Mackie Fiona L, Whittle Rebecca, Morris R Katie, Hyett Jon, Riley Richard D, Kilby Mark D
1Centre for Women's and Newborn Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT UK.
2Fetal Medicine Department, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG UK.
Diagn Progn Res. 2019 May 9;3:9. doi: 10.1186/s41512-019-0054-9. eCollection 2019.
Monochorionic twin pregnancies are at high risk of adverse outcomes, but it is not possible to predict which pregnancies will develop complications. The aim of the study was to evaluate, in monochorionic twin pregnancies, whether first-trimester ultrasound (nuchal translucency [NT], crown-rump length [CRL]), and maternal serum biomarkers (alpha-fetoprotein [AFP], soluble fms-like tyrosine kinase-1 [sFlt-1] and placental growth factor [PlGF]), are prognostic factors for fetal adverse outcome composite, twin-twin transfusion syndrome (TTTS), growth restriction, and intrauterine fetal death (IUFD).
A cohort study of 177 monochorionic diamniotic twin pregnancies. Independent prognostic ability of each factor was assessed by multivariable logistic regression, adjusting for standard prognostic factors. Factors were analysed as continuous data; thus, the reported ORs relate to either 1% change in NT or CRL inter-twin percentage discordance or one unit of measure in each serum biomarker.
The odds of the fetal adverse outcome composite were significantly associated with increased NT inter-twin percentage discordance (adjusted OR 1.03 [95% CI 1.01, 1.06]) and CRL inter-twin percentage discordance (adjusted OR 1.17 [95% CI 1.07, 1.29]). TTTS was significantly associated with increased NT discordance (adjusted OR 1.06 [95% CI 1.03, 1.10]) and decreased PlGF (adjusted OR 0.42 [95% CI 0.19, 0.93]). Antenatal growth restriction was significantly associated with increased CRL discordance (adjusted OR 1.20 [95% CI 1.08, 1.34]). Single and double IUFD were associated with decreased PlGF (adjusted OR 0.34 [95% CI 0.12, 0.98]) and (adjusted OR 0.18 [95%CI 0.05, 0.58]) respectively.
This study has identified potential individual prognostic factors in the first trimester (fetal biometric and maternal serum biomarkers) that show promise but require further robust evaluation in a larger, prospective series of MC twin pregnancies, so that their usefulness both individually and in combination can be defined.
ISRCTN 13114861 (retrospectively registered).
单绒毛膜双胎妊娠发生不良结局的风险很高，但无法预测哪些妊娠会出现并发症。本研究的目的是评估在单绒毛膜双胎妊娠中，孕早期超声检查（颈项透明层厚度[NT]、头臀长[CRL]）以及母体血清生物标志物（甲胎蛋白[AFP]、可溶性fms样酪氨酸激酶-1[sFlt-1]和胎盘生长因子[PlGF]）是否为胎儿不良结局综合指标、双胎输血综合征（TTTS）、生长受限和胎儿宫内死亡（IUFD）的预后因素。
对177例单绒毛膜双羊膜囊双胎妊娠进行队列研究。通过多变量逻辑回归评估每个因素的独立预后能力，并对标准预后因素进行校正。各因素作为连续数据进行分析；因此，报告的比值比（OR）与NT或CRL双胎间百分比差异每变化1%或每种血清生物标志物每变化一个测量单位相关。
胎儿不良结局综合指标的比值比与NT双胎间百分比差异增加（校正后OR 1.03[95%可信区间1.01,1.06]）和CRL双胎间百分比差异增加（校正后OR 1.17[95%可信区间1.07,1.29]）显著相关。TTTS与NT差异增加（校正后OR 1.06[95%可信区间1.03,1.10]）和PlGF降低（校正后OR 0.42[95%可信区间0.19,0.93]）显著相关。产前生长受限与CRL差异增加（校正后OR 1.20[95%可信区间1.08,1.34]）显著相关。单胎和双胎IUFD分别与PlGF降低（校正后OR 0.34[95%可信区间0.12,0.98]）和（校正后OR 0.18[95%可信区间0.05,0.58]）相关。
本研究确定了孕早期潜在的个体预后因素（胎儿生物测量指标和母体血清生物标志物），这些因素显示出一定前景，但需要在更大规模的前瞻性单绒毛膜双胎妊娠系列研究中进行进一步有力评估，以便确定其单独及联合应用的有效性。
ISRCTN 13114861（回顾性注册）
