{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T17:03:17Z","timestamp":1781715797078,"version":"3.54.5"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The use of twin\u2010specific <jats:italic>vs<\/jats:italic> singleton growth charts in the assessment of twin pregnancy has been controversial. The aim of this study was to assess whether a diagnosis of small\u2010for\u2010gestational age (SGA) made using twin\u2010specific estimated\u2010fetal\u2010weight (EFW) and birth\u2010weight (BW) charts is associated more strongly with adverse neonatal outcomes in twin pregnancies, compared with when the diagnosis is made using singleton charts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a cohort study of twin pregnancies delivered at St George's Hospital, London, between January 2007 and May 2020. Twin pregnancies complicated by intrauterine death of one or both twins, fetal aneuploidy or major abnormality, twin\u2013twin transfusion syndrome or twin anemia\u2013polycythemia sequence and those delivered before 32\u2009weeks' gestation, were excluded. SGA was defined as EFW or BW below the 10<jats:sup>th<\/jats:sup> centile, and was assessed using both twin\u2010specific and singleton EFW and BW charts. The main study outcome was composite adverse neonatal outcome. Mixed\u2010effects logistic regression analysis with random pregnancy\u2010level intercepts was used to test the association between SGA classified using the different charts and adverse neonatal outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1329 twin pregnancies were identified, of which 913 (1826 infants) were included in the analysis. Of these pregnancies, 723 (79.2%) were dichorionic and 190 (20.8%) were monochorionic. Using the singleton charts, 33.3% and 35.7% of pregnancies were classified as SGA based on EFW and BW, respectively. The corresponding values were 5.9% and 5.6% when using the twin\u2010specific charts. Classification as SGA based on EFW using the twin charts was associated significantly with composite adverse neonatal outcome (odds ratio (OR), 4.78 (95%\u2009CI, 1.47\u201314.7); <jats:italic>P<\/jats:italic>\u2009=\u20090.007), as compared with classification as appropriate\u2010for\u2010gestational age (AGA). However, classification as SGA based on EFW using the singleton standard was not associated significantly with composite adverse neonatal outcome (OR, 1.36 (95%\u2009CI, 0.63\u20132.88); <jats:italic>P<\/jats:italic>\u2009=\u20090.424). Classification as SGA based on EFW using twin\u2010specific standards provided a significantly better model fit than did using the singleton standard (likelihood ratio test, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). When twin\u2010specific charts were used, classification as SGA based on BW was associated significantly with a 9.3 times increased odds of composite adverse neonatal outcome (OR, 9.27 (95%\u2009CI, 2.86\u201330.0); <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Neonates classified as SGA according to the singleton BW standard but not according to the twin\u2010specific BW standards had a significantly lower rate of composite adverse neonatal outcome than did AGA twins (OR, 0.24 (95%\u2009CI, 0.07\u20130.66); <jats:italic>P<\/jats:italic>\u2009=\u20090.009).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The singleton charts classified one\u2010third of twins as SGA, both prenatally and postnatally. Infants classified as SGA according to the twin\u2010specific charts, but not those classified as SGA according to the singleton charts, had a significantly increased risk of adverse neonatal outcome compared with infants classified as AGA. This study provides further evidence that twin\u2010specific charts perform better than do singleton charts in the prediction of adverse neonatal outcome in twin pregnancies. The use of these charts may reduce misclassification of twins as SGA and improve identification of those that are truly growth restricted. \u00a9 2021 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23764","type":"journal-article","created":{"date-parts":[[2021,8,18]],"date-time":"2021-08-18T11:02:22Z","timestamp":1629284542000},"page":"377-384","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Adverse neonatal outcome in twin pregnancy complicated by small\u2010for\u2010gestational age: twin <i>vs<\/i> singleton reference charts"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1508-3473","authenticated-orcid":false,"given":"C.","family":"Briffa","sequence":"first","affiliation":[{"name":"Twins Trust Centre for Research and Clinical Excellence St George's University Hospitals NHS Foundation Trust  London 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Technical University Faculty of Arts and Sciences, Department of Statistics  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Giorgione","sequence":"additional","affiliation":[{"name":"Twins Trust Centre for Research and Clinical Excellence St George's University Hospitals NHS Foundation Trust  London UK"},{"name":"Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute St George's University of London  London UK"},{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust, University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Bhate","sequence":"additional","affiliation":[{"name":"Twins Trust Centre for Research and Clinical Excellence St George's University Hospitals NHS Foundation Trust  London UK"},{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust, University of London  London 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Hospitals NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-7670","authenticated-orcid":false,"given":"A.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Twins Trust Centre for Research and Clinical Excellence St George's University Hospitals NHS Foundation Trust  London UK"},{"name":"Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute St George's University of London  London UK"},{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust, University of London  London 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