Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK.
NHS Greater Glasgow and Clyde, Glasgow, UK.
Ultrasound Obstet Gynecol. 2024 Feb;63(2):189-197. doi: 10.1002/uog.27448. Epub 2024 Jan 12.
Twin pregnancy is associated with increased perinatal mortality and morbidity, but long-term neurodevelopmental outcome remains underinvestigated. The primary objective of this study was to investigate the incidence of adverse neurodevelopment after 1 year of age in complicated monochorionic diamniotic (MCDA) twin pregnancies compared with uncomplicated twin pregnancies.
This was a prospective cohort study conducted at St George's University Hospital NHS Foundation Trust, London, UK. Women with a twin pregnancy culminating in at least one surviving child, aged between 12 and 60 months (corrected for prematurity) at the time of assessment, were invited to complete the relevant Ages and Stages Questionnaire® version 3 (ASQ-3) test. The two study groups were: (1) complicated MCDA twin pregnancies, including those with twin-twin transfusion syndrome, twin anemia-polycythemia sequence, selective fetal growth restriction, twin reversed arterial perfusion sequence and/or single intrauterine demise; and (2) uncomplicated MCDA and dichorionic diamniotic twin pregnancies. The primary outcome measure was an abnormal ASQ-3 score, defined as a score of more than 2 SD below the mean in any one of the five domains. Mixed-effects multivariable logistic regression analysis was performed to determine whether a complicated MCDA twin pregnancy was associated independently with an abnormal ASQ-3 score.
The study included 174 parents who completed the questionnaire for one or both twins; therefore, 327 ASQ-3 questionnaires were available for analysis. Of those, 117 (35.8%) were complicated MCDA twin pregnancies and 210 (64.2%) were controls. The overall rate of an abnormal ASQ-3 score in children born of a complicated MCDA twin pregnancy was nearly double that of those from uncomplicated twin pregnancies (14.5% vs 7.6%; P = 0.056). Children born of a complicated MCDA twin pregnancy had a significantly higher rate of impairment in the gross-motor domain compared with the control group (8.5% vs 2.9%; P = 0.031). Complicated MCDA twin pregnancies that underwent prenatal intervention had a significantly higher rate of abnormal ASQ-3 score compared with those that did not undergo prenatal intervention (28.1% vs 1.7%; P < 0.001). On multilevel logistic regression analysis, complicated MCDA twin pregnancy was an independent predictor of abnormal ASQ-3 score (adjusted odds ratio, 3.28 (95% CI, 3.27-3.29); P < 0.001).
This study demonstrates that survivors of complicated MCDA twin pregnancies have a higher rate of adverse neurodevelopmental outcome, independently of prematurity. Long-term neurodevelopmental follow-up in these pregnancies can ensure timely and optimal management of those affected. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
双胞胎妊娠与围产儿死亡率和发病率增加有关，但长期神经发育结局仍未得到充分研究。本研究的主要目的是调查复杂的单绒毛膜双羊膜（MCDA）双胎妊娠与非复杂双胎妊娠相比，1 年后不良神经发育的发生率。
这是一项在英国伦敦圣乔治大学医院 NHS 基金会信托基金进行的前瞻性队列研究。邀请妊娠结局至少有一名存活儿童的 MCDA 双胎妊娠女性完成相关的年龄与阶段问卷®第 3 版（ASQ-3）测试。两组研究对象为：（1）复杂的 MCDA 双胎妊娠，包括双胎输血综合征、双胎贫血-红细胞增多序列、选择性胎儿生长受限、双胎反向动脉灌注序列和/或宫内单一胎儿死亡；（2）非复杂的 MCDA 和双绒毛膜双羊膜双胎妊娠。主要结局测量指标是 ASQ-3 评分异常，定义为任何一个五个领域的评分低于平均值 2 个标准差以上。采用混合效应多变量逻辑回归分析来确定复杂的 MCDA 双胎妊娠是否与 ASQ-3 评分异常独立相关。
本研究纳入了 174 名完成了一份或两份双胞胎问卷的家长；因此，共有 327 份 ASQ-3 问卷可用于分析。其中，117 例（35.8%）为复杂的 MCDA 双胎妊娠，210 例（64.2%）为对照组。与非复杂双胎妊娠相比，复杂的 MCDA 双胎妊娠的儿童中，ASQ-3 评分异常的发生率几乎翻了一番（14.5% vs 7.6%；P=0.056）。与对照组相比，复杂的 MCDA 双胎妊娠儿童在粗大运动领域的损害率显著更高（8.5% vs 2.9%；P=0.031）。接受产前干预的复杂 MCDA 双胎妊娠与未接受产前干预的复杂 MCDA 双胎妊娠相比，ASQ-3 评分异常的发生率显著更高（28.1% vs 1.7%；P<0.001）。在多水平逻辑回归分析中，复杂的 MCDA 双胎妊娠是 ASQ-3 评分异常的独立预测因素（调整后的优势比，3.28（95%CI，3.27-3.29）；P<0.001）。
本研究表明，复杂的 MCDA 双胎妊娠幸存者的神经发育不良结局发生率更高，与早产无关。对这些妊娠进行长期神经发育随访可以确保及时和最佳的管理。© 2023 作者。《超声医学》由约翰威立父子出版公司出版，代表国际妇产科超声学会。
