{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T16:48:09Z","timestamp":1776530889431,"version":"3.51.2"},"reference-count":15,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T00:00:00Z","timestamp":1717113600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["19K09788"],"award-info":[{"award-number":["19K09788"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["23K15823"],"award-info":[{"award-number":["23K15823"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Our objective was to investigate the association between the presence of placental anastomoses and intertwin differences in renin\u2010angiotensin\u2010aldosterone activation in monochorionic twins using amniotic fluid aldosterone (AF\u2010ALD) levels. In addition, this study also examined the association between AF\u2010ALD and the ALD levels in the umbilical cord blood (UCB\u2010ALD) in monochorionic twins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>This prospective study included monochorionic diamniotic (MD) twin pregnancies that were not complicated by twin\u2010to\u2010twin transfusion syndrome (TTTS) at delivery. Amniotic fluid and umbilical cord vein blood samples were collected from each twin at delivery, and the ALD levels were measured subsequently. The MD twins were divided into two groups: those with placental anastomoses and those without anastomoses owing to fetoscopic laser surgery. The differences in the AF\u2010ALD levels between the larger and smaller twins were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The AF\u2010ALD levels showed a strong and significant positive correlation with UCB\u2010ALD levels in 131 MD twins (<jats:italic>r<\/jats:italic>\u2009=\u20090.804, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Intertwin differences were examined in 41 and 28 pairs of MD twins with and without placental anastomoses, respectively. The AF\u2010ALD levels in the smaller twins were significantly higher than those in the larger twins among the pairs of MD twins with placental anastomoses (<jats:italic>p<\/jats:italic>\u2009=\u20090.003); however, no statistically significant intertwin differences were observed among the twins without placental anastomoses (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The AF\u2010ALD levels reflect the UCB\u2010ALD levels in MD twins. The presence of placental anastomoses led to intertwin discordance in the ALD levels in MD twins even uncomplicated with TTTS. It was considered that monochorionic twins have this clinical background, and it leads to the development of TTTS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14859","type":"journal-article","created":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T05:39:16Z","timestamp":1717220356000},"page":"1558-1563","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Intertwin discordance of aldosterone levels in amniotic fluid with placental anastomoses in monochorionic twins: Insight into the pathophysiology of twin\u2010to\u2010twin transfusion syndrome"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0512-1173","authenticated-orcid":false,"given":"Mayumi","family":"Takano","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Toho University Omori Medical Center  Tokyo Japan"},{"name":"Department of Obstetrics and Gynecology Toho University Faculty of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mayu","family":"Tachihara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Toho University Omori Medical Center  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mio","family":"Kamiya","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Toho University Omori Medical Center  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hikari","family":"Kotaki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Toho University Omori Medical Center  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makiko","family":"Shimabukuro","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Toho University Omori Medical Center  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumito","family":"Nagasaki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Toho University Omori Medical Center  Tokyo Japan"},{"name":"Department of Obstetrics and Gynecology Toho University Faculty of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiko","family":"Nakata","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Toho University Omori Medical Center  Tokyo Japan"},{"name":"Department of Obstetrics and Gynecology Toho University Faculty of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,5,31]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000313300"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/cells11203268"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s100240010124"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1203\/01.PDR.0000180558.03164.E8"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.652"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(72)90054-X"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajh.2011.171"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.12827"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000472713"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006254-199812010-00001"},{"issue":"234","key":"e_1_2_12_12_1","first-page":"e231","article-title":"Outcome after fetoscopic selective laser ablation of placental anastomoses vs equatorial laser dichorionization for the treatment of twin\u2010to\u2010twin transfusion syndrome","volume":"209","author":"Baschat AA","year":"2013","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15821"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1203\/00006450-198111000-00006"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/0039-128X(80)90015-X"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2011.136"}],"container-title":["Acta Obstetricia et Gynecologica 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