Association between pre-delivery maternal red blood cell distribution width and birth weight discordance in twin pregnancies: a twin pregnancy cohort study.
4 affiliations
- 1Center for Early Childhood Development, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, China.
- 2Clinical Trial Center, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, China.
- 3Department of Endoscopy, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang, China.
- 4Neonatal Intensive Care Center, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, China.
Abstract
Background
Twin growth discordance, commonly defined as an inter-twin birth weight difference ≥20%, is linked to increased neonatal morbidity, but simple maternal laboratory markers to aid late-pregnancy risk assessment are limited. Red blood cell distribution width (RDW), a routine hematological parameter associated with inflammation and placental dysfunction, has been associated with adverse perinatal outcomes in singleton pregnancies; however, its role in twin growth discordance remains unclear.Objective
This study aimed to examine the association between pre-delivery RDW measured within 1 week before delivery and twin growth discordance in a cohort of Chinese twin pregnancies.Study design
This retrospective cohort study included 1,714 women with twin pregnancies who delivered at the Gansu Provincial Maternity and Childcare Hospital between July 2020 and February 2024. Pre-delivery RDW was obtained from the last prenatal complete blood count within 1 week before delivery. Twin growth discordance was defined as inter-twin birth weight discordance ≥20%. Associations were assessed using multivariable logistic regression, with RDW modeled continuously and categorically (<14.3, 14.3-16.0%, and ≥16.1%). Restricted cubic spline, subgroup, and sensitivity analyses were also performed.Results
Overall, 231 women (13.5%) had twin growth discordance. Compared with the lowest RDW category, the highest category was associated with increased odds of twin growth discordance after adjustment for maternal age, IVF status, chorionicity, gestational age, pregestational body mass index, parity, hypertensive disorders of pregnancy, gestational diabetes mellitus, and hemoglobin [odds ratio (OR) 1.89, 95% confidence interval (CI) 1.28-2.80; p = 0.001]. A significant trend was observed across RDW categories (p for trend = 0.001). RDW modeled as a continuous variable showed a borderline association after full adjustment (OR 1.06, 95% CI 1.00-1.12; p = 0.060). Restricted cubic spline analysis suggested a nonlinear association (p for non-linearity = 0.013). Results were similar using discordance ≥25% (OR 2.24, 95% CI 1.31-3.83; p = 0.003).Conclusion
Higher pre-delivery RDW was associated with greater odds of twin growth discordance. Prospective studies with serial RDW measurements are needed to confirm these findings and determine their clinical relevance.
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BibTeX
@article{zhang2026association,
title = {{Association between pre-delivery maternal red blood cell distribution width and birth weight discordance in twin pregnancies: a twin pregnancy cohort study.}},
author = {Xiaoni Zhang and Jie Su and Li Yue and Hongyan Wang and Zhengqiang Bai and Huijie Wang and Bin Yi},
journal = {Frontiers in public health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1912722},
url = {https://europepmc.org/article/MED/42903141},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association between pre-delivery maternal red blood cell distribution width and birth weight discordance in twin pregnancies: a twin pregnancy cohort study.
AU - Xiaoni Zhang
AU - Jie Su
AU - Li Yue
AU - Hongyan Wang
AU - Zhengqiang Bai
AU - Huijie Wang
AU - Bin Yi
PY - 2026
DA - 2026/10/06
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1912722
UR - https://europepmc.org/article/MED/42903141
AB - Background Twin growth discordance, commonly defined as an inter-twin birth weight difference ≥20%, is linked to increased neonatal morbidity, but simple maternal laboratory markers to aid late-pregnancy risk assessment are limited. Red blood cell distribution width (RDW), a routine hematological parameter associated with inflammation and placental dysfunction, has been associated with adverse perinatal outcomes in singleton pregnancies; however, its role in twin growth discordance remains unclear.Objective This study aimed to examine the association between pre-delivery RDW measured within 1 week before delivery and twin growth discordance in a cohort of Chinese twin pregnancies.Study design This retrospective cohort study included 1,714 women with twin pregnancies who delivered at the Gansu Provincial Maternity and Childcare Hospital between July 2020 and February 2024. Pre-delivery RDW was obtained from the last prenatal complete blood count within 1 week before delivery. Twin growth discordance was defined as inter-twin birth weight discordance ≥20%. Associations were assessed using multivariable logistic regression, with RDW modeled continuously and categorically (<14.3, 14.3-16.0%, and ≥16.1%). Restricted cubic spline, subgroup, and sensitivity analyses were also performed.Results Overall, 231 women (13.5%) had twin growth discordance. Compared with the lowest RDW category, the highest category was associated with increased odds of twin growth discordance after adjustment for maternal age, IVF status, chorionicity, gestational age, pregestational body mass index, parity, hypertensive disorders of pregnancy, gestational diabetes mellitus, and hemoglobin [odds ratio (OR) 1.89, 95% confidence interval (CI) 1.28-2.80; p = 0.001]. A significant trend was observed across RDW categories (p for trend = 0.001). RDW modeled as a continuous variable showed a borderline association after full adjustment (OR 1.06, 95% CI 1.00-1.12; p = 0.060). Restricted cubic spline analysis suggested a nonlinear association (p for non-linearity = 0.013). Results were similar using discordance ≥25% (OR 2.24, 95% CI 1.31-3.83; p = 0.003).Conclusion Higher pre-delivery RDW was associated with greater odds of twin growth discordance. Prospective studies with serial RDW measurements are needed to confirm these findings and determine their clinical relevance.
SN - 2296-2565
ER -