Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-28T12:41:42.589Z Has data issue: false hasContentIssue false
  • English
  • Français

Optimal delivery timing for dizygotic twins – the short- and long-term perspective

Published online by Cambridge University Press:  04 March 2020

Majdi Imterat Open the ORCID record for Majdi Imterat [Opens in a new window] ,
Tamar Wainstock ,
Eyal Sheiner ,
Ruslan Sergienko ,
Daniella Landau  and
Asnat Walfisch
Majdi Imterat*
Affiliation:
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Tamar Wainstock
Affiliation:
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Eyal Sheiner
Affiliation:
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Ruslan Sergienko
Affiliation:
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Daniella Landau
Affiliation:
Department of neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Asnat Walfisch
Affiliation:
Department of Obstetrics and Gynecology, Hadassah Mt, Scopus Medical Center, Jerusalem, Israel
*
Address for correspondence: Majdi Imterat, MD, Department of Obstetrics and Gynecology, Soroka University Medical Center, 151 Izak Rager Ave., Beer-Sheva84101, Israel. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Major obstetrics and gynecology societies offer inconsistent recommendation regarding optimal delivery timing in uncomplicated dizygotic twins. We sought to investigate the impact of delivery timing within term gestation, in dizygotic twins, on the short- and long-term offspring morbidity. A prospectively analyzed cohort of dizygotic twin deliveries was conducted. All women delivered at a regional tertiary medical center, at term (≥37 0/7), between the years 1991 and 2014, were included. The primary exposure was delivery at 37 0/7–37 + 6/7 weeks, while delivery at ≥38 0/7 weeks’ gestation was considered the reference. Neonatal short- and long-term outcomes according to hospitalizations of offspring up to 18 years of age due to cardiac, respiratory, hematological, neurological, and infectious morbidity were compared. Kaplan–Meier survival curves were used to compare cumulative incidences per each major-system hospitalization. Cox regression models were used to estimate the adjusted hazard ratios, while adjusting for variables with clinical importance. During the study period, 612 dizygotic twin deliveries met the inclusion criteria. Of them, 200 (31.3%) occurred at 37–37 6/7 weeks, and 412 (68.7%) occurred at ≥38 0/7 weeks’ gestation. In the long-term analysis, rates of hospitalizations involving several major morbidity categories exhibited comparable rates in both groups. The Cox regression models did not demonstrate an independent association between gestational age within term and later major pediatric morbidity in offspring (total long-term morbidity: adjusted hazard ratio 1.33, 95% confidence interval 0.77–2.29). Dizygotic twin deliveries occurring at different gestational ages within term do not appear to significantly impact on major short- and long-term outcomes.

