The case for routine determination of chorionicity and zygosity in multiple pregnancy

Bajoria, Rekha; Kingdom, John

doi:10.1002/(sici)1097-0223(199712)17:13<1207::aid-pd295>3.0.co;2-f

Cited by 125 publications

(25 citation statements)

References 130 publications

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“…MC twins have a higher incidence of congenital heart disorders, and TTTS increases this risk even further [6]. However, even in the absence of TTTS, MC twins are seven times more likely to develop congenital heart disease, and this usually occurs in one twin only [5-7,13,21,24]. The higher risk nature of multiple pregnancies, their proclivity towards complications, and the twin-twin competition for maternal resources increases the probability of a skewed environment affecting the twins in utero [25,26].…”

Section: In Utero Environment and Discordancementioning

confidence: 99%

Genetic, environmental and stochastic factors in monozygotic twin discordance with a focus on epigenetic differences

Czyz

Morahan

Ebers

et al. 2012

BMC Med

100

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Genetic-epidemiological studies on monozygotic (MZ) twins have been used for decades to tease out the relative contributions of genes and the environment to a trait. Phenotypic discordance in MZ twins has traditionally been ascribed to non-shared environmental factors acting after birth, however recent data indicate that this explanation is far too simple. In this paper, we review other reasons for discordance, including differences in the in utero environment, genetic mosaicism, and stochastic factors, focusing particularly on epigenetic discordance. Epigenetic differences are gaining increasing recognition. Although it is clear that in specific cases epigenetic alterations provide a causal factor in disease etiology, the overall significance of epigenetics in twin discordance remains unclear. It is also challenging to determine the causality and relative contributions of environmental, genetic, and stochastic factors to epigenetic variability. Epigenomic profiling studies have recently shed more light on the dynamics of temporal methylation change and methylome heritability, yet have not given a definite answer regarding their relevance to disease, because of limitations in establishing causality. Here, we explore the subject of epigenetics as another component in human phenotypic variability and its links to disease focusing particularly on evidence from MZ twin studies.

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Section: In Utero Environment and Discordancementioning

confidence: 99%

Genetic, environmental and stochastic factors in monozygotic twin discordance with a focus on epigenetic differences

Czyz

Morahan

Ebers

et al. 2012

BMC Med

100

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“…The offspring of multiple pregnancies are at greater risk for adverse perinatal outcomes compared to their singleton counterparts, predominantly due to increased risks for preterm delivery and due to monochorionicity [3]. The link between monochorionicity and adverse perinatal outcomes has become increasingly strong [4].…”

Section: Risks Of Multiple Pregnancymentioning

confidence: 99%

Uncomplicated Monochorionic Diamniotic Twins and the Timing of Delivery

Cleary-Goldman

D’Alton²

2005

PLoS Med

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“…Twins are at higher risk for adverse perinatal outcomes compared to singleton gestation, predominantly due to increased risks for preterm delivery [10]. The incidence of preterm delivery and prematurity towards neonatal morbidity in twin pregnancies is significantly reduced as a result of improved neonatal care facilities [11].…”

Section: Discussionmentioning

confidence: 99%

Clinical factors affecting the timing of delivery in twin pregnancies

et al. 2014

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ObjectiveTo investigate clinical factors affecting the timing of delivery in twin pregnancies in order to minimize perinatal complications.MethodsA retrospective study involved 163 twin pregnancies delivered from January 2006 to September 2011 at Gachon University Gil Medical Center. These cases were divided into three groups based on the delivery timing: less than 32 weeks' gestation (group A), between 32 and 35+6 weeks' gestation (group B), and over 36 weeks' gestation (group C). Clinical factors including maternal age, parity, presence of premature uterine contraction, presence of premature rupture of membrane, white blood cell, high sensitive C-reactive protein level, cervical dilatation, maternal complication, chorionicity, twin specific complication, and perinatal complication were analyzed for each group.ResultsIn group B, the timing of delivery was postponed for 14 days or more from the time of admission, and there were fewer numbers of babies with low Apgar score at birth compared with other groups. The frequency of uterine contraction (P<0.001), presence of premature rupture of membranes (P=0.017), dilatation of cervix (P<0.001), increased white blood cell and high sensitive C-reactive protein levels (P=0.002, P<0.001) were important clinical factors during decision making process of delivery timing in twin pregnancies. Twin specific fetal conditions, such as twin-twin transfusion syndrome and discordant growth (over 25% or more) were shown more frequently in group A. However, there were no significant statistical differences among three groups (P=0.06, P=0.14).ConclusionProper management for preventing premature contraction and inflammation can be essential in twin pregnancies until 32 weeks' gestation, and may decrease maternal and perinatal complications.

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The case for routine determination of chorionicity and zygosity in multiple pregnancy

Cited by 125 publications

References 130 publications

Genetic, environmental and stochastic factors in monozygotic twin discordance with a focus on epigenetic differences

Genetic, environmental and stochastic factors in monozygotic twin discordance with a focus on epigenetic differences

Uncomplicated Monochorionic Diamniotic Twins and the Timing of Delivery

Clinical factors affecting the timing of delivery in twin pregnancies

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