Long-term effects of selective fetal growth restriction (LEMON): a cohort study of neurodevelopmental outcome in growth discordant identical twins in the Netherlands

Groene, Sophie G.; Stegmeijer, Koen; Tan, Ratna N G B; Steggerda, Sylke J.; Haak, Monique; Slaghekke, Femke; Roest, Arno A.W.; Heijmans, Bastiaan T.; Lopriore, Enrico; Klink, Jeanine M.M. van

doi:10.1016/s2352-4642(22)00159-6

Cited by 20 publications

(16 citation statements)

References 28 publications

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“…Another variable that may be random or iatrogenic as part of infertility therapies is twinning, or higher multiple birth. This latter random pre-birth impact on the potentialities of one identical twin versus the other, has been convincingly demonstrated by Groene et al (62). These investigators have recently reported on their study of monochorionic diamniotic twins (MCDA) with selective fetal growth restriction (sFGR).…”

Section: Stochastic Obstetrical Factorsmentioning

confidence: 75%

Pre-birth acquisition of personhood: Incremental accrual of attributes as the framework for individualization by serial and concurrently acting developmental factors

Hughes

2023

Front. Reprod. Health

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Discrete events and processes influence development of individual humans. Attribution of personhood to any individual human being cannot be disconnected from the underlying biological events and processes of early human development. Nonetheless, the philosophical, sociological and legal components that are integral to the meaning of the term as commonly used cannot be deduced from biology alone. The challenge for biomedical scientists to inform discussion in this arena then rests on profiling the key biological events and processes that must be assessed when considering how one might objectively reason about the task of superimposing the concept of personhood onto the developing biological entity of a potential human being. Endogenous genetic and epigenetic events and exogenous developmental milieu processes diversify developmental trajectories of potential individual humans prior to livebirth. First, fertilization and epigenetic resetting of each individual's organismic clock to time zero (t = 0) at the gastrulation/primitive streak stage (day 15 of embryogenesis), are two discrete unseen biological events that impact a potential individual human's attributes. Second, those two discrete unseen biological events are immersed in the continuous developmental process spanning pre-fertilization and gestation, further driving individualization of diverse attributes of each future human before the third discrete and blatant biological event of parturition and livebirth. Exposures of the gravida to multiple diverse exogenous exposures means that morphogenesis and physiogenesis of every embryo/fetus has individualized attributes for its future human lifespan. Our proposed framework based on the biological discrete events and processes spanning pre-fertilization and prenatal development, implies that personhood should be incrementally attributed, and societal protections should be graduated and applied progressively across the pre-birth timespan.

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Section: Stochastic Obstetrical Factorsmentioning

confidence: 75%

Pre-birth acquisition of personhood: Incremental accrual of attributes as the framework for individualization by serial and concurrently acting developmental factors

Hughes

2023

Front. Reprod. Health

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“…Furthermore, the relatively small number of pregnancies included may have made the analysis underpowered to evaluate this outcome. In view of the high risk of impaired neurodevelopmental outcome, twins affected by TTTS, irrespective of the coexistence of sFGR, should receive long‐term dedicated neurological follow‐up 36 . More evidence is needed to elucidate the burden and type of neurocognitive delay in pregnancies complicated by TTTS and sFGR.…”

Section: Discussionmentioning

confidence: 99%

“…In the present systematic review, the prevalence of sFGR complicating TTTS ranged between 28.2% and 65.3%. The presence of sFGR in the setting of TTTS can pose additional risks, which can impact on short-and long-term outcomes of the pregnancy [35][36][37] . Increased discordance in placental sharing leads to an increase in the net volume flow between the twins, leading to more interdependent circulations, and it is not uncommon to have twins with significantly different placental shares presenting with a similar weight at birth as a result of chronic compensatory perfusion from the larger to the smaller twin.…”

Section: Clinical and Research Implicationsmentioning

confidence: 99%

Outcome following laser surgery of twin–twin transfusion syndrome complicated by selective fetal growth restriction: systematic review and meta‐analysis

