The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward
Presented as an oral communication at the 29th Annual Scientific Meeting of the Society for Maternal–Fetal Medicine, San Diego, CA, Jan. 26-31, 2009.
Received 25 November 2008; received in revised form 15 January 2009; accepted 23 January 2009.
Objectives
We sought to document the pregnancy and neurodevelopmental outcome in monochorionic diamniotic twin pregnancies and to identify risk factors for death and impairment.
Study Design
We conducted a prospective cohort study of 136 monochorionic twins followed up from the first trimester until infancy.
Results
A total of 122 (90%) pregnancies resulted in 2 survivors, 6 (4%) in 1 survivor and 8 (6%) in no survivor. In all, 230 (92%) of 250 surviving infants were assessed at a mean age of 24 months. Neurodevelopmental impairment was present in 22 (10%) infants. Death or impairment of 1 or both infants occurred in 28 (22%) of 126 pregnancies. Twin-to-twin transfusion syndrome and assisted conception increased the risk of both death and impairment, whereas early-onset discordant growth only increased the risk of death.
Conclusion
The mortality in this prospective series was 8% and neurodevelopmental impairment occurred in 10% of infants.
aDepartment of Pediatrics, University Hospitals, Leuven, Belgium
bDepartment of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium
cDepartment of Pediatrics, Leiden University Medical Centre, Leiden, the Netherlands
dDepartment of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, the Netherlands
eDepartment of Obstetrics and Gynecology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
Reprints not available from the authors.
Dr L. Lewi is the recipient of a Grant of the 5th Framework Program of the European Commission (#QLG1-CT-2002-01632 EuroTwin2Twin). Dr Deprest is the recipient of a Fundamental Clinical Researcher Grant of the Fonds Wetenschappelijk Onderzoek (FWO)-(1.8.012.07.N.02).
Cite this article as: Ortibus E, Lopriore E, Deprest J, et al. The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward. Am J Obstet Gynecol 2009;200:494.e1-494.e8.
ABSTRACT
The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward