The impact of chorionicity on pregnancy outcome and neurodevelopment at 2 years old among twins born preterm: the EPIPAGE-2 cohort study

BJOG. 2021 Jan;128(2):281-291. doi: 10.1111/1471-0528.16170. Epub 2020 Mar 12.


Objective: To compare the short- and mid-term outcomes of preterm twins by chorionicity of pregnancy.

Design: Prospective nationwide population-based EPIPAGE-2 cohort study.

Setting: 546 maternity units in France, between March and December 2011.

Population: A total of 1700 twin neonates born between 24 and 34 weeks of gestation.

Methods: The association of chorionicity with outcomes was analysed using multivariate regression models.

Main outcome measures: First, survival at 2-year corrected age with or without neurosensory impairment, and second, perinatal, short-, and mid-term outcomes (survival at discharge, survival at discharge without severe morbidity) were described and compared by chorionicity.

Results: In the EPIPAGE 2 cohort, 1700 preterm births were included (850 twin pregnancies). In all, 1220 (71.8%) were from dichorionic (DC) pregnancies and 480 from monochorionic (MC) pregnancies. MC pregnancies had three times more medical terminations than DC pregnancies (1.67 versus 0.51%, P < 0.001), whereas there were three times more stillbirths in MC than in DC pregnancies (10.09 versus 3.78%, P < 0.001). Both twins were alive at birth in 86.6% of DC pregnancies compared with 80.0% among MC pregnancies (P = 0.008). No significant difference according to chorionicity was found regarding neonatal deaths and morbidities. Likewise, for children born earlier than 32 weeks, the 2-year follow-up neurodevelopmental results were not significantly different between DC and MC twins.

Conclusions: This study confirms that MC pregnancies have a higher risk of adverse outcomes. However, the outcomes among preterm twins admitted to neonatal intensive care units are similar irrespective of chorionicity.

Tweetable abstract: Monochorionicity is associated with adverse perinatal outcomes, but outcomes for preterm twins are comparable irrespective of their chorionicity.

Keywords: 2-year outcome; Chorionicity; EPIPAGE-2; monochorionic pregnancies; neonatal outcomes; prematurity; preterm birth; twins.

MeSH terms

  • Age Factors
  • Child, Preschool
  • Chorion / pathology*
  • Cohort Studies
  • Diseases in Twins / epidemiology*
  • Female
  • France
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / epidemiology*
  • Male
  • Neurodevelopmental Disorders / epidemiology*
  • Placenta / pathology
  • Pregnancy
  • Pregnancy Outcome
  • Pregnancy, Twin