Risk prediction of spontaneous preterm birth in twin pregnancy: a monogram
Gladkova K.A., Kiryanova A.O., Sakalo V.A., Vtorushina V.V.
Preterm birth remains a leading cause of perinatal morbidity and mortality in twin pregnancy.
Objective. To improve perinatal outcomes in twin pregnancies by creating a nomogram to predict the risks of spontaneous preterm births.
Materials and methods. The study included 839 patients with twin pregnancies. Based on pregnancy outcomes, the patients were divided into two groups. Group 1 consisted of women (n=175) whose pregnancies ended in term births. Group 2 included women (n=664) whose pregnancies ended in preterm births. A nomogram for the risk of preterm birth was constructed based on significant predictors, and its predictive performance was evaluated using ROC analysis.
Results. Multivariate analysis identified that independent predictors of preterm birth were twin growth discordance (OR=1.044; 95% CI 1.024–1.064; p<0.001) and twin chorionicity (monochorionic diamniotic twins: OR=2.993; 95% CI 1.677–5.340; p<0.001). The nomogram model included these predictors, and was developed to estimate the individual preterm birth risk. ROC curve analysis confirmed satisfactory predictive performance of the model (AUC=0.766).
Conclusion. The risk of spontaneous preterm birth in twin pregnancy is primarily associated with twin chorionicity and twin growth discordance, that is important for personalized high-risk patient management.
Authors' contributions. Gladkova K.A. – the study concept and design, statistical analysis, manuscript writing. structuring and finalization; Gladkova K.A., Sakalo V.A., Kiryanova A.O., Vtorushina V.V. — material collection, statistical data analysis and processing, manuscript writing and editing.
Conflicts of interest. The authors confirm that they have no conflict of interest to declare.
Funding. The authors received no funding for this study.
Ethical Approval. The study was approved by the local Ethics Committee of V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
Generative Artificial Intelligence. No generative AI tools were used in preparing this article.
Patient Consent for Publication. The patients have signed informed consent for publication of their data.
Authors' Data Sharing Statement. The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Gladkova K.A., Kiryanova A.O., Sakalo V.A., Vtorushina V.V.
Risk prediction of spontaneous preterm birth in twin pregnancy: a monogram.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (6): 82-91 (in Russian)
https://dx.doi.org/10.18565/aig.2026.21
Keywords
preterm birth
multiple pregnancy
risk factors
nomogram
References
- World Health Organization. Preterm birth. Available at: https://www.who.int/news-room/fact-sheets/detail/preterm-birth.
- Menzies R., Li A.L.K., Melamed N., Shah P.S., Horn D., Barrett J. et al. Risk of singleton preterm birth after prior twin preterm birth: a systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2020; 223(2): 204.e1-e8. https://dx.doi.org/10.1016/j.ajog.2020.02.003
- Zierden H.C., Shapiro R.L., DeLong K., Carter D.M., Ensign L.M. Next generation strategies for preventing preterm birth. Adv. Drug. Deliv. Rev. 2021; 174: 190-209. https://dx.doi.org/10.1016/j.addr.2021.04.021
- Emms A., Pilarski N., Hodgetts Morton V. Preterm labour and birth: prevention strategies and preparation for delivery. Obstet. Gynaecol. Reprod. Med. 2025; 35: 193-8. https://dx.doi.org/10.1016/j.ogrm.2025.04.003
- Deng C., Dai L., Yi L., Li X., Deng K., Mu Y. et al. Temporal trends in the birth rates and perinatal mortality of twins: a population-based study in China. PLoS One. 2019; 14(1): e0209962. https://dx.doi.org/10.1371/journal.pone.0209962
- Li S., Gao J., Liu J., Hu J., Chen X., He J. et al. Perinatal outcomes and risk factors for preterm birth in twin pregnancies in a Chinese population: a multi-center retrospective study. Front. Med. (Lausanne). 2021; 8: 657862. https://dx.doi.org/10.3389/fmed.2021.657862
- Amelio G.S., Provitera L., Raffaeli G., Tripodi M., Amodeo I., Gulden S. et al. Endothelial dysfunction in preterm infants: the hidden legacy of uteroplacental pathologies. Front. Pediatr. 2022; 10: 1041919. https://dx.doi.org/10.3389/fped.2022.1041919
- Гладкова К.А., Ходжаева З.С., Сакало В.А., Фролова Е.Р., Шакая М.Н., Киртбая А.Р. Роль факторов васкуло- и ангиогенеза в перинатальных исходах, неонатальной заболеваемости и смертности при осложненной монохориальной многоплодной беременности. Акушерство и гинекология. 2023; 12: 95-103. https://dx.doi.org/10.18565/aig.2023.243 [Gladkova K.A., Khodzhaeva Z.S., Sakalo V.A., Frolova E.R., Shakaya M.N., Kirtbaya A.R. The role of vasculogenic and angiogenic factors in perinatal outcomes, neonatal morbidity, and mortality in complicated monochorionic multiple pregnancies. Obstetrics and Gynecology. 2023; (12): 95-103 (in Russian). https://dx.doi.org/10.18565/aig.2023.243].
