Sang Hwa Park; Jae Jun Shin; Hoon Kim; Dar Oh Lim

doi:10.14734/kjp.2015.26.3.229

Journal List > Korean J Perinatol > v.26(3) > 1013758

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park, Shin, Kim, and Lim: The Discordance of Intra-twin Birth Weight by Infantile Gender and Birth Order in Korea; 2008–2013

Original Article

Korean J Perinatol 2015;26(3):229-236.

Published online: 20 September 2015

DOI: https://doi.org/10.14734/kjp.2015.26.3.229

The Discordance of Intra-twin Birth Weight by Infantile Gender and Birth Order in Korea; 2008–2013

Sang Hwa Park¹, Jae Jun Shin², Hoon Kim^1,², Dar Oh Lim^3,

¹Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea

²Department of Obstetrics and Gynecology, Seoul National University Hoapital, Seoul, Korea

³Department of Health Administration, Kongju National University, Kongju, Korea

Correspondence to: Dar Oh Lim, PhD Department of Health Administration, Kongju National University, 56 Gongjudaehak-ro, Gongju 32588, Korea Tel: +82-41-850-0327, Fax: +82-41-850-0320 E-mail: moon5@kongju.ac.kr

Received 31 July 2015 Revised 25 September 2015 Accepted 30 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the incidence of intra-twin birth weight discordance and its association with infantile gender and birth order.

Methods

We used the data of birth from 2008 to 2013 of Korea Statistics (38,140 pairs of twins). Adjusted logistic regression analyses were performed to describe the birth weight discordance (≥25%) according to infantile gender and birth order (twin A: 1st, twin B: 2nd). Birth weight discordance was calculated as 100 x (birth weight difference/birth weight of the heavier twin).

Results

Twin A (mean 2.431 kg) was heavier than twin B (mean 2.359 kg), and the weight difference was 0.281 kg on average. Overall incidence of birth weight discordance was 8.3 percent. The incidence of discordance was 8.8 percent among unlike-sexed pairs and 8.0 percent among like-sexed pairs. Twins with birth weight A≥B (10.2 percent) showed higher incidence of discordance than twins with birth weight A<B (5.4 percent), with an odds ratio (OR) of 1.870 (95% confidence interval (CI): 1.719–2.034). Unlike-sexed twins were associated with higher probability of discordance compared to like-sexed twins (OR 1.456, 95% CI: 13.10–1.619). Odds ratio of discordance was 2.918 (2.502–3.403) in unlike-sexed twins (male-female) with birth weight (A≥B) as compared to like-sexed twins (female-female) with birth weight (A<B).

Conclusion

Birth weight discordance was associated with unlike-sexed twin pairs and difference of inter-twin birth weight by birth order. However, close attention should be paid to the discordance of twin body weight to reduce the risk of adverse outcome.

Keywords: Twin birth, Birth weight discordance, Deciles

References

1. Blickstein I, Lancet M. The growth discordant twin. Obstet Gynecol Surv. 1988; 43:509–15.

2. Vergani P, Locatelli A, Ratti M, Scian A, Pozzi E, Pezzullo JC, et al. Preterm twins: what threshold of birth weight discordance heralds major adverse neonatal outcome? Am J Obstet Gynecol. 2004; 191:1441–5.

3. Hollier LM, McIntire DD, Leveno KJ. Outcome of twin pregnancies according to intrapair birth weight differences. Obstet Gynecol. 1999; 94:1006–10.

4. Blickstein I, Keith LG. Neonatal mortality rates among growth-discordant twins, classified according to the birth weight of the smaller twin. Am J Obstet Gynecol. 2004; 190:170–4.

5. Tan H, Wen SW, Fung Kee Fung K, Walker M, Demissie K. The distribution of intratwin birth weight discordance and its association with total twin birth weight, gestational age, and neonatal mortality. Eur J Obstet Gynecol Reprod Biol. 2005; 121:27–33.

6. Jacobs AR, Demissie K, Jain NJ, Kinzler WL. Birth weight discordance and adverse fetal and neonatal outcomes among triplets in the United States. Obstet Gynecol. 2003; 101:90914.

7. Buckler JM, Green M. Birth weight discordance of twin pairs and their subsequent growth patterns. Ann Hum Biol. 2011; 38:271–80.

8. Park SH, Kim TJ, Moon SY, Kim SH. Study on Trends of Multiple Birth in Korea: 1982–1998. Korean J Perinatol. 2001; 12:449–52.

9. Park SH, Chun DW, Kim JS, Han JH. Secular on Trends of Twin Births in Korea: 1981–2006. Journal of Reproductive Medicine and Population. 2009; 22:152–8.

10. Yang SH, Park SH, Choi SM, Seo YS, Roh JR, Jeong JH. A comparison of perinatal outcomes according to the degrees of birth weight discordance in twin gestations. Korean J Obstet Gynecol. 1998; 41:2312–7.

11. Lim JE, Park SH, Cho KM, Sul HJ, Kim T, Kim HJ, et al. Perinatal outcomes according to intrapair birth weight difference in twin gestations. Korean J Obstet Gynecol. 2003; 46:509–13.

