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Optimal delivery timing for dizygotic twins – the short- and long-term perspective

Published online by Cambridge University Press:  04 March 2020

Majdi Imterat Open the ORCID record for Majdi Imterat [Opens in a new window] ,
Tamar Wainstock ,
Eyal Sheiner ,
Ruslan Sergienko ,
Daniella Landau  and
Asnat Walfisch
Majdi Imterat*
Affiliation:
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Tamar Wainstock
Affiliation:
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Eyal Sheiner
Affiliation:
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Ruslan Sergienko
Affiliation:
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Daniella Landau
Affiliation:
Department of neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Asnat Walfisch
Affiliation:
Department of Obstetrics and Gynecology, Hadassah Mt, Scopus Medical Center, Jerusalem, Israel
*
Address for correspondence: Majdi Imterat, MD, Department of Obstetrics and Gynecology, Soroka University Medical Center, 151 Izak Rager Ave., Beer-Sheva84101, Israel. Email: magdi_333@hotmail.com
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Abstract

Major obstetrics and gynecology societies offer inconsistent recommendation regarding optimal delivery timing in uncomplicated dizygotic twins. We sought to investigate the impact of delivery timing within term gestation, in dizygotic twins, on the short- and long-term offspring morbidity. A prospectively analyzed cohort of dizygotic twin deliveries was conducted. All women delivered at a regional tertiary medical center, at term (≥37 0/7), between the years 1991 and 2014, were included. The primary exposure was delivery at 37 0/7–37 + 6/7 weeks, while delivery at ≥38 0/7 weeks’ gestation was considered the reference. Neonatal short- and long-term outcomes according to hospitalizations of offspring up to 18 years of age due to cardiac, respiratory, hematological, neurological, and infectious morbidity were compared. Kaplan–Meier survival curves were used to compare cumulative incidences per each major-system hospitalization. Cox regression models were used to estimate the adjusted hazard ratios, while adjusting for variables with clinical importance. During the study period, 612 dizygotic twin deliveries met the inclusion criteria. Of them, 200 (31.3%) occurred at 37–37 6/7 weeks, and 412 (68.7%) occurred at ≥38 0/7 weeks’ gestation. In the long-term analysis, rates of hospitalizations involving several major morbidity categories exhibited comparable rates in both groups. The Cox regression models did not demonstrate an independent association between gestational age within term and later major pediatric morbidity in offspring (total long-term morbidity: adjusted hazard ratio 1.33, 95% confidence interval 0.77–2.29). Dizygotic twin deliveries occurring at different gestational ages within term do not appear to significantly impact on major short- and long-term outcomes.

Keywords

Outcomemultiple gestationpregnancypediatric morbiditychildhood
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 12 , Issue 1 , February 2021 , pp. 88 - 93
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Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2020

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