Timing of Delivery for Twins With Growth Discordance and Growth Restriction: An Individual Participant Data Meta-analysis

Ashlee K Koch; Renée J Burger; Ewoud Schuit; Julio Fernando Mateus; Maria Goya; Elena Carreras; Sckarlet E Biancolin; Eran Barzilay; Nancy Soliman; Stephanie Cooper; Amy Metcalfe; Abhay Lodha; Anna Fichera; Valentina Stagnati; Hiroshi Kawamura; Maria Rustico; Mariano Lanna; Shama Munim; Francesca Maria Russo; Anwar Nassar; Line Rode; Arianne Lim; Sophie Liem; Katherine L Grantz; Karien Hack; C Andrew Combs; Vicente Serra; Alfredo Perales; Asma Khalil; Becky Liu; Jon Barrett; Wessel Ganzevoort; Sanne J Gordijn; R Katie Morris; Ben W Mol; Wentao Li

doi:10.1097/AOG.0000000000004789

Timing of Delivery for Twins With Growth Discordance and Growth Restriction: An Individual Participant Data Meta-analysis

Ashlee K Koch, Renée J Burger, Ewoud Schuit, Julio Fernando Mateus, Maria Goya, Elena Carreras, Sckarlet E Biancolin, Eran Barzilay, Nancy Soliman, Stephanie Cooper, Amy Metcalfe, Abhay Lodha, Anna Fichera, Valentina Stagnati, Hiroshi Kawamura, Maria Rustico, Mariano Lanna, Shama Munim, Francesca Maria Russo, Anwar NassarLine Rode, Arianne Lim, Sophie Liem, Katherine L Grantz, Karien Hack, C Andrew Combs, Vicente Serra, Alfredo Perales, Asma Khalil, Becky Liu, Jon Barrett, Wessel Ganzevoort, Sanne J Gordijn, R Katie Morris, Ben W Mol, Wentao Li^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

OBJECTIVE: First, to evaluate the risks of stillbirth and neonatal death by gestational age in twin pregnancies with different levels of growth discordance and in relation to small for gestational age (SGA), and on this basis to establish optimal gestational ages for delivery. Second, to compare these optimal gestational ages with previously established optimal delivery timing for twin pregnancies not complicated by fetal growth restriction, which, in a previous individual patient meta-analysis, was calculated at 37 0/7 weeks of gestation for dichorionic pregnancies and 36 0/7 weeks for monochorionic pregnancies.

DATA SOURCES: A search of MEDLINE, EMBASE, ClinicalTrials.gov, and Ovid between 2015 and 2018 was performed of cohort studies reporting risks of stillbirth and neonatal death in twin pregnancies from 32 to 41 weeks of gestation. Studies from a previous meta-analysis using a similar search strategy (from inception to 2015) were combined. Women with monoamniotic twin pregnancies were excluded.

METHODS OF STUDY SELECTION: Overall, of 57 eligible studies, 20 cohort studies that contributed original data reporting on 7,474 dichorionic and 2,281 monochorionic twin pairs.

TABULATION, INTEGRATION, AND RESULTS: We performed an individual participant data meta-analysis to calculate the risk of perinatal death (risk difference between prospective stillbirth and neonatal death) per gestational week. Analyses were stratified by chorionicity, levels of growth discordance, and presence of SGA in one or both twins. For both dichorionic and monochorionic twins, the absolute risks of stillbirth and neonatal death were higher when one or both twins were SGA and increased with greater levels of growth discordance. Regardless of level of growth discordance and birth weight, perinatal risk balanced between 36 0/7-6/7 and 37 0/7-6/7 weeks of gestation in both dichorionic and monochorionic twin pregnancies, with likely higher risk of stillbirth than neonatal death from 37 0/7-6/7 weeks onward.

CONCLUSION: Growth discordance or SGA is associated with higher absolute risks of stillbirth and neonatal death. However, balancing these two risks, we did not find evidence that the optimal timing of delivery is changed by the presence of growth disorders alone.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018090866.