Keywords

Outcomemultiple gestationpregnancypediatric morbiditychildhood
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 12 , Issue 1 , February 2021 , pp. 88 - 93
Check for updates
Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alrahmani, L, Abdelsattar, ZM, Adekola, H, Gonik, B, Awonuga, A. Adolescence and risk of preterm birth in multifetal gestations. J Matern Fetal Med. 2019; 32(8), 1321–1324.10.1080/14767058.2017.1404981CrossRefGoogle ScholarPubMed
Okby, R, Druyan, Y, Sonenklar, M, et al. Fertility treatment as a risk factor for maternal request of cesarean delivery in twin pregnancies. Arch Gynecol Obstet. 2016 Nov; 294(6), 1183–1187.10.1007/s00404-016-4151-5CrossRefGoogle ScholarPubMed
Martin, JA, Hamilton, BE, Osterman, MJK, Driscoll, AK, Drake, P. Births: Final data for 2017. National Vital Statistics Reports; vol 67 no 8. Hyattsville, MD: National Center for Health Statistics. 2018. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_08-508.pdf Google Scholar
Weiner, E, Barber, E, Feldstein, O, et al. Placental histopathology differences and neonatal outcome in dichorionic–diamniotic as compared to monochorionic–diamniotic twin pregnancies. Reprod Sci. 2018; 25(7), 1067–1072.Google ScholarPubMed
Okby, R, Harlev, A, Sacks, KN, Sergienko, R, Sheiner, E. Preeclampsia acts differently in in vitro fertilization versus spontaneous twins. Arch Gynecol Obstet. 2018 Mar; 297(3), 653–658.10.1007/s00404-017-4635-yCrossRefGoogle ScholarPubMed
Spong, CY. Defining “term” pregnancy: recommendations from the defining “Term” Pregnancy Workgroup. JAMA. 2013; 309(23), 2445–2446.Google ScholarPubMed
Baghdadi, S, Gee, H, Whittle, MJ, Khan, KS. Twin pregnancy outcome and chorionicity. Acta Obstet Gynecol Scand. 2003; 82, 18–21.Google ScholarPubMed
Lee, YM. Delivery of twins. Semin Perinatol. 2012; 36(3), 195–200.10.1053/j.semperi.2012.02.004CrossRefGoogle Scholar
Machado, LC, Passini, R, Rosa, IR, Carvalho, HB. Neonatal outcomes of late preterm and early term birth. Eur J Obstet Gynecol Reprod Biol. 2014; 179, 204–208.10.1016/j.ejogrb.2014.04.042CrossRefGoogle ScholarPubMed
Clark, SL, Miller, DD, Belfort, MA, et al. Neonatal and maternal outcomes associated with elective term delivery. Obstet Gynecol. 2009; 200(2), 156:e4.Google ScholarPubMed
Walfisch, A, Beharier, O, Wainstock, T, et al. Early‐term deliveries as an independent risk factor for long‐term respiratory morbidity of the offspring. Pediatr Pulmonol. 2017; 52(2), 198–204.10.1002/ppul.23529CrossRefGoogle ScholarPubMed
Chan, E, Leong, P, Malouf, R, Quigley, MA. Long‐term cognitive and school outcomes of late‐preterm and early‐term births: a systematic review. Child Care Health Dev. 2016; 42(3), 297–312.Google ScholarPubMed
Noble, KG, Fifer, WP, Rauh, VA, Nomura, Y, Andrews, HF. Academic achievement varies with gestational age among children born at term. Pediatrics. 2012; 130(2), e257–e264.10.1542/peds.2011-2157CrossRefGoogle ScholarPubMed
Luke, B. Reducing fetal deaths in multiple births: optimal birthweights and gestational ages for infants of twin and triplet births. Acta Genet Med Gemellol (Roma). 1996; 45, 333.10.1017/S0001566000000933CrossRefGoogle ScholarPubMed
Leveno, KJ, Quirk, JG, Whalley, PJ, Herbert, WN, Trubey, R. Fetal lung maturation in twin gestation. Am J Obstet Gynecol. 1984; 148(4), 405–411.10.1016/0002-9378(84)90716-6CrossRefGoogle ScholarPubMed
Minakami, H, Sato, I. Re‐estimating the date of delivery in multifetal pregnancies. JAMA. 1996; 275, 1432–1434.10.1001/jama.1996.03530420060037CrossRefGoogle Scholar
Breathnach, FM, McAuliffe, FM, Geary, M, et al. Optimum timing for planned delivery of uncomplicated monochorionic and dichorionic twin pregnancies. Obstet Gynecol. 2012; 119(1), 50–59.Google ScholarPubMed