D’Antonio

Marinceu

Prasad

et al. 2023

Ultrasound in Obstet & Gyne

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ObjectiveThe published literature mostly reports outcomes of twin pregnancies complicated by twin–twin transfusion syndrome (TTTS) without differentiating whether the pregnancy is also complicated by another pathology, such as selective fetal growth restriction (sFGR). The aim of this systematic review was to report the outcomes of monochorionic twin pregnancies undergoing laser surgery for TTTS complicated compared to those not complicated by the coexistence of sFGR.MethodsMedline, Embase and Cochrane databases were searched. The inclusion criteria were monochorionic diamniotic (MCDA) twin pregnancies with TTTS that are also complicated, compared to those non‐complicated by sFGR, undergoing laser therapy. The primary outcome was the overall fetal loss following laser surgery, defined as miscarriage and intra‐uterine death. The secondary outcomes included fetal loss within 24 h from laser surgery, survival at birth, preterm birth (PTB) prior to 32 weeks, PTB prior to 28 weeks of gestation, composite perinatal morbidity, neurological and respiratory morbidity, and survival free from neurological impairment. All these outcomes were explored in the overall population of twin pregnancies complicated compared to those not complicated by sFGR in the setting of TTTS, and in the donor and recipient twin separately. Random‐effect meta‐analyses were used to combine data and the results reported as pooled odd ratios (ORs) with their 95% confidence intervals (CIs).ResultsSix studies (1710 MCDA twin pregnancies) were included. The overall risk of fetal loss after laser surgery was significantly higher in MCDA twin pregnancies with TTTS complicated by sFGR (20.6% vs 14.56%) with an OR of 1.52, 95% CI 1.3‐1.9 (p<0.001). The risk of fetal loss was significantly higher for the donor but not for the recipient twin. The rate of alive twins was 79.4% (95% CI 73.3‐84.9%) in pregnancies complicated by TTTS with and 85.5% (95% CI 80.9‐89.6%) with no sFGR (pooled OR 0.66, 95% CI 0.5‐0.8; p<0.001). There was no significant difference in the risk of PTB prior to 32 (p=0.308) and prior to 28 weeks (p=0.310). Assessment of short‐ and long‐term perinatal morbidity was affected by the very small number of cases. There was no significant difference in the risk of composite (p=0.5189) or respiratory morbidity (p=0.531) between twins complicated by TTTS with compared to those without sFGR, while the risk of neurologic morbidity in the donor (OR 2.39, 95% CI 1.1‐5.2; p=0.029) but not in the recipient (p=0.361) twin was significantly higher in those with TTTS and sFGR. Survival free from neurological impairment was observed in 70.8% (95% CI 44.9‐91.0%) of twin pregnancies with TTTS complicate and in 75.8% (95% CI 51.9‐93.3%) of those not complicated by sFGR with no difference between the two groups.ConclusionssFGR coexisting with TTTS represents an additional risk factor for fetal loss following laser surgery. The findings of this meta‐analysis should be useful in individualized risk assessment of twin pregnancies complicated by TTTS and tailored counseling of the parents prior to laser surgery.This article is protected by copyright. All rights reserved.

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“…Halling et al assessed neurodevelopment in terms of recognition, language, and motor skills in discordant small and large twins after 3 years of age and reported that small babies were more disadvantaged [ 23 ]. Groene et al also demonstrated a difference in long-term neurodevelopmental outcomes between smaller and larger twins at birth in discordant MC twins [ 24 ]. However, because our study excluded TTTS and analyzed neurodevelopmental delay after 1 year of age, it would not be appropriate to make a direct comparison with previous studies and deem our findings inconsistent.…”

Section: Discussionmentioning

confidence: 99%

Perinatal Outcomes and Neurodevelopment 1 Year after Birth in Discordant Twins According to Chorionicity

Kim

Cha

et al. 2023

Medicina

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Background and Objectives: This study aimed to compare maternal complications, perinatal outcomes, and neurodevelopment 1 year after the birth between concordant and discordant twins in monochorionic and dichorionic twins. Materials and Methods: This retrospective study included twin pregnancies delivered between 24 + 1 and 38 + 2 weeks of gestation between January 2011 and September 2019. Chorionicity was confirmed by ultrasonography and was categorized into monochorionic and dichorionic. Each was then divided into two groups (concordant and discordant) according to birth weight discordancy. Maternal complications and neonatal outcomes, including neurodevelopmental delays, were compared between the two groups. Results: A total of 298 pairs of twin pregnancies were enrolled, of which 58 (19.26%) women were pregnant with monochorionic diamniotic twins and 240 (80.54%) with dichorionic diamniotic twins. In both monochorionic and dichorionic twins, the discordant twins had a greater incidence of emergency deliveries because of iatrogenic causes than the concordant twins. Among dichorionic twins, discordant twins had lower birth weight rates and higher hospitalization rates and morbidities than concordant twins. Among monochorionic twins, discordant twins had a lower birth weight and higher neonatal mortality than concordant twins. The neonatal size was not a predictor of neurodevelopment in this group. Based on the logistic regression analysis, male sex, respiratory distress syndrome, and bronchopulmonary dysplasia were risk factors for the neurodevelopmental delay; birth weight discordancy was significant only in dichorionic twins. Conclusions: Perinatal outcomes in discordant twins may be poor, and neurodevelopment 1 year after birth was worse in discordant twins than in concordant twins. Discordancy in twins can be a risk factor for neurodevelopmental delay.

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Long-term effects of selective fetal growth restriction (LEMON): a cohort study of neurodevelopmental outcome in growth discordant identical twins in the Netherlands

Cited by 20 publications

References 28 publications

Pre-birth acquisition of personhood: Incremental accrual of attributes as the framework for individualization by serial and concurrently acting developmental factors

Pre-birth acquisition of personhood: Incremental accrual of attributes as the framework for individualization by serial and concurrently acting developmental factors

Outcome following laser surgery of twin–twin transfusion syndrome complicated by selective fetal growth restriction: systematic review and meta‐analysis

Perinatal Outcomes and Neurodevelopment 1 Year after Birth in Discordant Twins According to Chorionicity

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