Increased Risk of Congenital Heart Disease in Twins in the North of England Between 1998 and 2010

Overview

Journal Heart

Date 2015 Sep 29

PMID 26412859

Citations 17

Authors

K E Best

J Rankin

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the relative risk (RR) of congenital heart disease (CHD) in twins compared with singletons, according to chorionicity.

Methods: Twins and singletons with CHD notified to the Northern Congenital Abnormality Survey between 1998 and 2010 were included in this population-based study. Information on chorionicity was obtained from the Northern Survey of Twins and Multiple Pregnancy. Prevalence was calculated as the number of cases occurring in live births, late miscarriages (20-23 weeks), stillbirths (≥24 weeks) and terminations of pregnancy for fetal anomaly, per 10 000 total births. The risk of CHD in twins compared with singletons was estimated using Poisson regression.

Results: There were 399 414 singleton births of which 2984 (0.7%) had CHD. Among 11 871 twin births, 154 (1.3%) had CHD; one twin was affected by CHD in 2.5% of twin pregnancies. Of 8605 dichorionic (DC) births and 2317 monochorionic (MC) births, 96 (1.1%) and 47 (2.0%) were associated with CHD. Compared with singletons, twins were at significantly increased risk of CHD (RR=1.73, 95% CI 1.48 to 2.04; p<0.001). MC twins were at 82% significantly increased risk of CHD compared with DC twins (RR=1.82, 95% CI 1.29 to 2.57; p<0.001). The RR of severe and mild CHD was particularly high in MC twins compared with singletons (292% increased risk, RR=3.92, 95% CI 1.25 to 12.30, p=0.02 and 207% increased risk, RR=3.07, 95% CI 2.20 to 4.28; p<0.001).

Conclusions: Compared with singletons, twins were at increased risk of CHD, the risk being substantially higher among MC twins. This information is important for health professionals when counselling women with twin pregnancies.

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References

Herskind A, Pedersen D, Christensen K . Increased prevalence of congenital heart defects in monozygotic and dizygotic twins. Circulation. 2013; 128(11):1182-8. DOI: 10.1161/CIRCULATIONAHA.113.002453. View

Khoshnood B, Loane M, Garne E, Addor M, Arriola L, Bakker M . Recent decrease in the prevalence of congenital heart defects in Europe. J Pediatr. 2012; 162(1):108-13.e2. DOI: 10.1016/j.jpeds.2012.06.035. View

Karatza A, Wolfenden J, Taylor M, Wee L, Fisk N, Gardiner H . Influence of twin-twin transfusion syndrome on fetal cardiovascular structure and function: prospective case-control study of 136 monochorionic twin pregnancies. Heart. 2002; 88(3):271-7. PMC: 1767329. DOI: 10.1136/heart.88.3.271. View

Lopriore E, Bokenkamp R, Rijlaarsdam M, Sueters M, Vandenbussche F, Walther F . Congenital heart disease in twin-to-twin transfusion syndrome treated with fetoscopic laser surgery. Congenit Heart Dis. 2008; 2(1):38-43. DOI: 10.1111/j.1747-0803.2007.00070.x. View

Herberg U, Gross W, Bartmann P, Banek C, Hecher K, Breuer J . Long term cardiac follow up of severe twin to twin transfusion syndrome after intrauterine laser coagulation. Heart. 2005; 92(1):95-100. PMC: 1860975. DOI: 10.1136/hrt.2004.057497. View

Li S, Ford N, Meister K, Bodurtha J . Increased risk of birth defects among children from multiple births. Birth Defects Res A Clin Mol Teratol. 2004; 67(10):879-85. DOI: 10.1002/bdra.10093. View

Hook E . Rates of chromosome abnormalities at different maternal ages. Obstet Gynecol. 1981; 58(3):282-5. View

Tararbit K, Houyel L, Bonnet D, De Vigan C, Lelong N, Goffinet F . Risk of congenital heart defects associated with assisted reproductive technologies: a population-based evaluation. Eur Heart J. 2010; 32(4):500-8. DOI: 10.1093/eurheartj/ehq440. View

Boyle B, McConkey R, Garne E, Loane M, Addor M, Bakker M . Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984-2007. BJOG. 2013; 120(6):707-16. DOI: 10.1111/1471-0528.12146. View

10.

Glinianaia S, Rankin J, Sturgiss S, Platt M, Crowder D, Bell R . The North of England Survey of Twin and Multiple Pregnancy. Twin Res Hum Genet. 2012; 16(1):112-6. DOI: 10.1017/thg.2012.65. View

11.

Snijders R, Sebire N, Nicolaides K . Maternal age and gestational age-specific risk for chromosomal defects. Fetal Diagn Ther. 1995; 10(6):356-67. DOI: 10.1159/000264259. View

12.

Cedergren M, Kallen B . Obstetric outcome of 6346 pregnancies with infants affected by congenital heart defects. Eur J Obstet Gynecol Reprod Biol. 2005; 125(2):211-6. DOI: 10.1016/j.ejogrb.2005.07.006. View

13.

Tang Y, Ma C, Cui W, Chang V, Ariet M, Morse S . The risk of birth defects in multiple births: a population-based study. Matern Child Health J. 2005; 10(1):75-81. DOI: 10.1007/s10995-005-0031-5. View

14.

Pharoah P . Causal hypothesis for some congenital anomalies. Twin Res Hum Genet. 2005; 8(6):543-50. DOI: 10.1375/183242705774860141. View

15.

Mastroiacovo P, Castilla E, Arpino C, Botting B, Cocchi G, Goujard J . Congenital malformations in twins: an international study. Am J Med Genet. 1999; 83(2):117-24. DOI: 10.1002/(sici)1096-8628(19990312)83:2<117::aid-ajmg7>3.0.co;2-4. View

16.

Bahtiyar M, Dulay A, Weeks B, Friedman A, Copel J . Prevalence of congenital heart defects in monochorionic/diamniotic twin gestations: a systematic literature review. J Ultrasound Med. 2007; 26(11):1491-8. DOI: 10.7863/jum.2007.26.11.1491. View

17.

Richards A, Garg V . Genetics of congenital heart disease. Curr Cardiol Rev. 2011; 6(2):91-7. PMC: 2892081. DOI: 10.2174/157340310791162703. View

18.

Forrester M, Merz R . Descriptive epidemiology of selected congenital heart defects, Hawaii, 1986-1999. Paediatr Perinat Epidemiol. 2004; 18(6):415-24. DOI: 10.1111/j.1365-3016.2004.00594.x. View

19.

Bruneau B . The developmental genetics of congenital heart disease. Nature. 2008; 451(7181):943-8. DOI: 10.1038/nature06801. View

20.

Glinianaia S, Rankin J, Wright C . Congenital anomalies in twins: a register-based study. Hum Reprod. 2008; 23(6):1306-11. DOI: 10.1093/humrep/den104. View