Committee on Practice Bulletins—Obstetrics, Society for maternal–fetal medicine. Practice Bulletin No. 169: Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol. 2016; 128, e131.Google Scholar
Vayssière, C, Benoist, G, Blondel, B, et al. Twin pregnancies: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2011; 156(1), 12–17.10.1016/j.ejogrb.2010.12.045CrossRefGoogle Scholar
National Collaborating Centre for Women’s and Children’s Health (UK). Multiple pregnancy: The management of twin and triplet pregnancies in the antenatal period. London: RCOG Press; 2011 Sep. (NICE Clinical Guidelines, No. 129.) 10, Timing of birth. Available from: https://www.ncbi.nlm.nih.gov/books/NBK83107/.Google Scholar
Cheong-See, F, Schuit, E, Arroyo-Manzano, D, et al. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. BMJ. 2016; 354, i4353.Google ScholarPubMed
Kiely, JL. The epidemiology of perinatal mortality in multiple births. Bull N Y Acad Med. 1990; 66(6), 618.Google ScholarPubMed
Kahn, B, Lumey, LH, Zybert, PA, et al. Prospective risk of fetal death in singleton, twin, and triplet gestations: implications for practice. Obstet Gynecol. 2003; 102, 685.Google ScholarPubMed
Statistics TCBo [Centeral Bureau of Statistics]. Localities in Israel, 2008–2017. [updated February 06, 2019]. Available from: https://www.cbs.gov.il/he/mediarelease/DocLib/2019/042/01_19_042b.pdf.Google Scholar
Be’er Sheva [Go South]. Israel [updated September 2017]. Available from: https://www.nbn.org.il/gosouth/community_profile/beer-sheva Google Scholar
Gouyon, JB, Vintejoux, A, Sagot, P, et al. Neonatal outcome associated with singleton birth at 34–41 weeks of gestation. Int J Epidemiol. 2010; 39(3), 769–776.10.1093/ije/dyq037CrossRefGoogle ScholarPubMed
Imterat, M, Wainstock, T, Moran-Gilad, J, Sheiner, E, Walfisch, A. The association between gestational age and otitis media during childhood: a population-based cohort analysis. J Dev Orig Health Dis. 2019; 10(2), 214–220.Google ScholarPubMed
Gutvirtz, G, Wainstock, T, Sheiner, E, Landau, D, Walfisch, A. Pediatric cardiovascular morbidity of the early term newborn. J Pediatr. 2018; 194, 81–86.e2.10.1016/j.jpeds.2017.09.060CrossRefGoogle ScholarPubMed
Levy, DP, Sheiner, E, Wainstock, T, et al. Evidence that children born at early term (37-38 6/7 weeks) are at increased risk for diabetes and obesity-related disorders. Am J Obstet Gynecol. 2017; 217(5), 588. e11.Google Scholar
Walfisch, A, Wainstock, T, Beharier, O, Landau, D, Sheiner, E. Early term deliveries and the risk of pediatric obstructive sleep apnoea in the offspring. Paediatr Perinat Epidemiol. 2017; 31(2), 149–156.Google ScholarPubMed
Stern, E, Cohen, N, Odom, E, et al. Long-term outcomes of twins based on gestational age at delivery. J Matern Fetal Med. 2018; 31(23), 3102–3107.Google Scholar
Dodd, JM, Crowther, CA, Haslam, RR, Robinson, JS. Twins Timing of Birth Trial Group. Elective birth at 37 weeks of gestation versus standard care for women with an uncomplicated twin pregnancy at term: The Twins Timing of Birth Randomised Trial. Br J Obstet Gynaecol. 2012; 119(8), 964–974.Google ScholarPubMed
Hartley, R, Emanuel, I, Hitti, J. Perinatal mortality and neonatal morbidity rates among twin pairs at different gestational ages: optimal delivery timing at 37–38 weeks’ gestation. Am J Obstet Gynecol. 2001; 184, 451–458.Google Scholar
Bellizzi, S, Sobel, H, Betran, AP, Temmerman, M. Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries. J Glob Health. 2018; 8(1), 010404.10.7189/jogh.08.010404CrossRefGoogle ScholarPubMed
Welmerink, DB, Voigt, LF, Daling, JR, Mueller, BA. Infertility treatment use in relation to selected adverse birth outcomes. Fertil Steril. 2010; 94(7), 2580–2586.Google ScholarPubMed
Supplementary material: File

Imterat et al. supplementary material

Table S1

Download Imterat et al. supplementary material(File)
File 110.5 KB