Archives of Gynecology and Obstetrics

, Volume 285, Issue 4, pp 973–978 | Cite as

Selective and non-selective intrauterine growth restriction in twin pregnancies: high-risk factors and perinatal outcome

  • Yu Gao
  • Zhiming He
  • Yanmin Luo
  • Hongyu Sun
  • Linhuan Huang
  • Manchao Li
  • Yi Zhou
  • Baojiang Chen
  • Qun Fang
Maternal-Fetal Medicine



To evaluate the high-risk factors and perinatal outcome in selective intrauterine growth restriction (sIUGR) and non-selective IUGR (non-sIUGR) in twins.


In total, 336 pairs of twins were enrolled from December 2003 to 2009. According to the birth weight, 295 pairs of twins were divided into sIUGR, non-sIUGR and normal growth groups. Maternal characteristics, complications, chorionicity, zygosity and perinatal outcomes were analyzed among the three groups.


The overall IUGR incidence (including sIUGR and non-sIUGR) in twin pregnancies was 23.2%. The sIUGR incidence was ten times greater than that of non-sIUGR. Monochorionicity and monozygosity were risk factors for overall IUGR, especially for the sIUGR (P < 0.01). Pre-eclampsia was more common in sIUGR than in the normal growth group (P < 0.05). Both the sIUGR and non-sIUGR groups had more intrauterine fetal death and neonatal death than the normal growth group (P < 0.01). The sIUGR group had more brain injury than the normal growth group (P < 0.01).


Monochorionicity, monozygosity, pre-eclampsia were high-risk factors for IUGR in twins. Perinatal death was more prevalent in the non-sIUGR group, and neonatal brain damage was more prevalent in the sIUGR group.


Twins Intrauterine growth restriction Risk factors Perinatal mortality 



The study was financially supported by GuangDong province Natural Science Foundation, People’s Republic of China (# 10151008901000160).

Conflict of interest

There is no conflict of interest.


