Increased total body and fat mass, as well as obesity. Gender nonconformity of identical twins with discordant. Twin gestations when compared to singletons are associated with higher perinatal morbidity and mortality. About 30% of monochorionic twin pregnancies are compli cated by twintotwin transfusion syndrome ttts, isolated discordant growth, twin. Twin pregnancy obstetric care guidelines brigham and. Discordant clinical features of identical hypertrophic. This design corresponds to a matched casecontrol study, where the ra affected twin in each pair is the case while the unaffected co twin serves as control.
We analyzed a retrospective cohort of 155 monochorionic pregnancies 312 twins with major discordant structural anomalies coded by the icd10 system in order to describe the spectrum of anomalies, the management of the pregnancies, and the perinatal outcome. In the largest published study of growth discordant twins, halling et al, using a similar definition of growth discrepancy to swamy et al, assessed 119 twin pairs at 23 years of age 20% were monochorionic and documented small but significant differences between the larger and smaller twin on bayley scale assessment in the areas of. Discordant fetal growth is defined as a 20% difference in the estimated fetal weight between the larger and the smaller twin. Diseaseassociated epigenetic changes in monozygotic twins.
The importance of a systematic approach to twin pregnancies. Methylomic analysis of monozygotic twins discordant for. Jul 31, 2014 monozygotic mz twins share nearly all of their genetic variants and many similar environments before and after birth. Sexual arousal patterns of identical twins with discordant.
Among the 96 discordant twin infants, intermediate care nursery admission was required for 15 16%, neonatal. A free powerpoint ppt presentation displayed as a flash slide show on id. Differences at the epigenetic level may account for such discordances. After adjusting for gestational age, discordant twins conceived by ivf or. Those pregnancies with discordant growth and at least one growthrestricted fetus have been associated with a 7. One proposed mechanism of discordance is postzygotically occurring genomic alterations resulting from mitotic recombination and other somatic changes.
Being bullied was associated with a wide range of psychiatric disorders in both children and young adults. To investigate the role of the gut microbiome, we studied 317 malawian twin pairs during the first 3 years of life. Laterality, monozygotic twins, dominant hemisphere, anatomic symmetry, iq. In order to establish a protocol considering the definition, diagnosis, and management of growth discordant twin gestations, a questionnaire was sent to 96. Does birth weight discordance in preterm twins affect neonatal. We gathered freeresponse questionnaire data from 497 families and. Feb 02, 2021 twin twin transfusion syndrome ttts is a recognised complication of multipleorder pregnancy 28 and has been implicated in discordant neurodevelopment between twins 29. However, discordant phenotypes have been reported in monozygotic twins. The definition, diagnosis, and management of growthdiscordant. Twin pregnancy obstetric care guidelines brigham and women. The discordant twins had 29 61% same gender pairs while the concordant group had 122 59. Pdf this editorial focuses on discordant twins as a valuable epidemiological design for psychiatric aetiological research.
Nov 07, 2019 we used a populationbased cohort of 10,000 twins to identify a rare sample of mz twins discordant for asc, with the primary aim of identifying biological differences free from genetic confounding. Dichorionic twins discordant for intrauterine growth. We examined these responses in 6 male twin pairs and 9 female twin pairs who reported discordant sexual orientations. Once structural malformations, chromosomal abnormalities, and twin. No differences were identified in the group of weightconcordant twins. Liver and pancreatic fat content and metabolism in healthy monozygotic twins with discordant physical activity. The risk of miscarriage after selective top in dcda twins ranges from 3% at 14 weeks to 8% at 20 weeks gestation. Sep 19, 2005 discordant growth in twins contributes significantly to rates of perinatal morbidity and mortality. We transplanted fecal microbiota from adult female twin pairs discordant for obesity into germ free mice fed lowfat mouse chow, as well as diets representing different levels of saturated fat and fruit and vegetable cons. However, in the last years, widespread zikv infection was shown for the first time to be associated with congenital zika syndrome czs and death of neonates. During this time, half of the twin pairs remained well nourished, whereas 43% became discordant, and 7% manifested concordance for. None of the normally grown co twins died or was handicapped as a result of iatrogenic prematurity.
