Abstract:
BACKGROUND:Although intertwin size difference is an important measure of fetal growth, the appropriate cut point to define discordance is unclear. Few studies have assessed intertwin differences in estimated fetal weight longitudinally or in relation to size differences at birth. OBJECTIVES:The objectives of the study were to estimate the magnitude of percentage differences in estimated fetal weight across gestation in dichorionic twins in relation to a fixed discordance cut point and compare classification of aberrant fetal growth by different measures (estimated fetal weight differences, birthweight discordance, small for gestational age). STUDY DESIGN:Women aged 18-45 years from 8 US centers with dichorionic twin pregnancies at 8 weeks 0 days to 13 weeks 6 days gestation planning to deliver in participating hospitals were recruited into the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Dichorionic Twins study and followed through delivery (n = 140; 2012-2013). Ultrasounds were conducted at 6 targeted study visits to obtain fetal biometrics and calculate estimated fetal weight. Percent estimated fetal weight and birthweight differences were calculated: ([weightlarger - weightsmaller]/weightlarger)*100; discordance was defined as ≥18% for illustration. Birth sizes for gestational age (both, 1, or neither small for gestational age) were determined; twins were categorized into combined birthweight plus small for gestational age groups: birthweight discordance ≥18% (yes, no) with both, 1, or neither small for gestational age. Linear mixed-models estimated percentiles of estimated fetal weight percent differences across gestation and compared estimated fetal weight differences between combined birthweight discordance and small for gestational age groups. A Fisher exact test compared birthweight discordance and small for gestational age classifications. RESULTS:Median estimated fetal weight percentage difference increased across gestation (5.9% at 15.0, 8.4% at 38.0 weeks), with greater disparities at higher percentiles (eg, 90th percentile: 15.6% at 15.0, 26.3% at 38.0 weeks). As gestation advanced, an increasing percentage of pregnancies were classified as discordant using a fixed cut point: 10% at 27.0, 15% at 34.0, and 20% at 38.0 weeks. Birthweight discordance and small for gestational age classifications differed (P = .002); for birthweight discordance ≥18% vs <18%: 44% vs 71% had neither small for gestational age; 56% vs 18% had 1 small for gestational age; no cases (0%) vs 11% had both small for gestational age, respectively. Estimated fetal weight percent difference varied across gestation by birthweight discordance plus small for gestational age classification (P = .040). Estimated fetal weight percentage difference increased with birthweight discordance ≥18% (neither small for gestational age: 0.46%/week [95% confidence interval, 0.08-0.84]; 1 small for gestational age: 0.57%/week [95% confidence interval, 0.25-0.90]) but less so without birthweight discordance (neither small for gestational age: 0.17%/week [95% confidence interval, 0.06-0.28]; 1 small for gestational age: 0.03%/week [95% confidence interval, -0.17 to 0.24]); both small for gestational age: 0.10%/week [95% confidence interval, -0.15 to 0.36]). CONCLUSION:The percentage of dichorionic pregnancies exceeding a fixed discordance cut point increased over gestation. A fixed cut point for defining twin discordance would identify an increasing percentage of twins as discordant as gestation advances. Small for gestational age and percentage weight differences assess distinct aspects of dichorionic twin growth. A percentile cut point may be more clinically useful for defining discordance, although further study is required to assess whether any specific percentile cut point correlates to adverse outcomes.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Amyx MM,Albert PS,Bever AM,Hinkle SN,Owen J,Grobman WA,Newman RB,Chien EK,Gore-Langton RE,Buck Louis GM,Grantz KLdoi
10.1016/j.ajog.2019.08.027subject
Has Abstractpub_date
2020-02-01 00:00:00pages
174.e1-174.e10issue
2eissn
0002-9378issn
1097-6868pii
S0002-9378(19)31029-4journal_volume
222pub_type
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90649-2
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abstract:OBJECTIVE:The objective of the study was to determine whether the epidemiology of low-grade ovarian serous cancers is distinct from that of high-grade ovarian serous cancers. STUDY DESIGN:The National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program reports incidence, and survival, data from...
journal_title:American journal of obstetrics and gynecology
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doi:10.1016/j.ajog.2008.01.035
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abstract:INTRODUCTION:The purpose of this study was to compare transobturator tape (MONARC) with tension-free vaginal tape in patients with borderline low maximum urethral closure pressure. STUDY DESIGN:Historical cohort analysis of 3-month outcomes in 145 subjects (MONARC = 85; tension-free vaginal tape = 60). A cut-off point...
journal_title:American journal of obstetrics and gynecology
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doi:10.1016/j.ajog.2006.07.011
更新日期:2006-12-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine whether the presence of prolactin in cervicovaginal washings is associated with preterm birth. STUDY DESIGN:A cohort of 80 patients underwent a washing of the ectocervix and vaginal fornices with a normal saline solution. The cohort consisted of two groups: 40 inpatients requirin...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
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更新日期:1994-10-01 00:00:00
abstract:OBJECTIVES:This study aimed to determine whether administration of lamivudine to pregnant women with chronic hepatitis B in the third trimester is a cost-effective strategy in preventing perinatal transmission. STUDY DESIGN:We developed a decision analysis model to compare the cost-effectiveness of 2 management strate...
journal_title:American journal of obstetrics and gynecology
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doi:10.1016/j.ajog.2012.06.001
更新日期:2012-09-01 00:00:00
abstract::We examined the effect of sustained hypoxemia with progressive acidemia on pituitary-adrenal endocrine function (adrenocorticotropic hormone, cortisol) and on adrenal blood flow in fetal sheep. Hypoxemia was induced by the maternal sheep breathing a gas mixture containing 9% oxygen, with 3% carbon dioxide added. Induc...
journal_title:American journal of obstetrics and gynecology
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journal_title:American journal of obstetrics and gynecology
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journal_title:American journal of obstetrics and gynecology
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abstract::Serum gonadotropin, estrogen, and androgen levels were measured in samples obtained from 19 patients with polycystic ovarian disease (PCO) and from 10 normal women on day 2 to 4 of their menstrual cycles. In patients with PCO, the mean (plus or minus S.E.) concentration was significantly higher (P smaller than 0.001) ...
journal_title:American journal of obstetrics and gynecology
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journal_title:American journal of obstetrics and gynecology
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doi:10.1016/j.ajog.2017.01.013
更新日期:2017-04-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
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doi:10.1016/j.ajog.2005.02.085
更新日期:2005-10-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
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journal_title:American journal of obstetrics and gynecology
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journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2005-05-01 00:00:00
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更新日期:1999-08-01 00:00:00