12. Lee KJ, Hur J, Yoo J. Twin weight discordance and maternal weight gain in twin pregnancies. Int J Gynaecol Obstet. 2007; 96:176–80.

13. Lim DO, Kim JS, Chun DW, Han JH, Park SH. Secular trends of home and hospital births in Korea. The Journal of Reproductive Medicine and Population. 2012; 25:95–103.

14. Lim DO, Park SH. Risk Factors for Preterm Birth and Low Birth Weight in Extramarital Birth: 2008–2012 Birth Certificated Data. The Korean Society of Health Service Management. 2014; 8:137–45.

15. Orlebeke JF, van Baal GC, Boomsma DI, Neeleman D. Birth weight in opposite sex twins as compared to same sex dizygotic twins. Eur J Obstet Gynecol Reprod Biol. 1993; 50:95–8.

16. Blickstein I, Goldman RD, Smith-Levitin M, Greenberg M, Sherman D, Rydhstroem H. The relation between inter-twin birth weight discordance and total twin birth weight. Obstet Gynecol. 1999; 93:113–6.

17. Miller J, Chauhan SP, Abuhamad AZ. Discordant twins: diagnosis, evaluation and management. Am J Obstet Gynecol. 2012; 206:10–20.

18. Kontopoulos EV, Ananth CV, Smulian JC, Vintzileos AM. The influence of mode of delivery on twin neonatal mortality in the US: variance by birth weight discordance. Am J Obstet Gynecol. 2005; 192:252–6.

19. Bagchi S, Salihu HM. Birth weight discordance in multiple gestations: occurrence and outcomes. J Obstet Gynaecol. 2006; 26:291–6.

20. Blickstein I, Goldman RD, Mazkereth R. Adaptive growth restriction as a pattern of birth weight discordance in twin gestations. Obstet Gynecol. 2000; 96:986–90.

21. Mazher SB, Kanwal S. Twin birth weight discordance: associated factors and outcome. J Coll Physicians Surg Pak. 2010; 20:391–4.

22. Amaru RC, Bush MC, Berkowitz RL, Lapinski RH, Gaddipati S. Is discordant growth in twins an independent risk factor for adverse neonatal outcome? Obstet Gynecol. 2004; 103:71–6.

23. Lim DO, Han JH, Park SH. Method of Delivery in Korean Singleton Birth, 2003–2012. Journal of Reproductive Medicine and Population. 2014; 27:95–102.

24. Eberle AM, Levesque D, Vintzileos AM, Egan JF, Tsapanos V, Salafia CM. Placental pathology in discordant twins. Am J Obstet Gynecol. 1993; 169:931–5.

25. Luke B, Hediger M, Min SJ, Brown MB, Misiunas RB, Gonzalez-Quintero VH, et al. Gender mix in twins and fetal growth, length of gestation and adult cancer risk. Paediatr Perinat Epidemiol. 2005; 19(Suppl 1):41–7.

26. Harper LM, Weis MA, Odibo AO, Roehl KA, Macones GA, Cahill AG. Significance of growth discordance in appropriately grown twins. Am J Obstet Gynecol. 2013; 208:393. e1–5.

27. Ananth CV, Demissie K, Hanley ML. Birth weight discordancy and adverse perinatal outcomes among twin gestations in the United States: the effect of placental abruption. Am J Obstet Gynecol. 2003; 188:954–60.

28. Wen SW, Tan H, Yang Q, Walker M. Prediction of intratwin birth weight discordance by binary logistic regression analysis. Gynecol Obstet Invest. 2006; 62:186–92.

29. Sannoh S, Demissie K, Balasubramanian B, Rhoads GG. Risk factors for intrapair birth weight discordance in twins. J Matern Fetal Neonatal Med. 2003; 13:230–6.

30. Tobe RG, Mori R, Shinozuka N, Kubo T, Itabashi K. Birthweight discordance, risk factors and its impact on perinatal mortality among Japanese twins: data from a national project during 2001–2005. Twin Res Hum Genet. 2010; 13:490–4.

Table 1.

Mean Birth Weight of Inter-twin, and Mean Difference of Inter-twin Birth Weight by Birth Order and Infantile Gender, 2008–2013

Infantile gender	N	Mean birth weight by birth order (kg)			Mean difference of inter-twins birth weight (kg)			Mean discordance (%)^∗,†
Infantile gender	N	Twin A	Twin B	Twin A+B^†	Heavier twin	Lighter twin	Difference^†	Mean discordance (%)^∗,†
Male-male	12,503	2.464	2.399	4.863	2.570	2.293	0.277^‡	10.8
Female-female	12,181	2.382	2.315	4.698	2.482	2.215	0.267	10.8
Male-female	6,786	2.495	2.311	4.807^‡	2.560	2.247	0.313	12.2
Female-male	6,670	2.393	2.413	4.806^‡	2.544	2.261	0.282^‡	11.1
Total	38,140	2.431	2.359	4.79	2.536	2.254	0.281	11.1

^∗ Birth weight discordance (%) = birth weight difference/birth weight of heavier twinx100.

^† ANOVA test,P<0.01.