Twin growth discordance radiology reference article. Morbidityfree survival and birth weight discordance in monochorionic twins without twintwin transfusion syn drome and dichorionic twins. For this purpose we performed a co twin control study including both monozygotic mz and dizygotic dz ra discordant twin pairs. Initially, a hypothesis free go enrichment analysis was done using the molecular function category to identify significant pathways. Dichorionic twins discordant for intrauterine growth retardation. Monozygotic twins discordant for body stalk anomaly the fetal. The use of intrapair differences in biparietal diameter bpd, abdominal. Phenotypically discordant monozygotic twins offer the possibility of gene discovery through delineation of molecular abnormalities in one member of the twin pair. First trimester prenatal diagnosis of trisomy 21 in. Identical twins discordant for multiple sclerosis have a. Eight publications provided evidence of discordance of at least 30%. We investigated phenotypic differences between identical twins with pathogenic sarcomere protein gene variants and. These rates vary according to chorionicity, timing of onset and severity. The analysis of data on the mz discordant twins supports a genuine environmental impact of bullying victimization on childhood social anxiety odds ratio or 1.
Using a qualitative monozygotic mz twin differences design we. Epigenetic signature of birth weight discordance in adult twins. Discordant definition of discordant by merriamwebster. Jan 01, 2012 for discordant twins, 3 studies of 6008 total pregnancies have implicated discordance as a factor for adverse perinatal outcome. The criteria to include twin pairs or triplets in the study were i discordance for the results of screening test at 3 to 5 days one positive twin, one negative, ii a confirmed diagnosis of ch in one of the twins of the pair, and iii at least 3 years of followup in both affected and healthy twins. Aug 03, 2020 author summary the zika virus zikv infection in adults is usually characterized by mild flulike symptoms, with most cases remaining asymptomatic. Two twins with early onset discordance twin and survival to term of the bigger fetus with good outcomes. Discordant growth in twins contributes significantly to rates of perinatal morbidity and mortality. In a more recent study of discordant ms twins, we observed that both the ms patients and their apparently healthy identical co twins have a shift in their naive cd4 t cell repertoires affecting. Controversies in pregnancy management after prenatal. The clinical diagnosis of discordant growth in a twin gestation is difficult. Autoantibodies in twins discordant for rheumatoid arthritis. Management of twins discordant for a major anomaly encephalocele ectopia cordis note. Diagnosis of a twin pregnancy discordant for trisomy 21 diagnosed by cell free fetal dna testing emine cetin1, tamina rawnaq2, boris schulzekoenig1, moritz doebert2, panagiota zoi3 and peter schwaerzler2 1center for prenatal diagnosis and fetal genetics hamburg, altonaer stra.
The mean age of women with discordant twins was 32 years versus 28 years in the other group p0. Thus, pregnancies affected by twin growth discordance. Twin gestations are at higher risk for fetal growth restriction and stillbirth compared to. A related avenue of investigation, but one that is hypothesis free, is the search for potential gene candidates via the genomewide association study gwas plomin et al. Prediction of twin birth weight discordancy was tested in 116 gestations using sonographic measurements of biparietal diameter bpd and abdominal perimeter. Differences in gender nonconformity within discordant twin pairs. First trimester prenatal diagnosis of trisomy 21 in discordant twins using fetal nuchal translucency thickness and maternal serum free bhcg and pappa screening for trisomy 21 in twin pregnancies poses a serious clinical, ethical and moral dilemma reynolds. Based on two careful examinations, 11 indexes in the discordant pairs, two schizophrenics in the concordant pairs, and two normal twins were judged as probably or definitely neurologically abnormal. Physical activity and dietary intake in bmi discordant. Do mz twins have discordant experiences of friendship. For discordant twins, 3 studies of 6008 total pregnancies have implicated discordance as a factor for adverse perinatal outcome. Monozygotic twins with discordant karyotypes for trisomy are rare.
Differential gene expression elicited by zikv infection in. Medical history of discordant twins and environmental. Dichorionic twin pregnancy discordant for fetal anencephaly. Discordant phenotypes in twins with infantile nystagmus. The highest reported likelihood ratio for detection of discordance was 5. However, they can also show phenotypic discordance for a wide range of traits.
