zero in all malformed twins, except for those with congenital heart defects (p = .0000083). Microcephaly (head circumference < 2 standard deviation, SD) was present in 3% of symmetrically smaller twin, and severe microcephaly (< 3 SD) was present in 0.6%. We found that an intertwin BW discordance of 18% or greater identified 50% of neonates with microcephaly, but only 11% of malformed twins. Conclusions: In case of one twin with a BW < 10th centile, a concomitant intertwin BW discordance ≥18% could reveal an increased risk for microcephaly but not for malformation. Lower values of BW, Ponderal index, Body mass index but above all negative value of BW difference mean ratio are associated with malformations in twin pairs.

Evaluation of clinical features and outcome of eight fetuses with ectopia cordis; A study from a fetal cardiology center

“…19 Monozygotic twinning is associated with early embryonic midline structural defects such as ventral body wall defects, holoprosencephaly malformation sequence, exstrophy of the cloaca malformation sequence, the VATERR association, and sirenomelia. 20 Only 5%-20% of such cases are concordant. 10,21 This seems to be the case for ectopia cordis as well.…”

“…The mean maternal age was 27.7 (range 19-33) years, the mean gestational week at diagnosis was 14.8 ± 6.5 (median: 12, range [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] weeks. Six of the eight cases were diagnosed in the first trimester, one fetus in the second trimester, one fetus was identified in the third trimester.…”

“…Approximately 10% of monozygotic twins are born with a congenital defect, which indicates a two‐ to threefold increase in congenital malformations in monozygotic twins compared to singleton newborns with a severe congenital anomaly 19 . Monozygotic twinning is associated with early embryonic midline structural defects such as ventral body wall defects, holoprosencephaly malformation sequence, exstrophy of the cloaca malformation sequence, the VATERR association, and sirenomelia 20 . Only 5%–20% of such cases are concordant 10,21 .…”

Outcomes of multiple pregnancies: results of a perinatology clinic in a tertiary health center

“…Piro et al (22) found the frequency of congenital anomalies in twin pregnancies as 11%. We found this rate lower in our patient population (3.5%).…”

The Association of Infant Birth Sizes and Anemia under Five Years Old: A Population-Based Prospective Cohort Study in China

“…Infant birth sizes, including body weight, crown–heel length, and head circumference at birth, are widely used to evaluate intrauterine growth and nutrition status [ 7 ]. Low birth weight after abnormal fetal growth is of prognostic significance for predicting perinatal death, congenital malformations, or nervous system abnormalities in early life [ 8 , 9 , 10 ]. Notably, infant sizes at birth have a linear relation with the amount of iron stores during the first 6–8 months of life [ 11 , 12 ].…”