The relationship between major anomalies and chorionicity in twin pregnancies referred for first trimester and second trimester detailed anatomic ultrasonography
Abstract
Objectives: The purpose of this study is to validate the relationship between chorionicity and congenital anomalies.
Material and methods: A retrospective analysis twin pregnancies that underwent ultrasonographic fetal anatomy screening in the first or second trimester was conducted. Analyzed variables were, gestational age, chorionicity, presence of major fetal structural anomalies, number of affected fetuses, anomaly type, and use of assisted reproductive techniques (ART).
Results: Of the 824 twin pregnancies included in the study, 116 (14%) had major fetal anomalies. The frequency of major fetal structural anomalies was higher in monochorionic (MC) twin pregnancies compared to dichorionic (DC) twin pregnancies (p < 0.001). When anomalies were categorized into cardiac, central nervous system, and other system anomalies, no significant correlation was found between chorionicity and anomaly groups (p = 0.794).
Conclusions: In MC twin pregnancies, major fetal structural abnormalities are more prevalent. Prioritizing the evaluation of chorionicity is essential due to the increased risk associated with twin pregnancies.
Keywords: pregnancytwinfetal anomaliesfetal ultrasonography
References
- Osterman MJK, Hamilton BE, Martin JA, et al. Births: Final Data for 2021. Natl Vital Stat Rep. 2023; 72(1): 1–53.
- Wang Y, Shi H, Chen L, et al. Absolute risk of adverse obstetric outcomes among twin pregnancies after in vitro fertilization by maternal age. JAMA Netw Open. 2021; 4(9): e2123634.
- Glinianaia SV, Rankin J, Wright C. Congenital anomalies in twins: a register-based study. Hum Reprod. 2008; 23(6): 1306–1311.
- Ting Y, Ting Z, Fei Z, et al. Prenatal diagnosis of structural anomaly among singletons and twins: eight-year experience in a chinese tertiary center. J Ultrasound Med. 2023; 42(1): 185–192.
- AlRais F, Feldstein VA, Srivastava D, et al. Monochorionic twins discordant for congenital heart disease: a referral center's experience and possible pathophysiologic mechanisms. Prenat Diagn. 2011; 31(10): 978–984.
- Rustico MA, Baietti MG, Coviello D, et al. Managing twins discordant for fetal anomaly. Prenat Diagn. 2005; 25(9): 766–771.
- Salomon LJ, Alfirevic Z, Berghella V, et al. ISUOG Clinical Standards Committee. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2011; 37(1): 116–126.
- Salomon LJ, Alfirevic Z, Bilardo CM, et al. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2013; 41(1): 102–113.
- Ferraz Liz C, Domingues S, Guedes A, et al. The impact of chorionicity and assisted reproductive therapies in obstetric and neonatal outcomes. J Matern Fetal Neonatal Med. 2022; 35(8): 1439–1444.
- Boyle B, McConkey R, Garne E, et al. Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984-2007. BJOG. 2013; 120(6): 707–716.
- Gringras P, Chen W. Mechanisms for differences in monozygous twins. Early Hum Dev. 2001; 64(2): 105–117.
- Haque FN, Gottesman II, Wong AHC. Not really identical: epigenetic differences in monozygotic twins and implications for twin studies in psychiatry. Am J Med Genet C Semin Med Genet. 2009; 151C(2): 136–141.
- Bahtiyar MO, Dulay AT, Weeks BP, et al. Prevalence of congenital heart defects in monochorionic/diamniotic twin gestations: a systematic literature review. J Ultrasound Med. 2007; 26(11): 1491–1498.
- Balasubramanian R, Vuppalapati S, Avanthika C, et al. Epidemiology, Genetics and Epigenetics of Congenital Heart Diseases in Twins. Cureus. 2021; 13(8): e17253.
- Springer S, Mlczoch E, Krampl-Bettelheim E, et al. Congenital heart disease in monochorionic twins with and without twin-to-twin transfusion syndrome. Prenat Diagn. 2014; 34(10): 994–999.
- Peng R, Zhou Y, Xie HN, et al. MCDA twins with discordant malformations: submicroscopic chromosomal anomalies detected by chromosomal microarray analysis and clinical outcomes. Prenat Diagn. 2016; 36(8): 766–774.
- Homatter C, Robillard PY, Omarjee A, et al. Discordant malformations in monochorionic twins: a retrospective cohort study in La Reunion Island. J Matern Fetal Neonatal Med. 2020; 33(24): 4069–4075.
- Zaganjor I, Sekkarie A, Tsang BL, et al. Describing the prevalence of neural tube defects worldwide: a systematic literature review. PLoS One. 2016; 11(4): e0151586.
- Windham GC, Sever LE. Neural tube defects among twin births. Am J Hum Genet. 1982; 34(6): 988–998.
- Mastroiacovo P, Castilla EE, Arpino C, et al. Congenital malformations in twins: an international study. Am J Med Genet. 1999; 83(2): 117–124, doi: 10.1002/(sici)1096-8628(19990312)83:2<117::aid-ajmg7>3.0.co;2-4.
- Corroenne R, Al Ibrahim A, Stirnemann J, et al. Management of monochorionic twins discordant for structural fetal anomalies. Prenat Diagn. 2020; 40(11): 1375–1382.
- Fernandes TR, Carvalho PRN, Flosi FB, et al. Perinatal outcome of discordant anomalous twins: a single-center experience in a developing country. Twin Res Hum Genet. 2016; 19(4): 389–392.
- Lu Y, Liu L, Zhang P, et al. Risk of birth defects in children conceived with assisted reproductive technology: A meta-analysis. Medicine (Baltimore). 2022; 101(52): e32405.
- Hansen M, Kurinczuk JJ, Milne E, et al. Assisted reproductive technology and birth defects: a systematic review and meta-analysis. Hum Reprod Update. 2013; 19(4): 330–353.
- Tandulwadkar S, Lodha P, Kharb V. Congenital malformations and assisted reproductive technique: Where is assisted reproductive technique taking us? J Hum Reprod Sci. 2012; 5(3): 244–247.
- Yang M, Fan XB, Wu JN, et al. Association of assisted reproductive technology and multiple pregnancies with the risks of birth defects and stillbirth: A retrospective cohort study. Sci Rep. 2018; 8(1): 8296.
