(743) Intra-uterine growth restriction and long-term cardiovascular morbidity of offspring in dichorionic diamniotic twin pregnancies

Placental- related complications such as preeclampsia and intra uterine growth restriction (IUGR) in singletons were noted as risk factors for long- term cardiovascular morbidity of both the mother and the child. Due to the relatively high prevalence of IUGR among twin pregnancies, we opted to investigate whether IUGR in dichorionic diamniotic twins is a risk factor for long- term cardiovascular morbidity of the offspring.

Study Design: A population-based retrospective cohort study, comparing the long-term cardiovascular morbidity among IUGR and non IUGR twins, born between the years 1991-2021 in a tertiary medical center, was conducted. Twins with congenital malformations or chromosomal abnormalities were excluded from the study. The study groups were followed until 18 years of age for cardiovascular-related morbidity. A Kaplan-Meier survival curve was used to compare cumulative cardiovascular morbidity incidence, and a multivariable Cox proportional hazard model was used to adjust for confounders.

Results:

During the study period 4,222 dichorionic diamniotic twin newborns were included of which 116 were complicated with IUGR of one or both twins. IUGR twins demonstrated a significantly higher rate of long-term cardiovascular morbidity (4.3% vs. 1.3% p=0.006, Table). Likewise, the cumulative incidence of long-term cardiovascular morbidity was significantly higher among IUGR twins (Kaplan-Meier survival curve Log rank p=0.008, Figure). In the Cox proportional hazard regression model, an independent association was found between IUGR and long-term cardiovascular morbidity, after adjusting for birth order and gender (adjusted HR 3.2, 95% CI 1.29-1.8.11, p=0.012).

Conclusion: Intra uterine growth restriction in dichorionic diamniotic twins is independently associated with an increased risk of long-term cardiovascular morbidity.