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Neuro-developmental outcome of a large cohort of growth discordant twins

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Abstract

Our aims were to study the effect of birthweight growth discordance (≥20 %) on neuro-developmental outcome of monochorionic and dichorionic twins and to compare the relative effects of foetal growth discordance and prematurity on cognitive outcome. We performed a cross-sectional multicentre prospective follow-up study from a cohort of 948 twin pregnancies. One hundred nineteen birthweight-discordant twin pairs were examined (24 monochorionic pairs) and were matched for gestational age at delivery with 111 concordant control pairs. Participants were assessed with the Bayley Scales between 24 and 42 months of age. Analysis was by paired t test for intra-twin pair differences and by multiple linear regression. Compared to the larger twin of a discordant pair, the smaller twin performed significantly worse in cognition (mean composite cognitive score difference = −1.7, 95 % confidence interval (CI) = 0.3–3.1, p = 0.01) and also in language and motor skills. Prematurity prior to 33 weeks’ gestation, however, had a far greater impact on cognitive outcomes (mean cognitive composite score difference = −5.8, 95 % CI = 1.2–10.5, p = 0.008).

Conclusion: Birthweight growth discordance of ≥20 % confers an independent adverse effect on long-term neuro-development of the smaller twin. However, prior to 33 weeks’ gestation, gestational age at birth adversely affects cognitive development to a greater extent than foetal growth discordance.

What is known:

• Growth discordance is a common problem encountered in monochorionic and dichorionic twin pregnancies.

• Previous studies have demonstrated adverse developmental outcomes in one or two areas of development.

What is new:

• Growth discordance has a negative impact on all three areas of development: cognition, language and motor skills.

• The current study is amongst the first to compare the impact of growth discordance and prematurity on cognitive outcomes.

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Abbreviations

AGA:

Appropriately grown for gestational age

BW:

Birthweight

CI:

Confidence interval

DC:

Dichorionic

ESPRiT (Study):

Evaluation of Sonographic Predictors of Restricted Growth in Twins

MC:

Monochorionic

NOTES (Study):

Neuro-Developmental Outcome for Twins of the ESPRiT Study

SGA:

Small for gestational age

TTTS:

Twin-twin transfusion syndrome

VLBW:

Very low birthweight

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Acknowledgments

The authors wish to thank contributors from The Perinatal Ireland Research Consortium: Dr Michael P Geary, Dr Sean Daly, Dr John Higgins, Dr James Dornan, Dr Gerard Burke, Dr Shane Higgins and Dr Stephen Carroll.

The authors also wish to thank the paediatric collaborators: Dr Louise Gibson, Dr Sinead Harty, Dr Orla Flanagan, Dr John Murphy, Dr Martin White and Dr Siobhan Gallagher.

Finally, thank you to our research nurses and psychologists: Ms Niamh Pearson, Ms Mairead Diviney, Ms Caroline Rawdon, Ms Roisin Reid, Ms Patricia McCreesh and Ms Anne Marie McCarthy.

Author’s contributions

Cecilie Halling (first author): Dr Halling conceptualized and designed the study, coordinated all data collection, drafted the initial manuscript and wrote the final manuscript with contributions from other authors.

John David Corcoran (senior author): Dr Corcoran conceptualized and helped design the study, supervised the study, reviewed and revised the initial manuscript and approved the final manuscript as submitted.

Fergal Malone: Dr Malone conceptualized and helped design the study, reviewed and revised the initial manuscript and approved the final manuscript as submitted.

Fionnuala Breathnach: Dr Breathnach conceptualized and helped design the study, reviewed and revised the initial manuscript and approved the final manuscript as submitted.

Moira Stewart: Dr Stewart conceptualized and helped design the study, revised the initial manuscript and approved the final manuscript as submitted.

Fionnuala McAuliffe: Dr McAuliffe conceptualized and helped design the study, reviewed and revised the initial manuscript and approved the final manuscript as submitted.

John J Morrison: Dr Morrison conceptualized and helped design the study, reviewed and revised the initial manuscript and approved the final manuscript as submitted.

Fiona Manning: Ms Manning conceptualized and helped design the study, helped with the grant application process, reviewed and revised the initial manuscript and approved the final manuscript as submitted.

Patrick Dicker: Mr Dicker conceptualized and helped design the study, designed the data collection instruments, carried out all statistical analysis for the study and approved the final manuscript as submitted.

Author information

Author notes

  1. Cecilie Halling

    Present address: Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

Authors and Affiliations

  1. The Rotunda Hospital, Dublin, Ireland

    Cecilie Halling, Fergal D. Malone, Fionnuala M. Breathnach & John David Corcoran

  2. Royal Victoria Maternity Hospital, Belfast, Northern Ireland, UK

    Moira C. Stewart

  3. Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland

    Fionnuala M. McAuliffe

  4. Obstetrics and Gynecology, National University of Ireland, Galway, Ireland

    John J. Morrison

  5. University Hospital Galway, Galway, Ireland

    John J. Morrison

  6. Royal College of Surgeons in Ireland, Dublin 2, Ireland

    Patrick Dicker & Fiona Manning

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on behalf of Perinatal Ireland Research Consortium

Corresponding author

Correspondence to Cecilie Halling.

Ethics declarations

Funding

This study was funded by the National Children’s Research Centre, Dublin, Ireland, and the ESPRiT study was funded by the Health Research Board Ireland. The funding source had no involvement in the study design, in the collection, analysis and interpretation of the data, in the writing of the manuscript or in the decision to submit the paper.

Conflict of interest

Author A declares that she has no conflict of interest. Author B declares that he has no conflict of interest. Author C declares that she has no conflict of interest. Author D declares that she has no conflict of interest. Author E declares that she has no conflict of interest. Author F declares that he has no conflict of interest. Author G declares that he has no conflict of interest. Author H declares that she has no conflict of interest. Author I declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Peter de Winter

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Halling, C., Malone, F.D., Breathnach, F.M. et al. Neuro-developmental outcome of a large cohort of growth discordant twins. Eur J Pediatr 175, 381–389 (2016). https://doi.org/10.1007/s00431-015-2648-8

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  • DOI: https://doi.org/10.1007/s00431-015-2648-8

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