Blood pressure evaluation in children treated with laser surgery for twin-twin transfusion syndrome at 2-year follow-up

Am J Obstet Gynecol. 2015 Sep;213(3):417.e1-7. doi: 10.1016/j.ajog.2015.05.031. Epub 2015 May 21.

Abstract

Objective: Twin survivors of twin-twin transfusion syndrome (TTTS) may be at risk for early onset of cardiovascular disease. The aim of this study was to determine prevalence and risk factors for elevated blood pressure (BP) among children treated with selective laser photocoagulation of communicating vessels.

Study design: Data were prospectively collected from surviving children treated for TTTS with laser surgery from 2008 through 2010. Systolic BP (SBP) and diastolic BP (DBP) were obtained from 91 child survivors at age 24 months (±6 weeks) and evaluated based on age, sex, and height percentile. BP percentiles were calculated for each patient and categorized as normal (<95%) or abnormal (>95%). Clinical variables were evaluated using multilevel regression models to evaluate risk factors for elevated BP.

Results: BP was categorized as normal in 38% and abnormal in 62% of twin survivors based on percentile for sex, age, and height; a comparable distribution was found for DBP elevation. There were no differences between donor and recipient twins for absolute SBP and DBP or BP classification. In a multivariate analysis, significant risk factors for higher SBP included prematurity (β -0.54; 95% confidence interval [CI], -0.99 to -0.09; P = .02), higher weight percentile (β 0.24; 95% CI, 0.05-0.42; P = .01), and presence of cardiac disease (β 0.50; 95% CI, 0.10-0.89; P = .01). Prematurity was also a significant risk for abnormal DBP (odds ratio, 0.89; 95% CI, 0.80-1.00; P = .05).

Conclusion: Child survivors of TTTS had elevated SBP and DBP measurements at 2 years of age, with no differences seen between former donor and recipient twins. Prematurity may be a risk factor for elevated BP measurements in this population. Future studies are warranted to ascertain whether these cardiovascular findings persist over time.

Keywords: cardiovascular disease; elevated blood pressure; fetal interventions; fetal physiology; twin-twin transfusion syndrome.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Child, Preschool
  • Female
  • Fetal Therapies*
  • Fetofetal Transfusion / complications
  • Fetofetal Transfusion / surgery*
  • Follow-Up Studies
  • Humans
  • Hypertension / diagnosis
  • Hypertension / epidemiology
  • Hypertension / etiology*
  • Laser Coagulation*
  • Linear Models
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / epidemiology
  • Pregnancy
  • Prevalence
  • Prospective Studies
  • Risk Factors