Twin-Specific Intrauterine ‘Growth’ Charts Based on Cross-Sectional Birthweight Data

Abstract The assessment of fetal growth is an essential component of good antenatal care, especially for twins. The aims of this study are to develop twin-specific intrauterine 'growth' charts, based on cross-sectional birthweight data, for monochorionic and dichorionic twins according to sex and parity, and to detect twins at risk for neonatal death by comparing the use of twin-specific and singleton charts. The study sample consisted of 76,471 singletons and 8454 twins (4227 pairs) born in East Flanders (Belgium). Birthweights were analyzed using a nonlinear Gaussian regression. After 33 weeks of gestation, the birthweights of twins started to deviate from singletons (difference of 900 grams at 42 weeks). Birthweights of dichorionic twins continued to increase, whereas those of monochorionic twins decreased after week 40 (difference of more than 300 g at 42 weeks). After 31 weeks of gestation, neonatal mortality increased as centile decreased, and was especially high if birthweight was below the twin-specific third centile: .032 (below) versus .007 (above). Using singleton centiles, this was less obvious. In conclusion, twin-specific growth charts, taking chorionicity into account, are more accurate to detect twins at risk for neonatal death. Therefore the presented charts, based on cross-sectional birthweight data, enable an improved assessment of twin growth.

[1]  R. Loos,et al.  Twin Birth Weight Standards , 2007, Neonatology.

[2]  R. Loos,et al.  Curves of placental weights of live-born twins. , 2006, Twin research and human genetics : the official journal of the International Society for Twin Studies.

[3]  S. Wen,et al.  Neonatal mortality and morbidity rates in term twins with advancing gestational age. , 2006, American journal of obstetrics and gynecology.

[4]  S. Vansteelandt,et al.  Preterm birth in twins after subfertility treatment: population based cohort study , 2005, BMJ : British Medical Journal.

[5]  J. Gardosi.  Fetal growth: towards an international standard , 2005, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[6]  L. Keith,et al.  Multiple Pregnancy : Epidemiology, Gestation, and Perinatal Outcome , 2005 .

[7]  R. Loos,et al.  Determinants of birthweight and intrauterine growth in liveborn twins. , 2005, Paediatric and perinatal epidemiology.

[8]  J. Gardosi,et al.  Prematurity and fetal growth restriction. , 2005, Early human development.

[9]  P. Crosignani.  ESHRE Capri Workshop Group , 2004 .

[10]  L. Keith,et al.  Neonatal mortality rates among growth-discordant twins, classified according to the birth weight of the smaller twin. , 2004, American journal of obstetrics and gynecology.

[11]  E. Blair,et al.  Predicted Birthweight for Singletons and Twins , 2002, Twin Research.

[12]  I. Blickstein.  Normal and abnormal growth of multiples. , 2002, Seminars in neonatology : SN.

[13]  R. Vlietinck,et al.  Birthweight in liveborn twins: the influence of the umbilical cord insertion and fusion of placentas , 2001, BJOG : an international journal of obstetrics and gynaecology.

[14]  P. Howie,et al.  Interval Between Fetal Measurements in Predicting Growth Restriction , 2001, Obstetrics and gynecology.

[15]  James K. Lindsey,et al.  Nonlinear models in medical statistics , 2001 .

[16]  A. Yajima,et al.  Growth Pattern of Twins of Different Chorionicity Evaluated by Sonographic Biometry , 2000, Obstetrics and gynecology.

[17]  B. Luke,et al.  Birth weight references for twins. , 2000, American journal of obstetrics and gynecology.

[18]  P. Crosignani,et al.  Optimal use of infertility diagnostic tests and treatments. The ESHRE Capri Workshop Group. , 2000, Human reproduction.

[19]  Luca Gianaroli,et al.  Multiple gestation pregnancy , 2000 .

[20]  R. Loos,et al.  The East Flanders Prospective Twin Survey (Belgium): a population-based registe , 1998, Twin Research.

[21]  J. Martin,et al.  What are the fetal growth patterns of singletons, twins, and triplets in the United States? , 1998, Clinical obstetrics and gynecology.

[22]  Ross Ihaka,et al.  Gentleman R: R: A language for data analysis and graphics , 1996 .

[23]  T. Eskes.  Multiple pregnancy. Epidemiology, gestation and perinatal outcome , 1996 .

[24]  J. Gardosi,et al.  Longitudinal study of fetal growth in subgroups of a low‐risk population , 1995, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[25]  J. Gardosi,et al.  An adjustable fetal weight standard , 1995, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[26]  B. Luke,et al.  The ideal twin pregnancy: patterns of weight gain, discordancy, and length of gestation. , 1993, American journal of obstetrics and gynecology.

[27]  M. Fowler,et al.  Comparison of infant mortality among twins and singletons: United States 1960 and 1983. , 1991, American journal of epidemiology.

[28]  B. Luke,et al.  Gestational age-specific birthweights of twins versus singletons. , 1991, Acta geneticae medicae et gemellologiae.

[29]  P. Marynen,et al.  Rapid detection of hypervariable regions by the polymerase chain reaction technique. , 1990, DNA and cell biology.

[30]  F. P. Hadlock,et al.  Estimation of fetal weight with the use of head, body, and femur measurements--a prospective study. , 1985, American journal of obstetrics and gynecology.

[31]  H. Akaike,et al.  Information Theory and an Extension of the Maximum Likelihood Principle , 1973 .

[32]  L. Lubchenco,et al.  INTRAUTERINE GROWTH AS ESTIMATED FROM LIVEBORN BIRTH-WEIGHT DATA AT 24 TO 42 WEEKS OF GESTATION. , 1963, Pediatrics.

[33]  N. F. Walker.  Determination of the zygosity of twins. , 1957, Acta genetica et statistica medica.