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
N1 - Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
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 -