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Vascular programming in twins: the effects of chorionicity and fetal therapy for twin-to-twin transfusion syndrome†

Published online by Cambridge University Press:  20 March 2012

H. M. Gardiner ,
A. Barlas ,
H. Matsui ,
A. Diemert ,
M. J. O. Taylor ,
J. Preece ,
F. Gordon ,
S. E. Greenwald  and
K. Hecher
H. M. Gardiner*
Affiliation:
Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, UK Royal Brompton NHS Foundation Trust Hospital, London, UK
A. Barlas
Affiliation:
Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, London, UK
H. Matsui
Affiliation:
Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, UK Royal Brompton NHS Foundation Trust Hospital, London, UK
A. Diemert
Affiliation:
Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg-Eppendorf, Germany
M. J. O. Taylor
Affiliation:
Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, UK
J. Preece
Affiliation:
Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, UK
F. Gordon
Affiliation:
Statistical Advisory Service, Imperial College, London, UK
S. E. Greenwald
Affiliation:
Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, London, UK
K. Hecher
Affiliation:
Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg-Eppendorf, Germany
*
*Address for correspondence: Dr H. M. Gardiner, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London W12 0HS, UK. (Email [email protected])
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Abstract

We assessed vascular programming in genetically identical monochorionic twin pairs with twin-to-twin transfusion syndrome (TTTS) treated differently in utero by serial amnioreduction or fetal laser arterial photocoagulation. This case–control study re-assessed four twin groups at median 11 years comprising 20 pairs of monochorionic diamniotic twins: nine treated by amnioreduction (TTTS-amnio) and eleven by laser (TTTS-laser) with seven monochorionic and six dichorionic control pairs. Outcome measures were current blood pressure (BP), brachio-radial arterial stiffness derived from pulse wave velocity (PWV), resting microcirculation (Flux) and response to heating and post-occlusive reactive hyperaemia measured using laser Doppler. Potential confounders [PWV and BP at first study, current height, weight, heart rate and twin type (ex-recipient, ex-donor or heavier/lighter of pair)] were accounted for by Mixed Linear Models statistical methodology. PWV dichorionic > monochorionic (P = 0.024); systolic and diastolic BP dichorionic > TTTS-amnio and TTTS-laser (P = 0.004, P = 0.02 and P = 0.005, P = 0.02, respectively). Within-twin pair pattern of PWV discordance was similar in laser treated and dichorionic controls (heavier-born > lighter), opposite to TTTS-amnio and monochorionic controls. Flux monochorionic > dichorionic (P = 0.044) and heavier > lighter-born (P = 0.024). TTTS-laser and dichorionic diamniotic showed greatest hyperaemic responses (dichorionic > TTTS-amnio or monochorionic controls (P = 0.007, P = 0.025). Hyperaemic responses were slower in heavier-born twins (P = 0.005). In summary, monochorionic twins had lower BP, arterial stiffness and increased resting vasodilatation than dichorionic twins implying shared fetal circulation affects vascular development. Vascular responses in laser-TTTS were similar to dichorionic and opposite to TTTS-amnio suggesting a lasting effect of fetal therapy on vascular health.

Keywords

arterial stiffnessblood pressuremicrocirculationmonochorionic twinsvascular programming
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 3 , Issue 3 , June 2012 , pp. 182 - 189
Copyright
Copyright © Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2012

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Footnotes

†

Study performed at Queen Charlotte's and Chelsea Hospital, Imperial College London, UK and Department of Obstetrics and Fetal Medicine, University Medical Centre, Hamburg-Eppendorf, Germany.

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