Adaptive growth restriction as a pattern of birth weight discordance in twin gestations
Section snippets
Patients and methods
We used data from the Israeli Birth Registry through the Central Bureau of Statistics, which includes all deliveries in Israel, as required by law. The database of 12,785 twin pairs delivered from 1993–1998 was used to select a cohort of 12,777 pairs (99.9%) with known birth weights and genders. Maternal parity was known in 12,565 (98.3%). The range of maternal age was 18–44 years, the range of parity 0–7. All women were Israeli citizens, roughly comprising 80% Jewish, 15% Moslem, and 5% other
Results
Frequencies of the variables studied are shown in Table 1. The numbers of discordant pairs in the categories 15–24.9%, 25–34.9%, and 35% or more were plotted as functions of the total twin birth weight deciles. The best-fit correlation for discordance level 15–24.9% was inversely linear (percentage of discordant twin pairs = −0.44 [decile order] + 21.8) but with a relatively low R2 value of 0.47 and the slope was not different than zero (P = .02; 95% confidence interval [CI] for the slope −.8,
Discussion
We used an epidemiologic approach to differentiate between patterns of discordant growth in twins. There is evidence that frequencies of divergent birth weight have a pattern based on total twin birth weight, suggesting that the greater the uterine capacity to nurture twins is, the smaller the likelihood of birth weight discordance.1
The first aspect we examined was the transition from low- to high-level birth weight discordance. Figure 1 shows that with more than 25% discordance, there is an
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