Selective intrauterine growth restriction of monochorionic diamniotic twin pregnancies: what is the neonatal prognosis? - 31/12/21

Doi : 10.1016/j.jogoh.2021.102304

Letizia Gremillet ^1,^⁎, Antoine Netter ^1,^2,^⁎ , Barthélemy Tosello ^3,⁴, Claude D'Ercole ^1,⁵, Florence Bretelle ^1,⁶, Cécile Chau ¹
¹ Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France
² Aix Marseille Univ, Avignon University, CNRS, IRD, IMBE, Marseille, France
³ Department of Neonatal Medicine, North Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
⁴ CNRS, EFS, ADES, Aix-Marseille Univ, Marseille, France
⁵ EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, 13284, Marseille, France
⁶ Research Unit on Tropical and Emerging Infectious Diseases, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France

^⁎Corresponding author: Department of Gynecology, Obstetrics and Reproductive Medicine, AP-HM La Conception - Pôle femmes parents enfants, 147 bd Baille, Marseille 13005, France. Phone: 04 91 38 00 00Department of Gynecology, Obstetrics and Reproductive MedicineAP-HM La Conception - Pôle femmes parents enfants147 bd BailleMarseille13005France

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Abstract

Objective

This study compares the neonatal morbidity and mortality of the smallest twins of monochorionic diamniotic (MCDA) pregnancies complicated with selective intrauterine growth restriction (sIUGR) with newborns from singleton pregnancies with intrauterine growth restriction (IUGR).

Methods

We conducted a retrospective cohort study of patients managed at the prenatal diagnosis center in a single tertiary care hospital between 2012 and 2019. MCDA twin pregnancies complicated with sIUGR (sIUGR group) were compared with singleton pregnancies with IUGR (IUGR group). The primary outcome was the comparison in neonatal morbidity and mortality between the two groups.

Results

The analysis included 251 patients: 67 in the sIUGR group and 184 in the IUGR group. The two groups were comparable in gestational age and birth weight (p > 0.05). Multivariate analysis controlling for factors that may influence neonatal status showed no significant difference between the two groups in any of the neonatal morbidity criteria or the composite morbidity-mortality endpoint (adjusted OR = 0.946 [95% CI = 0.317 - 2.827]; p = 0.921).

Conclusion

Despite supposedly different pathophysiological mechanisms, neonates from MCDA pregnancies complicated with sIUGR and those from singleton pregnancies with IUGR appear to have identical neonatal morbidity and mortality.

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Keywords : Monochorionic twin pregnancies, intrauterine growth restriction, neonatal morbidity