Frontiers in medicine · 2026
Goal-concordant outcomes in twin pregnancies: impact of chorionicity, fetal weight discordance, and fetal surgery in a 12-year prospective cohort study.
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Hašlík Lubomír, Krofta Ladislav, Hanulíková Petra, Halaj Matúš, Beňová Barbora, Hanáček Jiří
Аннотация
OBJECTIVE: The objective of the study was to introduce a goal-concordant outcome framework and evaluate the independent effects of chorionicity, fetal weight discordance ≥25%, and intrauterine fetal surgery on survival, timing of delivery, and neonatal growth in twin pregnancies.
METHODS: This prospective cohort study included 1,860 twin pregnancies delivered ≥24 weeks at a national referral center between 2012 and 2023: 1,097 pregnancies were dichorionic (DC), 559 were monochorionic without intervention (MC), and 204 were monochorionic with intrauterine surgery (MCS; 167 fetoscopic laser procedures and 37 selective reductions). The primary outcome was goal-concordant survival (GCS), defined as dual survival in DC and MC pregnancies, dual survival after laser therapy, or intended singleton survival after selective reduction. The secondary outcomes included goal-concordant week (GCW), defined as delivery within guideline-based gestational age windows, and goal-concordant weight (GCWt), defined as birthweight ≥1,500 g in all surviving neonates. Independent predictors of failure to achieve each outcome were assessed using a multivariable logistic regression analysis.
RESULTS: GCS was achieved in 99.0% of the DC, 98.4% of the MC, and 79.9% of the MCS pregnancies, including 78.4% after laser therapy and 86.5% after selective reduction. In a multivariable analysis, MCS was the strongest independent predictor of failure to achieve GCS (OR: 21.2, 95% CI: 10.5-42.6, p < 0.001), while fetal weight discordance ≥25% remained an additional independent risk factor (OR: 2.0, 95% CI: 1.1-3.6, p = 0.018). GCW was achieved in 52.1% of the DC, 54.2% of the MC, and 37.9% of the MCS pregnancies. Failure to achieve GCW was independently associated with fetal weight discordance ≥25% in DC and MC twins (OR: 2.9-3.1, p ≤ 0.002) and with MCS even in the absence of significant discordance (OR: 1.66, p = 0.006). GCWt was achieved in 82.9% of the DC, 69.4% of the MC, and 52.3% of the MCS pregnancies. Failure to achieve GCWt was most strongly associated with fetal weight discordance ≥25% in DC twins (OR 7.2, p < 0.001). Across chorionicity groups, pregnancies with fetal weight discordance ≥25% delivered 12-19 days earlier and had neonatal birthweights reduced by approximately 680-800 g.
CONCLUSION: Chorionicity, fetal weight discordance, and intrauterine fetal surgery independently and differentially affect survival, delivery timing, and neonatal growth. Goal-concordant outcomes provide a clinically intuitive, guideline-aligned benchmark for counseling and outcome comparison in twin pregnancies.
METHODS: This prospective cohort study included 1,860 twin pregnancies delivered ≥24 weeks at a national referral center between 2012 and 2023: 1,097 pregnancies were dichorionic (DC), 559 were monochorionic without intervention (MC), and 204 were monochorionic with intrauterine surgery (MCS; 167 fetoscopic laser procedures and 37 selective reductions). The primary outcome was goal-concordant survival (GCS), defined as dual survival in DC and MC pregnancies, dual survival after laser therapy, or intended singleton survival after selective reduction. The secondary outcomes included goal-concordant week (GCW), defined as delivery within guideline-based gestational age windows, and goal-concordant weight (GCWt), defined as birthweight ≥1,500 g in all surviving neonates. Independent predictors of failure to achieve each outcome were assessed using a multivariable logistic regression analysis.
RESULTS: GCS was achieved in 99.0% of the DC, 98.4% of the MC, and 79.9% of the MCS pregnancies, including 78.4% after laser therapy and 86.5% after selective reduction. In a multivariable analysis, MCS was the strongest independent predictor of failure to achieve GCS (OR: 21.2, 95% CI: 10.5-42.6, p < 0.001), while fetal weight discordance ≥25% remained an additional independent risk factor (OR: 2.0, 95% CI: 1.1-3.6, p = 0.018). GCW was achieved in 52.1% of the DC, 54.2% of the MC, and 37.9% of the MCS pregnancies. Failure to achieve GCW was independently associated with fetal weight discordance ≥25% in DC and MC twins (OR: 2.9-3.1, p ≤ 0.002) and with MCS even in the absence of significant discordance (OR: 1.66, p = 0.006). GCWt was achieved in 82.9% of the DC, 69.4% of the MC, and 52.3% of the MCS pregnancies. Failure to achieve GCWt was most strongly associated with fetal weight discordance ≥25% in DC twins (OR 7.2, p < 0.001). Across chorionicity groups, pregnancies with fetal weight discordance ≥25% delivered 12-19 days earlier and had neonatal birthweights reduced by approximately 680-800 g.
CONCLUSION: Chorionicity, fetal weight discordance, and intrauterine fetal surgery independently and differentially affect survival, delivery timing, and neonatal growth. Goal-concordant outcomes provide a clinically intuitive, guideline-aligned benchmark for counseling and outcome comparison in twin pregnancies.