Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

N-terminal pro-brain natriuretic peptide levels in monochorionic diamniotic twins with selective intrauterine growth restriction

Abstract

Objective:

To compare serum N-terminal pro-brain natriuretic peptide levels at birth between monochorionic diamniotic twins with and without selective intrauterine growth restriction.

Study Design:

Blood samples were collected from 73 monochorionic diamniotic twins without twin-to-twin transfusion syndrome. Two groups were studied on the basis of fetal ultrasonographic findings: 16 twins with and 57 twins without selective intrauterine growth restriction. Selective intrauterine growth restriction was defined as an estimated fetal weight below the 10th percentile in one twin at 18 to 26 weeks of gestation. Serum N-terminal pro-brain natriuretic peptide levels were measured.

Result:

Serum N-terminal pro-brain natriuretic peptide levels in monochorionic diamniotic twins with selective intrauterine growth restriction were significantly higher than in those without selective intrauterine growth restriction. Selective intrauterine growth restriction was independently associated with increased N-terminal pro-brain natriuretic peptide levels.

Conclusion:

N-terminal pro-brain natriuretic peptide levels at birth are elevated in monochorionic diamniotic twins with selective intrauterine growth restriction.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Gratacos E, Lewi L, Munoz B, Acosta-Rojas R, Hernandez-Andrade E, Martinez JM et al. A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet Gynecol 2007; 30 (1): 28–34.

    Article  CAS  Google Scholar 

  2. Lopriore E, Slaghekke F, Vandenbussche FP, Middeldorp JM, Walther FJ, Oepkes D . Cerebral injury in monochorionic twins with selective intrauterine growth restriction and/or birthweight discordance. Am J Obstet Gynecol 2008; 199 (6): 628.e1–628.e5.

    Article  Google Scholar 

  3. Ishii K, Murakoshi T, Sago H . Adverse outcome in monochorionic twins with selective intrauterine fetal growth restriction in the presence of abnormal umbilical artery Doppler and severe oligohydramnios. J Obstet Gynaecol Res 2012; 38 (10): 1271.

    Article  Google Scholar 

  4. de Haseth SB, Haak MC, Roest AA, Rijlaarsdam ME, Oepkes D, Lopriore E . Right ventricular outflow tract obstruction in monochorionic twins with selective intrauterine growth restriction. Case Rep Pediatr 2012; 2012: 426825.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Kondo Y, Hidaka N, Yumoto Y, Fukushima K, Tsukimori K, Wake N . Cardiac hypertrophy of one fetus and selective growth restriction of the other fetus in a monochorionic twin pregnancy. J Obstet Gynaecol Res 2010; 36 (2): 401–404.

    Article  Google Scholar 

  6. Munoz-Abellana B, Hernandez-Andrade E, Figueroa-Diesel H, Ferrer Q, Acosta-Rojas R, Cabero L et al. Hypertrophic cardiomyopathy-like changes in monochorionic twin pregnancies with selective intrauterine growth restriction and intermittent absent/reversed end-diastolic flow in the umbilical artery. Ultrasound Obstet Gynecol 2007; 30 (7): 977–982.

    Article  CAS  Google Scholar 

  7. Vanderheyden M, Bartunek, Claeys G, Manoharan G, Beckers JF, Ide L . Head to head comparison of N-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in patients with/without left ventricular systolic dysfunction. Clin Biochem 2006; 39 (6): 640–645.

    Article  CAS  Google Scholar 

  8. Walther T, Stepan H, Faber R . Dual natriuretic peptide response to volume load in the fetal circulation. Cardiovasc Res 2001; 49 (4): 817–819.

    Article  CAS  Google Scholar 

  9. Johns MC, Stephenson C . Amino-terminal pro-B-type natriuretic peptide testing in neonatal and pediatric patients. Am J Cardiol 2008; 101 (3A): 76–81.

    Article  Google Scholar 

  10. Moriichi A, Cho K, Mizushima M, Furuse Y, Akimoto T, Yamada T et al. B-type natriuretic peptide levels at birth predict cardiac dysfunction in neonates. Pediatr Int 2012; 54 (1): 89–93.

    Article  CAS  Google Scholar 

  11. Bajoria R, Ward S, Sooranna SR . Atrial natriuretic peptide mediated polyuria: pathogenesis of polyhydramnios in the recipient twin of twin-twin transfusion syndrome. Placenta 2001; 22 (8–9): 716–724.

    Article  CAS  Google Scholar 

  12. Van Mieghem T, Done E, Gucciardo L, Klaritsch P, Allegaert K, Van Bree R et al. Amniotic fluid markers of fetal cardiac dysfunction in twin-to-twin transfusion syndrome. Am J Obstet Gynecol 2010; 202 (1): 48.e1–48.e7.

    Article  Google Scholar 

  13. Habli M, Cnota J, Michelfelder E, Salisbury S, Schnell B, Polzin W et al. The relationship between amniotic fluid levels of brain-type natriuretic peptide and recipient cardiomyopathy in twin-twin transfusion syndrome. Am J Obstet Gynecol 2010; 203 (4): 404.e1–404.e7.

    Article  Google Scholar 

  14. Fujioka K, Sakai H, Tanaka S, Iwatani S, Wada K, Mizobuchi M et al. N-terminal pro-brain natriuretic peptide levels in monochorionic diamniotic twins with twin-to-twin transfusion syndrome treated by fetoscopic laser photocoagulation. Kobe J Med Sci 2013; 59 (1): E28–E35.

