Timing of Delivery for Twins With Growth Discordance and Growth Restriction: An Individual Participant Data Meta-analysis.
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Koch Ashlee K, Burger Renée J, Schuit Ewoud, Mateus Julio Fernando, Goya Maria, Carreras Elena, Biancolin Sckarlet E, Barzilay Eran, Soliman Nancy, Cooper Stephanie, Metcalfe Amy, Lodha Abhay, Fichera Anna, Stagnati Valentina, Kawamura Hiroshi, Rustico Maria, Lanna Mariano, Munim Shama, Russo Francesca Maria, Nassar Anwar, Rode Line, Lim Arianne, Liem Sophie, Grantz Katherine L, Hack Karien, Combs C Andrew, Serra Vicente, Perales Alfredo, Khalil Asma, Liu Becky, Barrett Jon, Ganzevoort Wessel, Gordijn Sanne J, Morris R Katie, Mol Ben W, Li Wentao
Аннотация
DATA SOURCES: A search of MEDLINE, EMBASE, ClinicalTrials.gov, and Ovid between 2015 and 2018 was performed of cohort studies reporting risks of stillbirth and neonatal death in twin pregnancies from 32 to 41 weeks of gestation. Studies from a previous meta-analysis using a similar search strategy (from inception to 2015) were combined. Women with monoamniotic twin pregnancies were excluded.
METHODS OF STUDY SELECTION: Overall, of 57 eligible studies, 20 cohort studies that contributed original data reporting on 7,474 dichorionic and 2,281 monochorionic twin pairs.
TABULATION, INTEGRATION, AND RESULTS: We performed an individual participant data meta-analysis to calculate the risk of perinatal death (risk difference between prospective stillbirth and neonatal death) per gestational week. Analyses were stratified by chorionicity, levels of growth discordance, and presence of SGA in one or both twins. For both dichorionic and monochorionic twins, the absolute risks of stillbirth and neonatal death were higher when one or both twins were SGA and increased with greater levels of growth discordance. Regardless of level of growth discordance and birth weight, perinatal risk balanced between 36 0/7-6/7 and 37 0/7-6/7 weeks of gestation in both dichorionic and monochorionic twin pregnancies, with likely higher risk of stillbirth than neonatal death from 37 0/7-6/7 weeks onward.
CONCLUSION: Growth discordance or SGA is associated with higher absolute risks of stillbirth and neonatal death. However, balancing these two risks, we did not find evidence that the optimal timing of delivery is changed by the presence of growth disorders alone.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018090866.