^‡ Non-significant difference between groups by post hoc multiple comparison (least significant difference, LSD).

Table 2.

Birth Weight Discordance of ≥25% Percent in Inter-twin by Total Twin Birth Weight Deciles

Deciles^∗	Birth weight discordance (%)			≥25% discordance by birth order^† [% (n)]		≥25% discordance by infantile gender [% (n)]
Deciles^∗	≤24	≥25	Total (n)	A < B	A ≥ B	Like-sex	Unlike-sex
First	79.6	20.4	100.0 (3,821)	13.5 (1,602)	25.3 (2,219)	21.2 (2,540)	18.7 (1,281)
Second	85.1	14.9	100.0 (3,856)	9.7 (1.490)	18.1 (2.366)	14.8 (2,518)	15.0 (1.338)
Third	89.0	11.0	100.0 (3,918)	6.5 (1,493)	13.7 (2,425)	10.4 (2,599)	12.1 (1,319)
Fourth	91.8	8.2	100.0 (3,776)	5.0 (1,472)	10.3 (2,304)	7.3 (2,477)	9.9 (1,299)
Fifth	93.5	6.5	100.0 (3,797)	4.7 (1,471)	7.7 (2,326)	5.9 (2,475)	7.7 (1,322)
Sixth	94.2	5.8	100.0 (4,035)	3.3 (1,537)	7.4 (2,498)	5.3 (2,548)	6.8 (1,487)
Seventh	94.8	5.2	100.0 (3,644)	3.4 (1,411)	6.3 (2,233)	4.7 (2,331)	6.0 (1,313)
Eighth	96.2	3.8	100.0 (3,731)	2.9 (1,609)	4.5 (2,122)	3.2 (2,382)	5.0 (1,349)
Ninth	95.9	4.1	100.0 (3,867)	3.1 (1,597)	4.8 (2,270)	3.4 (2,400)	5.2 (1,467)
Tenth	97.6	2.4	100.0 (3,695)	2.2 (1,618)	2.6 (2,077)	2.2 (2,414)	2.8 (1,281)
Total	91.7	8.3	100.0 (38,140)	5.4 (15,300)	10.2 (22,840)	8.0 (24,684)	8.8 (13,456)

^∗ Total twin birth weight deciles.

^† A≥B: heavier twin A (1st birth order), A<B: heavier twin B (2nd birth order).

Table 3.

Odds Ratio of ≥25 Percent Discordance of Inter-twin Birth Weight by Birth Order and Infantile Gender

Variables	Discordance of inter-twin birth weight (%)		Odds ratio of ≥25% discordance^† (95% confidence interval)
Variables	≤24	≥25	Odds ratio of ≥25% discordance^† (95% confidence interval)
Weight difference of birth order^∗
Twin A<B^‡	94.6	5.4	1.000
Twin A≥B	89.8	10.2	1.870 (1.719–2.034)^∮
Infantile gender
Male-male	91.9	8.1	1.265 (1.151–1.391)^∮
Female-female^‡	92.2	7.8	1.000
Male-female	89.6	10.4	1.456 (1.310–1.619)^∮
Female-male	92.8	7.2	1.110 (0.987–1.247)

^∗ Logistic regression adjusted by maternal and others variables. Twin A (1st birth order), twin B (2nd birth order).

^† Odds ratio: logistic regression adjusted by maternal age (20, 25, 30, 35, 40), maternal occupation (none=1, yes=0), education (≤ middle=1, high=2, college & university=3), total twin birth weight deciles (1–10), gestational age (21–43 weeks), and year of birth (2008–2013).

^‡ Reference group.

^∮ P<0.01.

Table 4.

Odds Ratio of ≥25 Percent Discordance in Inter-twin Birth Weight by Infantile Gender & Birth Order

Infantile gender by weight difference of birth order	Discordance of inter-twin birth weight (%)		Odds ratio of ≥25% discordance^∗ (95% confidence interval)
Infantile gender by weight difference of birth order	≤24	≥25	Odds ratio of ≥25% discordance^∗ (95% confidence interval)
Male-male (A<B)	94.4	5.6	1.291 (1.083–1.540)^‡
Male-male (A≥B)	90.2	9.8	2.313 (1.992–2.686)^‡
Female-female (A<B)^†	94.7	5.3	1.000
Female-female (A≥B)	90.4	9.6	1.841 (1.585–2.139)^‡
Male-female (A<B)	95.4	4.6	0.944 (0.731–1.219)
Male-female (A≥B)	87.4	12.6	2.918 (2.502–3.403)^‡
Female-male (A<B)	94.1	5.9	1.299 (1.073–1.573)^‡
Female-male (A≥B)	91.3	8.7	1.828 (1.529–2.185)^‡

^∗ Logistic regression adjusted by maternal and others variables. Odds ratio: logistic regression adjusted by maternal age (20, 25, 30, 35, 40 years), maternal occupation (none=1, yes=0), education (≤ middle=1, high=2, college & university=3), total twin birth weight deciles (1–10), gestational age (21–43 weeks), and year of birth (2008–2013).

^† Reference group.

^‡ P<0.01.

TOOLS

Similar articles