    PubMed  Google Scholar 

  15. Moriichi A, Cho K, Furuse Y, Akimoto T, Kaneshi Y, Yamada T et al. B-type natriuretic peptide levels are correlated with birth-weight discordance in monochorionic-diamniotic twins without twin-twin transfusion syndrome. J Perinatol 2013; 33 (3): 182–187.

    Article  CAS  Google Scholar 

  16. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M . Staging of twin-twin transfusion syndrome. J Perinatol 1999; 19 (8 Pt 1): 550–555.

    Article  CAS  Google Scholar 

  17. Ersdal HL, Mduma E, Svensen E, Perlman J . Birth asphyxia: a major cause of early neonatal mortality in a Tanzanian rural hospital. Pediatrics 2012; 129 (5): e1238–e1243.

    Article  Google Scholar 

  18. Ogawa Y, Iwamura T, Kuriya N, Nishida H, Takeuchi H, Takada M et al. Birth size standards by gestational age for Japanese neonates. Acta Neonatol Jpn 1998; 34 (3): 624–632 (In Japanese).

    Google Scholar 

  19. Bozynski ME, Hanafy FH, Hernandez RJ . Association of increased cardiothoracic ratio and intrauterine growth retardation. Am J Perinatol 1991; 8 (1): 28–30.

    Article  CAS  Google Scholar 

  20. Edwards DK, Higgins CB, Gilpin EA . The cardiothoracic ratio in newborn infants. AJR Am J Roentgenol 1981; 136 (5): 907–913.

    Article  CAS  Google Scholar 

  21. Bennasar M, Martinez JM, Gomez O, Figueras F, Olivella A, Puerto B et al. Intra- and interobserver repeatability of fetal cardiac examination using four-dimensional spatiotemporal image correlation in each trimester of pregnancy. Ultrasound Obstet Gynecol 2010; 35 (3): 318–323.

    Article  CAS  Google Scholar 

  22. Bajoria R, Ward S, Chatterjee R . Natriuretic peptides in the pathogenesis of cardiac dysfunction in the recipient fetus of twin-twin transfusion syndrome. Am J Obstet Gynecol 2002; 186 (1): 121–127.

    Article  CAS  Google Scholar 

  23. El-Khuffash A, Molloy EJ . Are B-type natriuretic peptide (BNP) and N-terminal-pro-BNP useful in neonates? Arch Dis Child Fetal Neonatal Ed 2007; 92 (4): F320–F324.

    Article  Google Scholar 

  24. Behnes M, Brueckmann M, Ahmad-Nejad P, Lang S, Wolpert C, Elmas E et al. Diagnostic performance and cost effectiveness of measurements of plasma N-terminal pro brain natriuretic peptide in patients presenting with acute dyspnea or peripheral edema. Int J Cardiol 2009; 135 (2): 165–174.

    Article  Google Scholar 

  25. Mant J, Doust J, Roalfe A, Barton P, Cowie MR, Glasziou P et al. Systematic review and individual patient data meta-analysis of diagnosis of heart failure, with modelling of implications of different diagnostic strategies in primary care. Health Technol Assess 2009; 13 (32): 1–207.

    Article  CAS  Google Scholar 

  26. Hammerer-Lercher A, Puschendorf B, Sommer R, Mair J, Tews G, Shebl O et al. Natriuretic peptides correlate between newborn twins but not between twins and their mothers. Clin Chim Acta 2007; 377 (1-2): 279–280.

    Article  CAS  Google Scholar 

  27. Fujioka K, Morioka I, Miwa A, Yokota T, Matsuo K, Morikawa S et al. Renin is activated in monochorionic diamniotic twins with birthweight discordance who do not have twin-to-twin transfusion syndrome. J Perinatol 2012; 32 (7): 514–519.

    Article  CAS  Google Scholar 

  28. Harkness UF, Crombleholme TM . Twin-twin transfusion syndrome: where do we go from here? Semin Perinatol 2005; 29 (5): 296–304.

    Article  Google Scholar 

  29. Valsky DV, Eixarch E, Martinez JM, Gratacos E . Selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies. Prenat Diagn 2010; 30 (8): 719–726.

    Article  Google Scholar 

  30. Quintero RA, Bornick PW, Morales WJ, Allen MH . Selective photocoagulation of communicating vessels in the treatment of monochorionic twins with selective growth retardation. Am J Obstet Gynecol 2001; 185 (3): 689–696.

    Article  CAS  Google Scholar 

  31. Leipala JA, Boldt T, Turpeinen U, Vuolteenaho O, Fellman V . Cardiac hypertrophy and altered hemodynamic adaptation in growth-restricted preterm infants. Pediatr Res 2003; 53 (6): 989–993.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Dr Kenji Kiyoshi for helpful discussion of perinatal management of MD twin pregnancies and Mr Kensuke Moriwaki for valuable advice on statistical analysis. This study was supported by grants for Scientific Research from Shinryokukai (KF), the Morinaga Hoshi-kai Foundation (KF) and the Ministry of Education, Culture, Sports, Science and Technology in Japan (KF).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to K Fujioka.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fujioka, K., Mizobuchi, M., Sakai, H. et al. N-terminal pro-brain natriuretic peptide levels in monochorionic diamniotic twins with selective intrauterine growth restriction. J Perinatol 34, 6–10 (2014). https://doi.org/10.1038/jp.2013.119

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2013.119

Keywords

Search

Quick links