Original language	English
Pages (from-to)	1155-1167
Number of pages	13
Journal	Obstetrics and Gynecology
Volume	139
Issue number	6
DOIs	https://doi.org/10.1097/AOG.0000000000004789
Publication status	Published - 1-Jun-2022

Keywords

Female
Fetal Growth Retardation/epidemiology
Gestational Age
Humans
Infant, Newborn
Infant, Newborn, Diseases
Perinatal Death/etiology
Pregnancy
Pregnancy, Twin
Prospective Studies
Retrospective Studies
Stillbirth/epidemiology
Twins

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Koch, A. K., Burger, R. J., Schuit, E., Mateus, J. F., Goya, M., Carreras, E., Biancolin, S. E., Barzilay, E., Soliman, N., Cooper, S., Metcalfe, A., Lodha, A., Fichera, A., Stagnati, V., Kawamura, H., Rustico, M., Lanna, M., Munim, S., Russo, F. M., ... Li, W. (2022). Timing of Delivery for Twins With Growth Discordance and Growth Restriction: An Individual Participant Data Meta-analysis. Obstetrics and Gynecology, 139(6), 1155-1167. https://doi.org/10.1097/AOG.0000000000004789

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title = "Timing of Delivery for Twins With Growth Discordance and Growth Restriction: An Individual Participant Data Meta-analysis",

abstract = "OBJECTIVE: First, to evaluate the risks of stillbirth and neonatal death by gestational age in twin pregnancies with different levels of growth discordance and in relation to small for gestational age (SGA), and on this basis to establish optimal gestational ages for delivery. Second, to compare these optimal gestational ages with previously established optimal delivery timing for twin pregnancies not complicated by fetal growth restriction, which, in a previous individual patient meta-analysis, was calculated at 37 0/7 weeks of gestation for dichorionic pregnancies and 36 0/7 weeks for monochorionic pregnancies.DATA SOURCES: A search of MEDLINE, EMBASE, ClinicalTrials.gov, and Ovid between 2015 and 2018 was performed of cohort studies reporting risks of stillbirth and neonatal death in twin pregnancies from 32 to 41 weeks of gestation. Studies from a previous meta-analysis using a similar search strategy (from inception to 2015) were combined. Women with monoamniotic twin pregnancies were excluded.METHODS OF STUDY SELECTION: Overall, of 57 eligible studies, 20 cohort studies that contributed original data reporting on 7,474 dichorionic and 2,281 monochorionic twin pairs.TABULATION, INTEGRATION, AND RESULTS: We performed an individual participant data meta-analysis to calculate the risk of perinatal death (risk difference between prospective stillbirth and neonatal death) per gestational week. Analyses were stratified by chorionicity, levels of growth discordance, and presence of SGA in one or both twins. For both dichorionic and monochorionic twins, the absolute risks of stillbirth and neonatal death were higher when one or both twins were SGA and increased with greater levels of growth discordance. Regardless of level of growth discordance and birth weight, perinatal risk balanced between 36 0/7-6/7 and 37 0/7-6/7 weeks of gestation in both dichorionic and monochorionic twin pregnancies, with likely higher risk of stillbirth than neonatal death from 37 0/7-6/7 weeks onward.CONCLUSION: Growth discordance or SGA is associated with higher absolute risks of stillbirth and neonatal death. However, balancing these two risks, we did not find evidence that the optimal timing of delivery is changed by the presence of growth disorders alone.SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018090866.",

keywords = "Female, Fetal Growth Retardation/epidemiology, Gestational Age, Humans, Infant, Newborn, Infant, Newborn, Diseases, Perinatal Death/etiology, Pregnancy, Pregnancy, Twin, Prospective Studies, Retrospective Studies, Stillbirth/epidemiology, Twins",

