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OC15.04: Vascular development and responses in twins: influence of monochorionicity, inter‐twin transfusion and fetal therapy

2010; Wiley; Volume: 36; Issue: S1 Linguagem: Inglês

10.1002/uog.7860

1469-0705

H. M. Gardiner, Hikoro Matsui, Kurt Hecher, Anke Diemert, M. J. Taylor, Samuel Greenwald, Alex Barlas, J. B. Preece, Fabiana Gordon,

Pregnancy and preeclampsia studies

To compare blood pressure and vascular responses in 10 year follow-up case-control study of 66 twins; 18 twin–twin transfusion syndrome (TTTS) treated prenatally by amnioreduction or laser (22), 14 monochorionic (MCDA) and 12 dichorionic (DCDA) controls. Arm and aortic arterial stiffness were derived from pulse wave velocity (PWV) recorded non-invasively using reflectance photoplethysmography. Resting microcirculation (flux) and post-occlusive reactive hyperaemia (PORH) were measured using laser Doppler. Mixed models methodology analysed interaction effects. Considering current size, PWV was significantly higher in MCDA than amnioreduction (P = 0.015) and laser (P = 0.049). Discordant intra-twin pair PWV remained a feature of TTTS with trend to higher values in ex-donors than recipients in the amnioreduction group and the reverse in laser group. Systolic and diastolic blood pressures were higher in DCDA than MCDA and all TTTS (P < 0.01). Good weight gain resulted in lower blood pressure. Changes in diastolic blood pressure tracked from the initial study were positive in amnioreduction and MCDA and negative in laser and DCDA. All monochorionic twins (MCDA and TTTS, regardless of treatment), showed increased resting flux vs. DCDA (P < 0.05) and the twin born heavier had higher flux than its lighter co-twin (P = 0.027). POHR was greater in DCDA vs. amnioreduction and MCDA (P = 0.007), but similar to laser (P = 0.13), where hyperaemic response was slower (P = 0.047). Monochorionic twins had lower blood pressure and arterial compliance and higher resting vasodilatation than DCDA implying shared fetal circulation results in altered vascular development. The influence of laser therapy on TTTS resulting in differing PWV, diastolic blood pressure tracking patterns, flux and POHR suggests a beneficial effect of laser therapy on subsequent vascular health in childhood.