Background
Twin gestations are at significantly higher risk of fetal growth restriction in comparison
with singletons. Using fetal biometric charts customized for obstetrical and parental
characteristics may facilitate an accurate assessment of fetal growth.
Objective
The objective of the study was to construct reference charts for the gestation of
fetal biometric parameters stratified by chorionicity and customized for obstetrical
and parental characteristics.
Study Design
Fetal biometric measurements obtained from serial ultrasound examinations in uncomplicated
twin pregnancies delivering after 36 weeks of gestation were collected by 19 Italian
fetal medicine units under the auspices of the Società Italiana di Ecografia Ostetrica
e Ginecologica. The measurements acquired in each fetus at each examination included
biparietal diameter, head circumference, abdominal circumference, and femur length.
Multilevel linear regression models were used to adjust for the serial ultrasonographic
measurements obtained and the clustering of each fetus in twin pregnancy. The impact
of maternal and paternal characteristics (height, weight, ethnicity), parity, fetal
sex, and mode of conception was also considered. Models for each parameter were stratified
by fetal chorionicity and compared with our previously constructed growth curves for
singletons.
Results
The data set included 1781 twin pregnancies (dichorionic, n = 1289; monochorionic
diamniotic, n = 492) with 8923 ultrasonographic examinations with a median of 5 (range,
2–8) observations per pregnancy in dichorionic and 6 in (range, 2–11) monochorionic
pregnancies. Growth curves of twin pregnancies differed from those of singletons,
and differences were more marked in monochorionic twins and during the third trimester.
A significant influence of parental characteristics was found.
Conclusion
Curves of fetal biometric measurements in twins are influenced by parental characteristics.
There is a reduction in the growth rate during the third trimester. The reference
limits for gestation constructed in this study may provide a useful tool for a more
accurate assessment of fetal growth in twin pregnancies.
Key words
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Article Info
Publication History
Published online: January 05, 2017
Accepted:
December 29,
2016
Received in revised form:
December 14,
2016
Received:
September 9,
2016
Footnotes
The authors report no conflict of interest.
Cite this article as: Ghi T, Prefumo F, Fichera A, et al. Development of customized fetal growth charts in twins. Am J Obstet Gynecol 2017;216:514.e1-17.
Identification
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