Fetal Growth Restriction and Long-Term Cardiovascular Morbidity of Offspring in Dichorionic–Diamniotic Twin Pregnancies

Tuval Tzafrir, Tamar Wainstock, Eyal Sheiner, Shayna Miodownik, Gali Pariente

Research output: Contribution to journalArticlepeer-review


Objective: We opted to investigate whether fetal growth restriction (FGR) in dichorionic–diamniotic twins is a risk factor for long-term cardiovascular morbidity in offspring. Study design: A population-based retrospective cohort study, comparing long-term cardiovascular morbidity among FGR and non-FGR twins, born between the years 1991 and 2021 in a tertiary medical center. Study groups were followed until 18 years of age (6570 days) for cardiovascular-related morbidity. A Kaplan–Meier survival curve compared the cumulative cardiovascular morbidity. A Cox proportional hazard model assisted with adjusting for confounders. Results: In this study, 4222 dichorionic–diamniotic twins were included; 116 were complicated with FGR and demonstrated a significantly higher rate of long-term cardiovascular morbidity (4.4% vs. 1.3%, OR = 3.4, 95% CI 1.35–8.78, p = 0.006). The cumulative incidence of long-term cardiovascular morbidity was significantly higher among FGR twins (Kaplan–Meier Log rank test p = 0.007). A Cox proportional-hazard model found an independent association between FGR and long-term cardiovascular morbidity, when adjusted for both birth order and gender (adjusted HR 3.3, 95% CI 1.31–8.19, p = 0.011). Conclusions: FGR in dichorionic–diamniotic twins is independently associated with an increased risk for long-term cardiovascular morbidity in offspring. Therefore, increased surveillance may be beneficial.

Original languageEnglish
Article number1628
JournalJournal of Clinical Medicine
Issue number4
StatePublished - 17 Feb 2023


  • diamniotic–dichorionic twin pregnancies
  • fetal growth restriction (FGR)
  • long-term cardiovascular morbidity
  • offspring

ASJC Scopus subject areas

  • Medicine (all)


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