title: Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy.
abstract: BACKGROUND
  The Twin Birth Study randomized women with uncomplicated pregnancies, between 32(0/7)-38(6/7) weeks' gestation where the first twin was in cephalic presentation, to a policy of either a planned cesarean or planned vaginal delivery. The primary analysis showed that planned cesarean delivery did not increase or decrease the risk of fetal/neonatal death or serious neonatal morbidity as compared with planned vaginal delivery.
  
  
  OBJECTIVE
  This study presents the secondary outcome of death or neurodevelopmental delay at 2 years of age.
  
  
  METHODS
  A total of 4603 children from the initial cohort of 5565 fetuses/infants (83%) contributed to the outcome of death or neurodevelopmental delay. Surviving children were screened using the Ages and Stages Questionnaire with abnormal scores validated by a clinical neurodevelopmental assessment. The effect of planned cesarean vs planned vaginal delivery on death or neurodevelopmental delay was quantified using a logistic model to control for stratification variables and using generalized estimating equations to account for the nonindependence of twin births.
  
  
  RESULTS
  Baseline maternal, pregnancy, and infant characteristics were similar. Mean age at assessment was 26 months. There was no significant difference in the outcome of death or neurodevelopmental delay: 5.99% in the planned cesarean vs 5.83% in the planned vaginal delivery group (odds ratio, 1.04; 95% confidence interval, 0.77-1.41; P = .79).
  
  
  CONCLUSIONS
  A policy of planned cesarean delivery provides no benefit to children at 2 years of age compared with a policy of planned vaginal delivery in uncomplicated twin pregnancies between 32(0/7)-38(6/7)weeks' gestation where the first twin is in cephalic presentation.
authors.affiliation: Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada. Electronic address: elizabeth.asztalos@sunnybrook.ca.
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Asztalos
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Hannah
authors.affiliation: Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Eileen K
authors.initials: EK
authors.lastname: Hutton
authors.affiliation: Department of Ontario Child Health Support Unit, SickKids Research Institute, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Willan
authors.affiliation: Department of Pediatrics, Izaak Walton Killam Health Center, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Allen
authors.affiliation: Department of Obstetrics and Gynecology, Izaak Walton Killam Health Center, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: B Anthony
authors.initials: BA
authors.lastname: Armson
authors.affiliation: Center for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.affiliation: Department of Obstetrics and Gynecology and the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Arne
authors.initials: A
authors.lastname: Ohlsson
authors.affiliation: Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Ross
authors.affiliation: Center for Mother, Infant, and Child Research, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.
authors.forename: J Johanna
authors.initials: JJ
authors.lastname: Sanchez
authors.affiliation: Center for Mother, Infant, and Child Research, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Mangoff
authors.affiliation: Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jon F R
authors.initials: JF
authors.lastname: Barrett
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D002675:Child, Preschool; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D065886:Neurodevelopmental Disorders / Q000453:epidemiology*; D036801:Parturition; D011247:Pregnancy; D059285:Pregnancy, Twin; D055815:Young Adult
keywords: cesarean vs vaginal delivery; neurodevelopmental outcome; twin pregnancies