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Article

Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

by 1,2,3,†, 1,2,†, 1,2,3, 1,3 and 1,2,3,*
1
Twins Trust Centre for Research and Clinical Excellence, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0RE, UK
2
Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
3
Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0RE, UK
*
Author to whom correspondence should be addressed.
Shared first authorship.
Academic Editor: Erich Cosmi
J. Clin. Med. 2021, 10(4), 643; https://doi.org/10.3390/jcm10040643
Received: 1 January 2021 / Revised: 31 January 2021 / Accepted: 5 February 2021 / Published: 8 February 2021
(This article belongs to the Special Issue Improving Perinatal Outcomes in Twin and Multiple Pregnancy)
Twin pregnancies are commonly assessed using singleton growth and birth weight reference charts. This practice has led to a significant number of twins labelled as small for gestational age (SGA), causing unnecessary interventions and increased risk of iatrogenic preterm birth. However, the use of twin-specific charts remains controversial. This study aims to assess whether twin-specific estimated fetal weight (EFW) and birth weight (BW) charts are more predictive of adverse outcomes compared to singleton charts. Centiles of EFW and BW were calculated using previously published singleton and twin charts. Categorical data were compared using Chi-square or McNemar tests. The study included 1740 twin pregnancies, with the following perinatal adverse outcomes recorded: perinatal death, preterm birth <34 weeks, hypertensive disorders of pregnancy (HDP) and admissions to the neonatal unit (NNU). Twin-specific charts identified prenatally and postnatally a smaller proportion of infants as SGA compared to singleton charts. However, twin charts showed a higher percentage of adverse neonatal outcomes in SGA infants than singleton charts. For example, perinatal death (SGA 7.2% vs. appropriate for gestational age (AGA) 2%, p < 0.0001), preterm birth <34 weeks (SGA 42.1% vs. AGA 16.4%, p < 0.0001), HDP (SGA 21.2% vs. AGA 13.5%, p = 0.015) and NNU admissions (SGA 69% vs. AGA 24%, p < 0.0001), when compared to singleton charts (perinatal death: SGA 2% vs. AGA 1%, p = 0.029), preterm birth <34 weeks: (SGA 20.6% vs. AGA 17.4%, p = 0.020), NNU admission: (SGA 34.5% vs. AGA 23.9%, p < 0.000). There was no significant association between HDP and SGA using the singleton charts (p = 0.696). In SGA infants, according to the twin charts, the incidence of abnormal umbilical artery Doppler was significantly more common than in SGA using the singleton chart (27.0% vs. 8.1%, p < 0.001). In conclusion, singleton charts misclassify a large number of twins as at risk of fetal growth restriction. The evidence suggests that the following twin-specific charts could reduce unnecessary medical interventions prenatally and postnatally. View Full-Text
Keywords: twin pregnancy; singleton; estimated fetal weight; birth weight; small for gestational age; fetal growth restriction; chorionicity-specific; reference charts; ultrasound twin pregnancy; singleton; estimated fetal weight; birth weight; small for gestational age; fetal growth restriction; chorionicity-specific; reference charts; ultrasound
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MDPI and ACS Style

Giorgione, V.; Briffa, C.; Di Fabrizio, C.; Bhate, R.; Khalil, A. Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts. J. Clin. Med. 2021, 10, 643. https://doi.org/10.3390/jcm10040643

AMA Style

Giorgione V, Briffa C, Di Fabrizio C, Bhate R, Khalil A. Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts. Journal of Clinical Medicine. 2021; 10(4):643. https://doi.org/10.3390/jcm10040643

Chicago/Turabian Style

Giorgione, Veronica, Corey Briffa, Carolina Di Fabrizio, Rohan Bhate, and Asma Khalil. 2021. "Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts" Journal of Clinical Medicine 10, no. 4: 643. https://doi.org/10.3390/jcm10040643

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