J Korean Med Sci.  2023 Sep;38(38):e300. 10.3346/jkms.2023.38.e300.

The Effect of Vanishing Twin on Firstand Second-Trimester Maternal Serum Markers and Nuchal Translucency: A Multicenter Prospective Cohort Study

• Lee SJ
• Han YJ
• Kim M
• Shim JY
• Lee MY
• Oh Sy
• Lee J
• Kim SH
• Cha DH
• Cho GJ
• Kwon HS
• Kim BJ
• Park MH
• Cho HY
• Ko HS
• Bae JH
• Park CW
• Park JS
• Jun JK
• Oh S
• Lee DR
• Ryu HM
• Lee SM

• KMID: 2546220
• DOI: http://doi.org/10.3346/jkms.2023.38.e300

Abstract

Background
The purpose of this study was to evaluate the effect of vanishing twin (VT) on maternal serum marker concentrations and nuchal translucency (NT).
Methods
This is a secondary analysis of a multicenter prospective cohort study in 12 institutions. Serum concentrations of pregnancy-associated plasma protein-A in the first trimester and alpha-fetoprotein (AFP), total human chorionic gonadotrophin, unconjugated estriol, and inhibin A in the second trimester were measured, and NT was measured between 10 and 14 weeks of gestation.
Results
Among 6,793 pregnant women, 5,381 women were measured for serum markers in the first or second trimester, including 65 cases in the VT group and 5,316 cases in the normal singleton group. The cases in the VT group had a higher median multiple of the median value of AFP and inhibin A than the normal singleton group. The values of other serum markers and NT were not different between the two groups. After the permutation test with adjustment,AFP and inhibin A remained significant differences. The frequency of abnormally increased AFP was also higher in the VT group than in the normal singleton group.
Conclusion
VT can be considered as an adjustment factor for risk assessment in the secondtrimester serum screening test.

Keyword

Vanishing Twin; First- and Second-Trimester Maternal Serum Markers; PAPP-A; AFP; hCG; uE3

Figure

• 

  Fig. 1 The MoM of the AFP (A) and inhibin A (B) in the vanishing twin group and normal singleton group.AFP = alpha-fetoprotein, MoM = multiple of median.

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  Fig. 2 The association between MoM of the first- and second-trimester serum markers and gestational age at diagnosis of vanishing twin (PAPP-A, P = 0.745; AFP, P = 0.765; β-hCG, P = 0.402; uE3, P = 0.476; Inhibin-A, P = 0.818).PAPP-A = pregnancy-associated plasma protein A, MoM = multiple of median, AFP = alpha-fetoprotein, hCG = human chorionic gonadotrophin, uE3 = unconjugated estriol.

• 

  Fig. 3 The association between MoM of the first- and second-trimester serum markers and interval between gestational age at diagnosis of vanishing twin and blood sampling date (PAPP-A, P = 0.578; AFP, P = 0.861; β-hCG, P = 0.352; uE3, P = 0.549; Inhibin-A, P = 0.700).PAPP-A = pregnancy-associated plasma protein A, MoM = multiple of median, AFP = alpha-fetoprotein, hCG = human chorionic gonadotrophin, uE3 = unconjugated estriol.

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