دورية أكاديمية
Clinical implications of crown-rump length discordance at 11 to 14 weeks in dichorionic twins.
| العنوان: | Clinical implications of crown-rump length discordance at 11 to 14 weeks in dichorionic twins. |
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| المؤلفون: | Janssen MK; Maternal-Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: matthew.janssen@pennmedicine.upenn.edu., Levine LD; Maternal-Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Bromley B; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston MA., Chasen ST; Department of Obstetrics and Gynecology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY., Russo ML; Women & Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI., Roman AS; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY., Limaye MA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY., Ranzini AC; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH., Clifford CM; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI., Biggio JR Jr; Women's Service Line, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health, New Orleans, LA., Subramanian A; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL., Seasely A; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL., Patil AS; Department of Obstetrics and Gynecology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ., Weed S; Franciscan Maternal-Fetal Medicine Associates, Tacoma, WA., Page JM; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health and Intermountain Healthcare, Salt Lake City, UT., Nicholas S; Axia Women's Health Main Line Perinatal Associates, Wynnewood, PA., Idler J; Allegheny Health Network, Drexel University College of Medicine, Pittsburgh, PA., Rao R; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA., Crowder A; Centura Health, Littleton, CO., Shree R; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA., McLennan G; Labcorp, San Diego, CA., Dugoff L; Maternal-Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. |
| مؤلفون مشاركون: | Twin Cell-Free DNA Study Consortium |
| المصدر: | American journal of obstetrics and gynecology [Am J Obstet Gynecol] 2024 Jan; Vol. 230 (1), pp. 83.e1-83.e11. Date of Electronic Publication: 2023 Jul 23. |
| نوع المنشور: | Multicenter Study; Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 0370476 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6868 (Electronic) Linking ISSN: 00029378 NLM ISO Abbreviation: Am J Obstet Gynecol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: <2005->: New York : Elsevier Original Publication: St. Louis. |
| مواضيع طبية MeSH: | Down Syndrome* , Premature Birth*/etiology , Cell-Free Nucleic Acids*, Pregnancy ; Female ; Infant, Newborn ; Humans ; Crown-Rump Length ; Pregnancy Outcome ; Birth Weight ; Retrospective Studies ; Pregnancy Trimester, First ; Ultrasonography, Prenatal/adverse effects ; Twins, Dizygotic ; Pregnancy, Twin ; Trisomy |
| مستخلص: | Background: Crown-rump length discordance, defined as ≥10% discordance, has been investigated as an early sonographic marker of subsequent growth abnormalities and is associated with an increased risk of fetal loss in twin pregnancies. Previous studies have not investigated the prevalence of fetal aneuploidy or structural anomalies in twins with discordance or the independent association of crown-rump length discordance with adverse perinatal outcomes. Moreover, data are limited on cell-free DNA screening for aneuploidy in dichorionic twins with discordance. Objective: This study aimed to evaluate whether crown-rump length discordance in dichorionic twins between 11 and 14 weeks of gestation is associated with a higher risk of aneuploidy, structural anomalies, or adverse perinatal outcomes and to assess the performance of cell-free DNA screening in dichorionic twin pregnancies with crown-rump length discordance. Study Design: This was a secondary analysis of a multicenter retrospective cohort study that evaluated the performance of cell-free DNA screening for the common trisomies in twin pregnancies from December 2011 to February 2020. For this secondary analysis, we included live dichorionic pregnancies with crown-rump length measurements between 11 and 14 weeks of gestation. First, we compared twin pregnancies with discordant crown-rump lengths with twin pregnancies with concordant crown-rump lengths and analyzed the prevalence of aneuploidy and fetal structural anomalies in either twin. Second, we compared the prevalence of a composite adverse perinatal outcome, which included preterm birth at <34 weeks of gestation, hypertensive disorders of pregnancy, stillbirth or miscarriage, small-for-gestational-age birthweight, and birthweight discordance. Moreover, we assessed the performance of cell-free DNA screening in pregnancies with and without crown-rump length discordance. Outcomes were compared with multivariable regression to adjust for confounders. Results: Of 987 dichorionic twins, 142 (14%) had crown-rump length discordance. The prevalence of aneuploidy was higher in twins with crown-rump length discordance than in twins with concordance (9.9% vs 3.9%, respectively; adjusted relative risk, 2.7; 95% confidence interval, 1.4-4.9). Similarly, structural anomalies (adjusted relative risk, 2.5; 95% confidence interval, 1.4-4.4]) and composite adverse perinatal outcomes (adjusted relative risk, 1.2; 95% confidence interval, 1.04-1.3) were significantly higher in twins with discordance. A stratified analysis demonstrated that even without other ultrasound markers, there were increased risks of aneuploidy (adjusted relative risk, 3.5; 95% confidence interval, 1.5-8.4) and structural anomalies (adjusted relative risk, 2.7; 95% confidence interval, 1.5-4.8) in twins with CRL discordance. Cell-free DNA screening had high negative predictive values for trisomy 21, trisomy 18, and trisomy 13, regardless of crown-rump length discordance, with 1 false-negative for trisomy 21 in a twin pregnancy with discordance. Conclusion: Crown-rump length discordance in dichorionic twins is associated with an increased risk of aneuploidy, structural anomalies, and adverse perinatal outcomes, even without other sonographic abnormalities. Cell-free DNA screening demonstrated high sensitivity and negative predictive values irrespective of crown-rump length discordance; however, 1 false-negative result illustrated that there is a role for diagnostic testing. These data may prove useful in identifying twin pregnancies that may benefit from increased screening and surveillance and are not ascertained by other early sonographic markers. (Copyright © 2023 Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: adverse perinatal outcome; aneuploidy; cell-free DNA; crown-rump length discordance; dichorionic twins; fetal anomalies; first-trimester ultrasound; genetics; nuchal translucency; trisomy 13; trisomy 18; trisomy 21 |
| المشرفين على المادة: | 0 (Cell-Free Nucleic Acids) |
| تواريخ الأحداث: | Date Created: 20230724 Date Completed: 20231225 Latest Revision: 20240813 |
| رمز التحديث: | 20240813 |
| DOI: | 10.1016/j.ajog.2023.07.029 |
| PMID: | 37487855 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1097-6868 |
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| DOI: | 10.1016/j.ajog.2023.07.029 |