Association between chorionicity and preterm birth in twin pregnancies: a systematic review involving 29 864 twin pregnancies

Shemoon Marleen*, Chamalika Dias, Ruvini Nandasena, Rebecca MacGregor, John Allotey, Joseph Aquilina, Asma Khalil, Shakila Thangaratinam

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)
15 Downloads (Pure)

Abstract

Background: The perinatal mortality and morbidity among twins vary by chorionicity. Although it is considered that monochorionicity is associated with an increased risk of preterm birth in twin pregnancies, no systematic review exists evaluating this association.

Objectives: This systematic review was undertaken to assess the association between preterm birth and chorionicity in twin pregnancies.

Search strategy: We searched the electronic databases from January 1990 to July 2019 without language restrictions.

Selection criteria: All studies on twin pregnancies where chorionicity and preterm birth were evaluated were included.

Data collection and analysis: Findings are reported as odds ratios with 95% confidence intervals. The estimates are pooled using random-effects meta-analysis.

Main results: From 13 156 citations, we included 39 studies (29 864 pregnancies). Monochorionicity was significantly associated with increased risk of preterm birth at ≤28, ≤32, ≤34 and <37 weeks in women asymptomatic and symptomatic for preterm labour (odds ratio [OR] 2.14, 95% CI 1.52–3.02, I2 = 46%, OR 1.55, 95% CI 1.27–1.89 I2 = 68%, OR 1.47, 95% CI 1.27–1.69, I2 = 60%, OR 1.66, 95% CI 1.43–1.93, I2 = 65%, respectively). Among those asymptomatic for preterm labour, significantly increased odds of preterm birth were seen for monochorionicity at gestations ≤34 weeks (OR 1.85, 95% CI 1.42–2.40, I2 = 25%) and <37 weeks (OR 1.75, 95% CI 1.22–2.53, I2 = 61%). Sensitivity analysis showed significantly increased odds of spontaneous preterm birth at ≤34 and <37 weeks for monochorionicity (OR 1.25, 95% CI 1.01–1.55, I2 = 0% and OR 1.41, 95% CI 1.13–1.78, I2 = 0%).

Conclusions: Monochorionicity is significantly associated with preterm birth at all gestations.

Tweetable abstract: In twin pregnancies, monochorionicity is associated with an increased risk of preterm birth at all gestations.
Original languageEnglish
Pages (from-to)788-796
Number of pages9
JournalBJOG: An International Journal of Obstetrics & Gynaecology
Volume128
Issue number5
Early online date5 Sept 2020
DOIs
Publication statusPublished - Apr 2021

Bibliographical note

Publisher Copyright:
© 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd

Keywords

  • Chorionicity
  • multiple pregnancy
  • preterm birth
  • preterm labour
  • twins
  • ultrasound predictors

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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