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已发表论文
胎儿游离DNA比例升高与出生体重不一致及选择性胎儿生长受限的关联：一项回顾性研究
Authors Hua R, Xia Y, Lin N, Wang S, Sun J, Shi Y, Wang Y
Received 3 September 2025
Accepted for publication 14 January 2026
Published 20 January 2026 Volume 2026:18 564371
DOI https://doi.org/10.2147/IJWH.S564371
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Matteo Frigerio
Renyi Hua,1,2,* Yuanqing Xia,1,2,* Nan Lin,1,2,* Shan Wang,1,2 Jinling Sun,1,2 Yiru Shi,1,2 Yanlin Wang1,2
1Department of Prenatal Diagnosis, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, People’s Republic of China; 2Shanghai Key Laboratory of Embryo Original Diseases, the International Peace Maternity and Child Health Hospital, Shanghai, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yanlin Wang, Email wyanlin@163.com Yiru Shi, Email yiru_shi@sina.com
Background: Twin pregnancies are at increased risk for selective fetal growth restriction (sFGR) and birthweight discordance, which contribute to elevated perinatal mortality and morbidity. Early identification of at-risk pregnancies remains challenging, limiting optimal prenatal counselling and timely clinical intervention.
Objective: To determine whether fetal fraction (FF) from cell-free fetal DNA (cffDNA) screening correlates with birthweight differences and predicts birthweight discordance and sFGR in twin pregnancies.
Methods: This retrospective study included 224 twin pregnancies (both dichorionic and monochorionic twins) that underwent cffDNA aneuploidy screening and delivered at the International Peace Maternity and Child Health Hospital in Shanghai between 2018 and 2021. FF values and neonatal birthweights were collected and analyzed for correlations and predictive accuracy.
Results: FF showed significant positive correlation with inter-twin birthweight differences (β=0.365, 95% CI: 0.122~0.608). For every 1% increase in the FF, the difference in the birthweight between twins increased by 0.365%. A higher FF was significantly associated with an increased risk of birthweight discordance of 20% (adjusted OR: 1.073, 95% CI: 1.009~1.142), 25% (adjusted OR: 1.092, 95% CI: 1.006~1.185), and sFGR (adjusted OR: 1.130, 95% CI: 1.038~1.231). Using ROC analysis, we obtained optimum cut-off points for FFs ≥ 11.790 and ≥ 14.800 for birthweight discordance of 20% and sFGR, respectively. Compared with women with FFs of < 11.790, there was a 1.091-fold higher risk of birthweight discordance of 20% (adjusted OR: 2.091, 95% CI: 1.218~3.591) when the FF was ≥ 11.790. There were also significantly increased risks of birthweight discordance of 25% (adjusted OR: 3.045, 95% CI: 1.297~7.149) and sFGR (adjusted OR: 3.526, 95% CI: 1.443~8.618) among women with FFs of ≥ 14.800.
Conclusion: FF demonstrates strong positive correlation with birthweight differences and represents a novel predictive biomarker for birthweight discordance and sFGR in twin pregnancies. This accessible parameter from routine prenatal screening enables cost-neutral risk stratification and individualized pregnancy monitoring.
Keywords: twin pregnancy, non-invasive prenatal testing, fetal fraction, selective fetal growth restriction
1Department of Prenatal Diagnosis, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, People’s Republic of China; 2Shanghai Key Laboratory of Embryo Original Diseases, the International Peace Maternity and Child Health Hospital, Shanghai, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yanlin Wang, Email wyanlin@163.com Yiru Shi, Email yiru_shi@sina.com
Background: Twin pregnancies are at increased risk for selective fetal growth restriction (sFGR) and birthweight discordance, which contribute to elevated perinatal mortality and morbidity. Early identification of at-risk pregnancies remains challenging, limiting optimal prenatal counselling and timely clinical intervention.
Objective: To determine whether fetal fraction (FF) from cell-free fetal DNA (cffDNA) screening correlates with birthweight differences and predicts birthweight discordance and sFGR in twin pregnancies.
Methods: This retrospective study included 224 twin pregnancies (both dichorionic and monochorionic twins) that underwent cffDNA aneuploidy screening and delivered at the International Peace Maternity and Child Health Hospital in Shanghai between 2018 and 2021. FF values and neonatal birthweights were collected and analyzed for correlations and predictive accuracy.
Results: FF showed significant positive correlation with inter-twin birthweight differences (β=0.365, 95% CI: 0.122~0.608). For every 1% increase in the FF, the difference in the birthweight between twins increased by 0.365%. A higher FF was significantly associated with an increased risk of birthweight discordance of 20% (adjusted OR: 1.073, 95% CI: 1.009~1.142), 25% (adjusted OR: 1.092, 95% CI: 1.006~1.185), and sFGR (adjusted OR: 1.130, 95% CI: 1.038~1.231). Using ROC analysis, we obtained optimum cut-off points for FFs ≥ 11.790 and ≥ 14.800 for birthweight discordance of 20% and sFGR, respectively. Compared with women with FFs of < 11.790, there was a 1.091-fold higher risk of birthweight discordance of 20% (adjusted OR: 2.091, 95% CI: 1.218~3.591) when the FF was ≥ 11.790. There were also significantly increased risks of birthweight discordance of 25% (adjusted OR: 3.045, 95% CI: 1.297~7.149) and sFGR (adjusted OR: 3.526, 95% CI: 1.443~8.618) among women with FFs of ≥ 14.800.
Conclusion: FF demonstrates strong positive correlation with birthweight differences and represents a novel predictive biomarker for birthweight discordance and sFGR in twin pregnancies. This accessible parameter from routine prenatal screening enables cost-neutral risk stratification and individualized pregnancy monitoring.
Keywords: twin pregnancy, non-invasive prenatal testing, fetal fraction, selective fetal growth restriction