The relationship between preoperative fetal head circumference and 2-year cognitive performance after laser surgery for twin-twin transfusion syndrome

Prenat Diagn. 2018 Feb;38(3):173-178. doi: 10.1002/pd.5204. Epub 2018 Jan 24.


Objective: To determine the relationship between preoperative fetal head circumference (HC) and cognitive performance among children treated with laser surgery for twin-twin transfusion syndrome (TTTS).

Methods: Donor and recipient twin HCs were measured preoperatively (16-26 weeks' gestation) and at 2 years corrected age. Multilevel multivariate regression models were used to test pregnancy and child-level risk factors for lower Battelle Developmental Inventory Second Edition (BDI-2) scores. A repeated-measures ANOVA was used to examine HC growth among recipients and donors between preoperative and 2 years.

Results: Ninety-nine children were evaluated. The average BDI-2 score for the cohort was 101.4 (SD = 12.2). After controlling for covariates, larger preoperative HC percentiles were significantly associated with an increase in total BDI-2 scores (β = 0.29; P < 0.001), where a 12.5% increase in preoperative HC percentile was associated with 1-point increase in total BDI-2 score. The mean recipient and donor twin HC percentiles preoperatively and at age 2 years were 51st percentile vs 20th percentile (P = .050) and 60th percentile vs 49th percentile (P = .676), respectively.

Conclusion: Smaller preoperative HC percentiles identified children at risk of lower, but still within normal range, total BDI-2 scores. The discordance in HC percentiles between the donor and recipient twin decreased after laser surgery.

MeSH terms

  • Child, Preschool
  • Cognition*
  • Female
  • Fetal Therapies
  • Fetofetal Transfusion / diagnostic imaging
  • Fetofetal Transfusion / surgery*
  • Follow-Up Studies
  • Head / diagnostic imaging
  • Head / growth & development*
  • Humans
  • Laser Therapy
  • Male
  • Pregnancy
  • Ultrasonography, Prenatal