Cardiac adaptation and malformation in twin-twin transfusion syndrome and selective fetal growth restriction: A systematic review.

OBJECTIVES: This systematic review explores cardiac adaptation in monochorionic (MC) twins with twin-twin transfusion syndrome (TTTS) or selective fetal growth restriction (sFGR) and assesses the risk of congenital heart defects (CHDs). METHODS: Adhering to PRISMA guidelines, 63 studies were reviewed (49 on cardiac adaptation, 13 on CHD, one on both). A narrative synthesis of cardiac adaptation patterns was performed. Additionally, a meta-analysis compared the livebirth prevalence of CHD in TTTS and sFGR against uncomplicated MC twins. RESULTS: In TTTS recipients, cardiac function may be impaired for diastolic, systolic, as well as global functions, while in donors, cardiac function is generally preserved. In sFGR, large twins may show hypertrophic cardiomyopathy, and small twins may show impaired systolic function. Co-occurrence of TTTS and sFGR magnifies cardiac impact but is often underreported. Meta-analysis for CHD prevalence revealed a relative risk ratio of 3.5 (95% CI: 2.5-4.9) for TTTS and 2.2 (95%CI: 1.3-3.5) for sFGR compared with uncomplicated MC twins. CONCLUSIONS: This study highlights the well-documented cardiac adaptation in TTTS, contrasting with limited understanding in sFGR. Elevated CHD risks were observed in both conditions. Enhanced cardiovascular surveillance is warranted in complicated MC twin pregnancies. Future research should explore cardiac adaptation in sFGR and its long-term consequences.

[Closing the vaccine gap: pregnant women in the Netherlands will be offered a flu jab]. / Meer grip op griep bij zwangere vrouwen.

Influenza immunisation during pregnancy is recommended by the WHO since 2010 and implemented in the majority of the Western countries. Finally, the Dutch government follows this recommendation and will be offering vaccination to pregnant women starting upcoming influenza season. Remarkably, this new guideline mainly focuses on the benefits for infants. In this article we want to make healthcare workers aware of the fact that the maternal influenza vaccination has substantial benefits for both mothers and their infants. Vaccination will reduce the risk of infection and influenza-associated hospitalizations. Potentially, the vaccination has positive effects on pregnancy outcomes like birth weight and premature delivery, but further research is needed. Offering the vaccination requires a solid campaign, in which all involved healthcare workers should advocate for vaccination. In addition, the vaccination should not only be available for pregnant women above 22 weeks of gestational age, but throughout the entire pregnancy if necessary.