Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-26T17:57:13.108Z Has data issue: false hasContentIssue false
  • English
  • Français

Vascular programming in twins: the effects of chorionicity and fetal therapy for twin-to-twin transfusion syndrome†

Published online by Cambridge University Press:  20 March 2012

H. M. Gardiner ,
A. Barlas ,
H. Matsui ,
A. Diemert ,
M. J. O. Taylor ,
J. Preece ,
F. Gordon ,
S. E. Greenwald  and
K. Hecher
H. M. Gardiner*
Affiliation:
Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, UK Royal Brompton NHS Foundation Trust Hospital, London, UK
A. Barlas
Affiliation:
Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, London, UK
H. Matsui
Affiliation:
Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, UK Royal Brompton NHS Foundation Trust Hospital, London, UK
A. Diemert
Affiliation:
Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg-Eppendorf, Germany
M. J. O. Taylor
Affiliation:
Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, UK
J. Preece
Affiliation:
Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, UK
F. Gordon
Affiliation:
Statistical Advisory Service, Imperial College, London, UK
S. E. Greenwald
Affiliation:
Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, London, UK
K. Hecher
Affiliation:
Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg-Eppendorf, Germany
*
*Address for correspondence: Dr H. M. Gardiner, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London W12 0HS, UK. (Email [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

We assessed vascular programming in genetically identical monochorionic twin pairs with twin-to-twin transfusion syndrome (TTTS) treated differently in utero by serial amnioreduction or fetal laser arterial photocoagulation. This case–control study re-assessed four twin groups at median 11 years comprising 20 pairs of monochorionic diamniotic twins: nine treated by amnioreduction (TTTS-amnio) and eleven by laser (TTTS-laser) with seven monochorionic and six dichorionic control pairs. Outcome measures were current blood pressure (BP), brachio-radial arterial stiffness derived from pulse wave velocity (PWV), resting microcirculation (Flux) and response to heating and post-occlusive reactive hyperaemia measured using laser Doppler. Potential confounders [PWV and BP at first study, current height, weight, heart rate and twin type (ex-recipient, ex-donor or heavier/lighter of pair)] were accounted for by Mixed Linear Models statistical methodology. PWV dichorionic > monochorionic (P = 0.024); systolic and diastolic BP dichorionic > TTTS-amnio and TTTS-laser (P = 0.004, P = 0.02 and P = 0.005, P = 0.02, respectively). Within-twin pair pattern of PWV discordance was similar in laser treated and dichorionic controls (heavier-born > lighter), opposite to TTTS-amnio and monochorionic controls. Flux monochorionic > dichorionic (P = 0.044) and heavier > lighter-born (P = 0.024). TTTS-laser and dichorionic diamniotic showed greatest hyperaemic responses (dichorionic > TTTS-amnio or monochorionic controls (P = 0.007, P = 0.025). Hyperaemic responses were slower in heavier-born twins (P = 0.005). In summary, monochorionic twins had lower BP, arterial stiffness and increased resting vasodilatation than dichorionic twins implying shared fetal circulation affects vascular development. Vascular responses in laser-TTTS were similar to dichorionic and opposite to TTTS-amnio suggesting a lasting effect of fetal therapy on vascular health.

Keywords

arterial stiffnessblood pressuremicrocirculationmonochorionic twinsvascular programming
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 3 , Issue 3 , June 2012 , pp. 182 - 189
Copyright
Copyright © Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

†

Study performed at Queen Charlotte's and Chelsea Hospital, Imperial College London, UK and Department of Obstetrics and Fetal Medicine, University Medical Centre, Hamburg-Eppendorf, Germany.

