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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 helena.gardiner@imperial.ac.uk)
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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

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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