A cohort study of fetal growth in twin pregnancies by chorionicity: comparison with European and American standards

Savirón-Cornudella, R. ; Esteban, L.M. ; Aznar-Gimeno, R. ; Pérez-López, F.R. ; Chóliz Ezquerro, M. ; Dieste Pérez, P. (Universidad de Zaragoza) ; Campillos Maza, J.M. (Universidad de Zaragoza) ; Sanz, G. (Universidad de Zaragoza) ; Castan Larraz, B. ; Tajada-Duaso, M. (Universidad de Zaragoza)

Resumen: Objective:To develop fetal growth standards for twin gestations by placental chorionicity in a Spanish population and compare them with European and American standards to estimate the suitability of their use in clinical practice. Study design: This was a retrospective cohort study of 518 twin pregnancies, 435 dichorionic-diamniotic and 83 monochorionic-diamniotic, performed between January 2012 and December 2017. A total of 4,783 and 1,455 estimated fetal weights were considered from the 17 th to the 37 th week of gestation, using multilevel models, to build dichorionic-diamniotic and monochorionic-diamniotic standards, respectively. The percentages of small and large for gestational age were calculated as a model adjustment measure and adjustment to the studied data and the values provided by our model were compared against those of six European and American twin standards and three singleton standards. Correlation analyses between percentile predictions were performed using Cohen kappa coefficient. The predictive ability to detect small for gestational age was also provided by the sensitivity and positive predictive value. Results: We found slight differences between standards by chorionicity, being dichorionic-diamniotic percentiles slightly higher than monochorionic-diamniotic ones from the 17 th to 37 th weeks’ gestation. For dichorionic-diamniotic cases, both our standard (9.8-8.2) and that of Grantz (8.2-10.5) showed good adjustments for the 10 th and 90 th percentiles while the other compared standards underestimated or overestimated them. For monochorionic-diamniotic cases, both our standard (10.2-8.5) and that of Shivkumar (11.4-6.8) had the most suitable adjustment. The correlation analysis between small and large for gestational age cases provided by standards, showed clear differences among them. Kappa’s coefficient showed a substantial agreement between both Ananth (0.7) and Stirrup (0.69) dichorionic-diamniotic cases and our standard. There was also a substantial agreement between the Shivkumar (0.77) standard and our results for monochorionic-diamniotic cases. The correlation was moderate for all other comparisons. Conclusions: Our model showed a good adjustment to the studied population. There are clear differences among small and large for gestational age cases provided by twin standards in our studied population. The twin growth standards depend on the population characteristics and model structure. We found the use of singleton standards for twin pregnancies inadequate.

Idioma: Inglés

DOI: 10.1016/j.ejogrb.2020.08.044

Año: 2020

Publicado en: European Journal of Obstetrics and Gynecology and Reproductive Biology 253 (2020), 238-248
ISSN: 0301-2115

Factor impacto JCR: 2.435 (2020)

Categ. JCR: REPRODUCTIVE BIOLOGY rank: 22 / 30 = 0.733 (2020) - Q3 - T3
Categ. JCR: OBSTETRICS & GYNECOLOGY rank: 49 / 83 = 0.59 (2020) - Q3 - T2

Factor impacto SCIMAGO: 0.841 - Reproductive Medicine (Q2) - Obstetrics and Gynecology (Q2)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Área Estadís. Investig. Opera. (Dpto. Métodos Estadísticos)
Área (Departamento): Área Obstetricia y Ginecología (Dpto. Cirugía)