References

1. Denbow, ML, Cox, P, Taylor, M, et al. . Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. Am J Obstet Gynecol. 2000; 182, 417–426.CrossRefGoogle ScholarPubMed
2. Mari, G, Roberts, A, Detti, L, et al. . Perinatal morbidity and mortality rates in severe twin–twin transfusion syndrome: results of the International Amnioreduction Registry. Am J Obstet Gynecol. 2001; 185, 708–715.CrossRefGoogle ScholarPubMed
3. Mahieu-Caputo, D, Dommergues, M, Delezoide, AL, et al. . Twin-to-twin transfusion syndrome. Role of the fetal renin-angiotensin system. Am J Pathol. 2000; 56, 629–636.CrossRefGoogle Scholar
4. Bajoria, R, Sullivan, M, Fisk, NM. Endothelin concentrations in monochorionic twins with severe twin–twin transfusion syndrome. Hum Reprod. 1999; 14, 1614–1618.CrossRefGoogle ScholarPubMed
5. Cheung, YF, Taylor, MJO, Fisk, NM, et al. . Fetal origins of reduced arterial distensibility in the donor twin in twin–twin transfusion syndrome. Lancet. 2000; 355, 1157–1158.Google Scholar
6. Moise, KJ Jr, Dorman, K, Lamvu, G, et al. . A randomized trial of amnioreduction versus septostomy in the treatment of twin–twin transfusion syndrome. Am J Obstet Gynecol. 2005; 193, 701–707.CrossRefGoogle ScholarPubMed
7. Hecher, K, Plath, H, Bregenzer, T, et al. . Endoscopic laser surgery versus serial amniocenteses in the treatment of severe twin–twin transfusion syndrome. Am J Obstet Gynecol. 1999; 180, 717–724.Google Scholar
8. Rossi, AC, D'Addario, V. Laser therapy and serial amnioreduction as treatment for twin–twin transfusion syndrome: a meta-analysis and review of literature. Am J Obstet Gynecol. 2008; 198, 147–152.CrossRefGoogle ScholarPubMed
9. Senat, MV, Deprest, J, Boulvain, M, et al. . Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. New Eng J Med. 2004; 351, 136–144.CrossRefGoogle ScholarPubMed
10. Gardiner, HM, Taylor, MJO, Karatza, AA, et al. . Twin–twin transfusion syndrome: the influence of intrauterine laser-photocoagulation on arterial distensibility in childhood. Circulation. 2003; 107, 1906–1911.CrossRefGoogle ScholarPubMed
11. Cole, TJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr. 1990; 44, 45–60.Google ScholarPubMed
12. Kontis, S, Gosling, RG. On-line Doppler ultrasound measurement of aortic compliance and its repeatability in normal subjects. Clin Phys Physiol Meas. 1989; 10, 127–135.CrossRefGoogle ScholarPubMed
13. Loukogeorgakis, S, Dawson, R, Phillips, N, et al. . Validation of a device to measure arterial pulse wave velocity by a photoplethysmographic method. Physiol Meas. 2002; 23, 581–596.CrossRefGoogle ScholarPubMed
14. Pickering, TG, Hall, JE, Appel, LJ, et al. . Recommendations for blood pressure measurement in humans and experimental animals, Part 1. Hypertension 2005 ; 45, 142–161.Google Scholar
15. Barker, DJP, Gluckman, PD, Godfrey, KM, et al. . Fetal nutrition and cardiovascular disease in adult life. Lancet. 1993; 341, 938–941.Google Scholar
16. Cheung, YF, Wong, KY, Lam, BCC, Tsoi, NS. Relation of arterial stiffness with gestational age and birthweight. Arch Dis Child. 2004; 89, 217–221.Google Scholar
17. Oberg, S, Cnattingius, S, Sandin, S, Lichtenstein, P, Iliadou, AN. Birth weight predicts risk of cardiovascular disease within dizygotic but not monozygotic twin pairs. Circulation. 2011; 123, 2792–2798.CrossRefGoogle Scholar
18. Tapp, RJ, Williams, C, Witt, N, et al. . Impact of size at birth on the microvasculature: the Avon longitudinal study of parents and children. Pediatrics. 2007; 120, e1225–e1228.Google Scholar
19. Gardiner, HM, Celemajer, DS, Sorensen, KE, et al. . Arterial reactivity is markedly abnormal in normotensive young adults following successful repair of coarctation of the aorta in childhood. Circulation. 1994; 89, 1745–1750.CrossRefGoogle Scholar
20. Ranjan, K, Pradhan, RK, Chakravarthy, VS. Informational dynamics of Vasomotion in Microvascular Networks: a review. Acta Physiol. 2010; 10, 1716–1748.Google Scholar
21. Hecher, K, Ville, Y, Snijders, R, et al. . Doppler studies of the fetal circulation in twin–twin transfusion syndrome. Ultrasound Obstet Gynecol. 1995; 5, 318–324.CrossRefGoogle ScholarPubMed
22. Chen, X, Wang, Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation. 2008; 117, 3171–3180.CrossRefGoogle ScholarPubMed
23. Barker, DJ, Bagby, SP, Hanson, MA. Mechanisms of disease: in utero programming in the pathogenesis of hypertension. Nat Clin Pract Nephrol. 2006; 2, 700–707.Google Scholar
24. Avolio, AP, Chen, SG, Wang, RP, et al. . Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community. Circulation. 1983; 68, 50–58.Google Scholar
25. Laogun, AA, Gosling, RG. In vivo arterial compliance in man. Clin Phys Physiol Meas. 1982; 3, 201–212.Google Scholar
26. Greenwald, SE. Pulse pressure and arterial elasticity. QJM. 2002; 95, 67–74.Google Scholar
27. Cruickshank, K, Riste, L, Anderson, SG, et al. . Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002; 106, 2085–2090.Google Scholar
28. Nichols, WW, Conti, CR, Walker, WE, et al. . Input impedance of the systemic circulation in man. Circ Res. 1977; 40, 451–458.Google Scholar
29. Newman, DL, Sipkema, P, Greenwald, SE, et al. . High frequency characteristics of the arterial system. J Biomech. 1986; 19, 817–824.Google Scholar
30. Smulyan, H, Safar, ME. Blood pressure measurement: retrospective and prospective views. Am J Hypertens. 2011; 24, 628–634.CrossRefGoogle ScholarPubMed