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Nutritional Supplementation in Monochorionic Diamniotic Twin Pregnancies: Impact on Twin–Twin Transfusion Syndrome
21 October 2008 (online)
Twin-to-twin transfusion syndrome (TTTS) has been related to unbalanced unidirectional arteriovenous anastomoses in the placenta of monochorionic diamniotic (DiMo) twin gestations. As maternal malnutrition accounting for hypoproteinemia and anemia has been detected in severe cases of TTTS, the purpose of this study was to evaluate the impact of early diet supplementation on TTTS. Fifty-one DiMo twin pregnancies were given commercially available oral nutritional diet supplements and then compared in a retrospective cohort study to 52 twin gestations with the same chorionicity but not subjected to nutritional supplementation. Diet supplementation was associated with lower overall incidence of TTTS (20/52 versus 8/51, p = 0.02) and with lower prevalence of TTTS at delivery (18/52 versus 6/51, p = 0.012) when compared with no supplementation. Nutritional intervention also significantly prolonged the time between the diagnosis of TTTS and delivery (9.4 ± 3.7 weeks versus 4.6 ± 6.5 weeks; p = 0.014). The earlier nutritional regimen was introduced, the lesser chance of detecting TTTS (p = 0.001). Although not statistically significant, dietary intervention was also associated with lower Quintero stage, fewer invasive treatments, and lower twin birth weight discordance. Diet supplementation appears to counter maternal metabolic abnormalities in DiMo twin pregnancies and improve perinatal outcomes in TTTS when combined with the standard therapeutic options.
Twin-to-twin transfusion syndrome - nutritional supplementation - pregnancy outcome - diamniotic monochorionic twins
- 1 Quintero R A.
Pathophysiology. In: Quintero RA Twin-Twin Transfusion Syndrome. Colchester, UK; Informa 2007: 17-27
- 2 Sperling L, Kiil C, Larsen L U et al.. Detection of chromosomal abnormalities, congenital abnormalities and transfusion syndrome in twins. Ultrasound Obstet Gynecol. 2007; 29 517-526
- 3 Norton M E. Evaluation and management of twin-twin transfusion syndrome: still a challenge. Am J Obstet Gynecol. 2007; 196 419-420
- 4 Dickinson J E, Evans S F. Obstetrics and perinatal outcomes from the Australian and New Zealand twin-twin transfusion syndrome registry. Am J Obstet Gynecol. 2000; 182 706-712
- 5 Galea P, Jain V, Fisk N M. Insights into the pathophysiology of twin-twin transfusion syndrome. Prenat Diagn. 2005; 25 777-785
- 6 Robyr R, Quarello E, Ville Y. Management of fetofetal transfusion syndrome. Prenat Diagn. 2005; 25 786-795
- 7 Quintero R A, Dickinson J E, Morales W J et al.. Stage based treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2003; 188 1333-1340
- 8 Senat M V, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004; 351 136-144
- 9 Luke B. Nutrition and multiple gestation. Semin Perinatol. 2005; 29 349-354
- 10 De Lia J E, Kuhlmann R S, Emery M G. Maternal metabolic abnormalities in twin-to-twin transfusion syndrome at mid-pregnancy. Twin Res. 2000; 3 113-117
- 11 De Lia J E, Carr M H. Twin-twin transfusion syndrome. UpToDate Web Site. 2008. http://Available at: www.uptodate.com Accessed February 14, 2008
- 12 Quintero R A, Morales W J, Allen M H, Bornick P W, Johnson P K, Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol. 1999; 19 550-555
- 13 Sibley C P, Boyd R D.
Mechanisms of transfer across the human placenta. In: Polin RA, Fox WW Fetal and Neonatal Physiology. Philadelphia; W.B. Saunders 1992: 62-74
- 14 Pitkin R M, Reynolds W A, Williams G A, Hargis G K. Calcium metabolism in normal pregnancy: a longitudinal study. Am J Obstet Gynecol. 1979; 133 781-790
- 15 Robertson E G, Cheyne G A. Plasma biochemistry in relation to oedema of pregnancy. J Obstet Gynecol British Commonwealth. 1972; 79 769-776
- 16 Wu P Y, Udani V, Chan L, Miller F C, Hennenman C E. Colloid osmotic pressure: variations in normal pregnancy. J Perinat Med. 1983; 11 193-199
- 17 Lopriore E, van Wezel-Meijler G, Middeldorp J M et al.. Incidence, origin and character of cerebral injury in twin to twin transfusion syndrome treated with fetoscopic laser surgery. Am J Obstet Gynecol. 2006; 194 1215-1220
- 18 Cavicchioni O, Yamamoto M, Robyr R, Takahashi Y, Ville Y. Intrauterine fetal demise following laser treatment in twin-to-twin transfusion syndrome. BJOG. 2006; 113 590-594
- 19 Yamamoto M, El Murr L, Robyr R, Leleu F, Takahashy Y, Ville Y. Incidence and impact of perioperative complications in 175 fetoscopy-guided laser coagulations of chorionic plate anastomoses in fetofetal transfusion syndrome before 26 weeks of gestation. Am J Obstet Gynecol. 2005; 193 1110-1116
Giuseppe Chiossi, M.D.
Allegheny General Hospital
7th Floor South Tower, 320 East North Avenue, Pittsburgh, PA 15212
Email: [email protected]