author = "Koch, {Ashlee K} and Burger, {Ren{\'e}e J} and Ewoud Schuit and Mateus, {Julio Fernando} and Maria Goya and Elena Carreras and Biancolin, {Sckarlet E} and Eran Barzilay and Nancy Soliman and Stephanie Cooper and Amy Metcalfe and Abhay Lodha and Anna Fichera and Valentina Stagnati and Hiroshi Kawamura and Maria Rustico and Mariano Lanna and Shama Munim and Russo, {Francesca Maria} and Anwar Nassar and Line Rode and Arianne Lim and Sophie Liem and Grantz, {Katherine L} and Karien Hack and Combs, {C Andrew} and Vicente Serra and Alfredo Perales and Asma Khalil and Becky Liu and Jon Barrett and Wessel Ganzevoort and Gordijn, {Sanne J} and Morris, {R Katie} and Mol, {Ben W} and Wentao Li",

year = "2022",

month = jun,

day = "1",

doi = "10.1097/AOG.0000000000004789",

language = "English",

volume = "139",

pages = "1155--1167",

journal = "Obstetrics and Gynecology",

issn = "0029-7844",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "6",

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Koch, AK, Burger, RJ, Schuit, E, Mateus, JF, Goya, M, Carreras, E, Biancolin, SE, Barzilay, E, Soliman, N, Cooper, S, Metcalfe, A, Lodha, A, Fichera, A, Stagnati, V, Kawamura, H, Rustico, M, Lanna, M, Munim, S, Russo, FM, Nassar, A, Rode, L, Lim, A, Liem, S, Grantz, KL, Hack, K, Combs, CA, Serra, V, Perales, A, Khalil, A, Liu, B, Barrett, J, Ganzevoort, W, Gordijn, SJ, Morris, RK, Mol, BW & Li, W 2022, 'Timing of Delivery for Twins With Growth Discordance and Growth Restriction: An Individual Participant Data Meta-analysis', Obstetrics and Gynecology, vol. 139, no. 6, pp. 1155-1167. https://doi.org/10.1097/AOG.0000000000004789