Characterising metabolically healthy obesity in weight. Monochorionic diamniotic twin pregnancies karger publishers. Diagnostic tests comparing growth discordant and concordant twin pairs were streptococcus culture test, cord arterial gases base and cord. Degree and rate of growth discordance in dichorionic twins.
Delivery decisions in discordant dcda twins with single. The main aim of this study was to ascertain the performance of bw and ultrasound efw discordance in the prediction of perinatal loss in twin. Rna sequencing of identical twins discordant for autism. Stepwise approach to the sonographic evaluation in twin pregnancies. Is discordant growth in twins an independent risk factor for. Major discordant structural anomalies in monochorionic twins.
First trimester prenatal diagnosis of trisomy 21 in discordant twins using fetal nuchal translucency thickness and maternal serum free bhcg and pappa screening for trisomy 21 in twin pregnancies poses a serious clinical, ethical and moral dilemma reynolds, 1995, leading some authors to advocate that such. Cellfree dna analysis for noninvasive examination of tri. However, degree of contribution from epigenetic and environmental factors in clinical presentation of hcm is currently unclear. This method is free of the limitations of selfreport because it does not rely on subjective. Kaplanmeier morbidity free survival curves and birth weight discordance in the. Integrative analysis of dna methylation in discordant twins. Diagnosis, evaluation and management approximately 16% of twin gestations have discordance of at least 20%. The role of specific gut microbes in shaping body composition remains unclear.
Kaplanmeier morbidityfree survival curves and birth weight disc. A policy of expectant management until 32 weeks of gestation in 29 dichorionic pregnancies discordant for growth retardation resulted in an overall mortality of 24% 95% ci. Kwashiorkor, an enigmatic form of severe acute malnutrition, is the consequence of inadequate nutrient intake plus additional environmental insults. Twin pregnancies resulting from assisted reproductive treatments art are particularly affected by this condition 6. There are a number of drawbacks and limitations with the approach taken. Abdominal perimeter measurement differences of 20 mm or greater were more sensitive and specific than bpd difference in detecting twins with dissimilar birth weights. Although our ability to identify discordant twins is limited, once suspected and at viable gestational age, these pregnancies should have antepartum testing. A free powerpoint ppt presentation displayed as a flash slide show on. Ppt twintotwin transfusion syndrome ttts powerpoint. Prediction of discordant twins using ultrasound measurement. Jan 25, 20 the total risk of perinatal loss stillbirth and neonatal death in twins with a bw discordance of. Intrauterine growth pattern and birthweight discordance in twin. Gut microbiota from twins discordant for obesity modulate.
Delivery decisions in discordant dcda twins with single fetal. Conclusion there is a dearth of evidence on the optimal timing of deliver of discordant dcda twins with growth restriction in one fetus. Increased total body and fat mass, as well as obesityassociated metabolic phenotypes, were. It is well established that epigenetic states can contribute to phenotypic variation, including disease. Gut microbiomes of malawian twin pairs discordant for. Pdf discordant twins as a tool to unravel the aetiology of. Definition of intertwin birth weight discordance rcsi student. With the advent of single nucleotide marker snp microarrays that assay up to.
It is clear that diagnosis of discordant growth has improved due to the use of serial ultrasound. To compare neonatal morbidity and mortality between hospitalized discordant and concordant preterm twin pairs. A quantitative intrapair difference was found for all but two of the behavioral measures, with the largest effect size for the srs2 total score r0. G fetal and neonatal mortality among twin gestations in the united states. Pdf liver and pancreatic fat content and metabolism in. Pregnancy outcomes of discordant twin pairs were compared between the two. We identified 14 risk factors for divergent growth. It is estimated that czs occurs in 140% of cases of pregnant women infected by zikv. In dichorionic twins discordant for anencephaly, there are three management options. Group 1 discordant twins differed only for structural constituent of ribosome go. Mar 09, 2021 genetics, notably pathogenic genetic variants in sarcomere protein genes, play a major role in development of hypertrophic cardiomyopathy hcm. In the metaanalysis of 15 twin pairs discordant for lcssc, 153 cytosines showed suggestive differential methylation p twin pairs, most of which mapped to gene bodies 117, 77% of 115 distinct genes additional file 2. The statistical test showed that the proportion of preterm twin pairs in the extremely discordant twin pairs 10 out of 17 or 58.
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