Patterns of Second- and Third-Trimester Growth and Discordance in Twin Pregnancy: Analysis of the Southwest Thames Obstetric Research Collaborative (STORK) Multiple Pregnancy Cohort

Introduction: This study investigates patterns of intertwin size discordance in dichorionic diamniotic (DCDA) and monochorionic diamniotic (MCDA) twin pregnancies.

Material and methods: Ultrasound measurements of twin pregnancies, from 14 weeks to term, were collected by 9 hospitals over a 10-year period. This analysis considers the modelled and observed levels of discordance in abdominal circumference (AC) and estimated fetal weight (EFW) in relation to gestational age. Fitted models were analysed to produce charts displaying the expected range of intertwin discordance in AC and EFW at any given examination.

Results: The dataset for analysis included a total of 9,866 ultrasound examinations in 1,802 DCDA and 323 MCDA twin pregnancies. The 95th percentile of intertwin discordance in EFW increased from 18.3% (95% CI, 17.8-18.7%) at 20 weeks to 21.9% (95% CI, 21.3-22.4%) at 30 weeks for DCDA pregnancies. The 95th percentile for intertwin discordance in AC was stable at 10-11% for this period. Slightly higher levels of discordance were observed for MCDA than for DCDA pregnancies.

Discussion: The expected range of intertwin discordance in EFW and AC shows differences with gestational age and between DCDA and MCDA pregnancies.