  1. 1.
    Fox NS, Rebarber A, Klauser CK, Roman AS, Saltzman DH (2010) Intrauterine growth restriction in twin pregnancies: incidence and associated risk factors. Am J Perinatol 28(4):267–272Google Scholar
  2. 2.
    Lin CC, Santolaya-Forgas J (1998) Current concepts of fetal growth restriction: part I. Causes, classification, and pathophysiology. Obstet Gynecol 92(6):1044–1055PubMedCrossRefGoogle Scholar
  3. 3.
    Schwendemann WD, O’Brien JM, Barton JR, Milligan DA, Istwan N (2005) Modifiable risk factors for growth restriction in twin pregnancies. Am J Obstet Gynecol 192(5):1440–1442PubMedCrossRefGoogle Scholar
  4. 4.
    Inde Y, Satomi M, Iwasaki N, Ono S, Yamashita E, Igarashi M et al (2011) Maternal risk factors for small-for-gestational age newborns in Japanese dichorionic twins. J Obstet Gynaecol Res 37(1):24–31PubMedCrossRefGoogle Scholar
  5. 5.
    Chang YL, Chang SD, Chao AS, Hsieh PC, Wang CN, Wang TH (2009) Clinical outcome and placental territory ratio of monochorionic twin pregnancies and selective intrauterine growth restriction with different types of umbilical artery Doppler. Prenat Diagn 29(3):253–256PubMedCrossRefGoogle Scholar
  6. 6.
    Machin G (2009) Non-identical monozygotic twins, intermediate twin types, zygosity testing, and the non-random nature of monozygotic twinning: a review. Am J Med Genet C Semin Med Genet 151C(2):110–127PubMedCrossRefGoogle Scholar
  7. 7.
    De Paepe ME, Shapiro S, Young L, Luks FI (2010) Placental characteristics of selective birth weight discordance in diamniotic-monochorionic twin gestations. Placenta 31(5):380–386PubMedCrossRefGoogle Scholar
  8. 8.
    Gratacos E, Lewi L, Carreras E, Becker J, Higueras T, Deprest J et al (2004) Incidence and characteristics of umbilical artery intermittent absent and/or reversed end-diastolic flow in complicated and uncomplicated monochorionic twin pregnancies. Ultrasound Obstet Gynecol 23(5):456–460PubMedCrossRefGoogle Scholar
  9. 9.
    Gratacos E, Carreras E, Becker J, Lewi L, Enriquez G, Perapoch J et al (2004) Prevalence of neurological damage in monochorionic twins with selective intrauterine growth restriction and intermittent absent or reversed end-diastolic umbilical artery flow. Ultrasound Obstet Gynecol 24(2):159–163PubMedCrossRefGoogle Scholar
  10. 10.
    Gratacos E, Lewi L, Munoz B, Acosta-Rojas R, Hernandez-Andrade E, Martinez JM et al (2007) A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet Gynecol 30(1):28–34PubMedCrossRefGoogle Scholar
  11. 11.
    Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M (1999) Staging of twin–twin transfusion syndrome. J Perinatol 19(8 Pt 1):550–555PubMedCrossRefGoogle Scholar
  12. 12.
    Alexander GR, Kogan M, Martin J, Papiernik E (1998) What are the fetal growth patterns of singletons, twins, and triplets in the United States. Clin Obstet Gynecol 41(1):114–125PubMedCrossRefGoogle Scholar
  13. 13.
    Carroll SG, Soothill PW, Abdel-Fattah SA, Porter H, Montague I, Kyle PM (2002) Prediction of chorionicity in twin pregnancies at 10–14 weeks of gestation. Bjog 109(2):182–186PubMedGoogle Scholar
  14. 14.
    Cleary-Goldman J, D’Alton ME (2008) Growth abnormalities and multiple gestations. Semin Perinatol 32(3):206–212PubMedCrossRefGoogle Scholar
  15. 15.
    Corsello G, Piro E (2010) The world of twins: an update. J Matern Fetal Neonatal Med 23(Suppl 3):59–62PubMedCrossRefGoogle Scholar
  16. 16.
    Resnik R (2002) Intrauterine growth restriction. Obstet Gynecol 99(3):490–496PubMedCrossRefGoogle Scholar
  17. 17.
    Blickstein I, Goldman RD (2003) Intertwin birth weight discordance as a potential adaptive measure to promote gestational age. J Reprod Med 48(6):449–454PubMedGoogle Scholar
  18. 18.
    Blickstein I, Kalish RB (2003) Birthweight discordance in multiple pregnancy. Twin Res 6(6):526–531PubMedCrossRefGoogle Scholar
  19. 19.
    Blickstein I, Keith LG (2004) Neonatal mortality rates among growth-discordant twins, classified according to the birth weight of the smaller twin. Am J Obstet Gynecol 190(1):170–174PubMedCrossRefGoogle Scholar
  20. 20.
    Russell Z, Quintero RA, Kontopoulos EV (2007) Intrauterine growth restriction in monochorionic twins. Semin Fetal Neonatal Med 12(6):439–449PubMedCrossRefGoogle Scholar
  21. 21.
    Valsky DV, Eixarch E, Martinez JM, Crispi F, Gratacos E (2010) Selective intrauterine growth restriction in monochorionic twins: pathophysiology, diagnostic approach and management dilemmas. Semin Fetal Neonatal Med 15(6):342–348PubMedCrossRefGoogle Scholar
  22. 22.
    Machin GA (2004) Why is it important to diagnose chorionicity and how do we do it. Best Pract Res Clin Obstet Gynaecol 18(4):515–530PubMedCrossRefGoogle Scholar
  23. 23.
    Maulik D, Frances EJ, Ragolia L (2006) Fetal growth restriction: pathogenic mechanisms. Clin Obstet Gynecol 49(2):219–227PubMedCrossRefGoogle Scholar
  24. 24.
    Petronis A (2006) Epigenetics and twins: three variations on the theme. Trends Genet 22(7):347–350PubMedCrossRefGoogle Scholar
  25. 25.
    Handunnetthi L, Handel AE, Ramagopalan SV (2010) Contribution of genetic, epigenetic and transcriptomic differences to twin discordance in multiple sclerosis. Expert Rev Neurother 10(9):1379–1381PubMedCrossRefGoogle Scholar
  26. 26.
    Kuratomi G, Iwamoto K, Bundo M, Kusumi I, Kato N, Iwata N, Ozaki N (2008) Kato T: aberrant DNA methylation associated with bipolar disorder identified from discordant monozygotic twins. Mol Psychiatry 13(4):429–441PubMedCrossRefGoogle Scholar
  27. 27.
    Javierre BM, Fernandez AF, Richter J, Al-Shahrour F, Martin-Subero JI, Rodriguez-Ubreva J, Berdasco M, Fraga MF, O’Hanlon TP, Rider LG et al (2010) Changes in the pattern of DNA methylation associate with twin discordance in systemic lupus erythematosus. Genome Res 20(2):170–179PubMedCrossRefGoogle Scholar
  28. 28.
    Ollikainen M, Smith KR, Joo EJ, Ng HK, Andronikos R, Novakovic B, Abdul Aziz NK, Carlin JB, Morley R, Saffery R et al (2010) DNA methylation analysis of multiple tissues from newborn twins reveals both genetic and intrauterine components to variation in the human neonatal epigenome. Hum Mol Genet 19(21):4176–4188PubMedCrossRefGoogle Scholar
  29. 29.
    Kaminsky ZA, Tang T, Wang SC, Ptak C, Oh GH, Wong AH, Feldcamp LA, Virtanen C, Halfvarson J, Tysk C et al (2009) DNA methylation profiles in monozygotic and dizygotic twins. Nat Genet 41(2):240–245PubMedCrossRefGoogle Scholar
  30. 30.
    Fraga MF, Ballestar E, Paz MF, Ropero S, Setien F, Ballestar ML, Heine-Suner D, Cigudosa JC, Urioste M, Benitez J et al (2005) Epigenetic differences arise during the lifetime of monozygotic twins. Proc Natl Acad Sci USA 102(30):10604–10609PubMedCrossRefGoogle Scholar
  31. 31.
    Yinon Y, Mazkereth R, Rosentzweig N, Jarus-Hakak A, Schiff E, Simchen MJ (2005) Growth restriction as a determinant of outcome in preterm discordant twins. Obstet Gynecol 105(1):80–84PubMedCrossRefGoogle Scholar
  32. 32.
    Valsky DV, Eixarch E, Martinez JM, Gratacos E (2010) Selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies. Prenat Diagn 30(8):719–726PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Yu Gao
    • 1
  • Zhiming He
    • 1
  • Yanmin Luo
    • 1
  • Hongyu Sun
    • 2
  • Linhuan Huang
    • 1
  • Manchao Li
    • 1
  • Yi Zhou
    • 1
  • Baojiang Chen
    • 1
  • Qun Fang
    • 1
  1. 1.Department of Obstetrics and Gynecology, Fetal Medicine CenterThe 1st Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouPeople’s Republic of China
  2. 2.Department of Forensic MedicineSun Yat-Sen UniversityGuangzhouPeople’s Republic of China

Personalised recommendations