TY - JOUR

T1 - Timing of Delivery for Twins With Growth Discordance and Growth Restriction

T2 - An Individual Participant Data Meta-analysis

AU - Koch, Ashlee K

AU - Burger, Renée J

AU - Schuit, Ewoud

AU - Mateus, Julio Fernando

AU - Goya, Maria

AU - Carreras, Elena

AU - Biancolin, Sckarlet E

AU - Barzilay, Eran

AU - Soliman, Nancy

AU - Cooper, Stephanie

AU - Metcalfe, Amy

AU - Lodha, Abhay

AU - Fichera, Anna

AU - Stagnati, Valentina

AU - Kawamura, Hiroshi

AU - Rustico, Maria

AU - Lanna, Mariano

AU - Munim, Shama

AU - Russo, Francesca Maria

AU - Nassar, Anwar

AU - Rode, Line

AU - Lim, Arianne

AU - Liem, Sophie

AU - Grantz, Katherine L

AU - Hack, Karien

AU - Combs, C Andrew

AU - Serra, Vicente

AU - Perales, Alfredo

AU - Khalil, Asma

AU - Liu, Becky

AU - Barrett, Jon

AU - Ganzevoort, Wessel

AU - Gordijn, Sanne J

AU - Morris, R Katie

AU - Mol, Ben W

AU - Li, Wentao

PY - 2022/6/1

Y1 - 2022/6/1

N2 - OBJECTIVE: First, to evaluate the risks of stillbirth and neonatal death by gestational age in twin pregnancies with different levels of growth discordance and in relation to small for gestational age (SGA), and on this basis to establish optimal gestational ages for delivery. Second, to compare these optimal gestational ages with previously established optimal delivery timing for twin pregnancies not complicated by fetal growth restriction, which, in a previous individual patient meta-analysis, was calculated at 37 0/7 weeks of gestation for dichorionic pregnancies and 36 0/7 weeks for monochorionic pregnancies.DATA SOURCES: A search of MEDLINE, EMBASE, ClinicalTrials.gov, and Ovid between 2015 and 2018 was performed of cohort studies reporting risks of stillbirth and neonatal death in twin pregnancies from 32 to 41 weeks of gestation. Studies from a previous meta-analysis using a similar search strategy (from inception to 2015) were combined. Women with monoamniotic twin pregnancies were excluded.METHODS OF STUDY SELECTION: Overall, of 57 eligible studies, 20 cohort studies that contributed original data reporting on 7,474 dichorionic and 2,281 monochorionic twin pairs.TABULATION, INTEGRATION, AND RESULTS: We performed an individual participant data meta-analysis to calculate the risk of perinatal death (risk difference between prospective stillbirth and neonatal death) per gestational week. Analyses were stratified by chorionicity, levels of growth discordance, and presence of SGA in one or both twins. For both dichorionic and monochorionic twins, the absolute risks of stillbirth and neonatal death were higher when one or both twins were SGA and increased with greater levels of growth discordance. Regardless of level of growth discordance and birth weight, perinatal risk balanced between 36 0/7-6/7 and 37 0/7-6/7 weeks of gestation in both dichorionic and monochorionic twin pregnancies, with likely higher risk of stillbirth than neonatal death from 37 0/7-6/7 weeks onward.CONCLUSION: Growth discordance or SGA is associated with higher absolute risks of stillbirth and neonatal death. However, balancing these two risks, we did not find evidence that the optimal timing of delivery is changed by the presence of growth disorders alone.SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018090866.

AB - OBJECTIVE: First, to evaluate the risks of stillbirth and neonatal death by gestational age in twin pregnancies with different levels of growth discordance and in relation to small for gestational age (SGA), and on this basis to establish optimal gestational ages for delivery. Second, to compare these optimal gestational ages with previously established optimal delivery timing for twin pregnancies not complicated by fetal growth restriction, which, in a previous individual patient meta-analysis, was calculated at 37 0/7 weeks of gestation for dichorionic pregnancies and 36 0/7 weeks for monochorionic pregnancies.DATA SOURCES: A search of MEDLINE, EMBASE, ClinicalTrials.gov, and Ovid between 2015 and 2018 was performed of cohort studies reporting risks of stillbirth and neonatal death in twin pregnancies from 32 to 41 weeks of gestation. Studies from a previous meta-analysis using a similar search strategy (from inception to 2015) were combined. Women with monoamniotic twin pregnancies were excluded.METHODS OF STUDY SELECTION: Overall, of 57 eligible studies, 20 cohort studies that contributed original data reporting on 7,474 dichorionic and 2,281 monochorionic twin pairs.TABULATION, INTEGRATION, AND RESULTS: We performed an individual participant data meta-analysis to calculate the risk of perinatal death (risk difference between prospective stillbirth and neonatal death) per gestational week. Analyses were stratified by chorionicity, levels of growth discordance, and presence of SGA in one or both twins. For both dichorionic and monochorionic twins, the absolute risks of stillbirth and neonatal death were higher when one or both twins were SGA and increased with greater levels of growth discordance. Regardless of level of growth discordance and birth weight, perinatal risk balanced between 36 0/7-6/7 and 37 0/7-6/7 weeks of gestation in both dichorionic and monochorionic twin pregnancies, with likely higher risk of stillbirth than neonatal death from 37 0/7-6/7 weeks onward.CONCLUSION: Growth discordance or SGA is associated with higher absolute risks of stillbirth and neonatal death. However, balancing these two risks, we did not find evidence that the optimal timing of delivery is changed by the presence of growth disorders alone.SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018090866.

KW - Female

KW - Fetal Growth Retardation/epidemiology

KW - Gestational Age

KW - Humans

KW - Infant, Newborn

KW - Infant, Newborn, Diseases

KW - Perinatal Death/etiology

KW - Pregnancy

KW - Pregnancy, Twin

KW - Prospective Studies

KW - Retrospective Studies

KW - Stillbirth/epidemiology

KW - Twins

U2 - 10.1097/AOG.0000000000004789

DO - 10.1097/AOG.0000000000004789

M3 - Article

C2 - 35675615

SN - 0029-7844

VL - 139

SP - 1155

EP - 1167

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

IS - 6

ER -

Timing of Delivery for Twins With Growth Discordance and Growth Restriction: An Individual Participant Data Meta-analysis

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