- Oger A.S., Robillard P.Y., Barau G., Randrianaivo H., Bonsante F., Iacobelli S. et al. Perinatal outcome of monochorionic and dichorionic twin gestations: a study of 775 pregnancies at Reunion Island. J. Gynecol. Obstet. Biol. Reprod. (Paris). 2013; 42(7): 655-61. French. https://dx.doi.org/10.1016/j.jgyn.2013.02.010
- Нефтерева А.А., Сакало В.А, Гладкова К.А., Костюков К.В., Ходжаева З.С. Возможные молекулярно-биологические механизмы формирования синдрома селективной задержки роста плода при монохориальной беременности. Акушерство и гинекология. 2021; 10: 5-12. https://dx.doi.org/10.18565/aig.2021.10.5-12 [Neftereva A.A., Sakalo V.A., Gladkova K.A., Kоstyukov K.V., Khodzhaeva Z.S. Possible molecular and biological mechanisms for the development of selective fetal growth restriction in monochorionic twin pregnancy. Obstetrics and Gynecology. 2021; (10): 5-12 (in Russian). https://dx.doi.org/10.18565/aig.2021.10.5-12].
- Гладкова К.А., Сакало В.А., Фролова Е.Р., Костюков К.В., Ходжаева З.С. Осложнения фетоскопической лазерной коагуляции сосудистых анастомозов плаценты при фето-фетальном трансфузионном синдроме. Проблемы репродукции. 2024; 30(5): 55-63. https://dx.doi.org/10.17116/repro20243005155 [Gladkova K.A., Sakalo V.A., Frolova E.R., Kostyukov K.V., Khodzhaeva Z.S. Complications of fetoscopic laser coagulation of placental anastomosis in twin-to-twin transfusion syndrome. Russian Journal of Human Reproduction. 2024; 30(5): 55‑63. (in Russian). https://doi.org/10.17116/repro20243005155].
- Seetho S., Kongwattanakul K., Saksiriwuttho P., Thepsuthammarat K. Epidemiology and factors associated with preterm births in multiple pregnancy: a retrospective cohort study. BMC Pregnancy Childbirth. 2023; 23(1): 872. https://dx.doi.org/10.1186/s12884-023-06186-0
- Yang X., Zhong Q., Li L., Chen Y., Tang C., Liu T. et al. Development and validation of a prediction model on spontaneous preterm birth in twin pregnancy: a retrospective cohort study. Reprod. Health. 2023; 20(1): 187. https://dx.doi.org/10.1186/s12978-023-01728-3
- Vandenbroucke J.P., von Elm E., Altman D.G., Gotzsche P.C., Mulrow C.D., Pocock S.J. et al. Повышение качества отчетов о наблюдательных исследованиях в эпидемиологии (STROBE): разъяснения и уточнения. Вопросы современной педиатрии. 2022; 21(3): 173-208. https://dx.doi.org/10.15690/vsp.v21i3.2426 [Vandenbroucke J.P., von Elm E., Altman D.G., Gotzsche P.C., Mulrow C.D., Pocock S.J. et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. Current Pediatrics. 2022; 21(3): 173-208. (in Russian). https://doi.org/10.15690/vsp.v21i3.2426].
- Министерство здравоохранения Российской Федерации. Клинические рекомендации. Преждевременные роды. М.; 2024. 28 с. [Ministry of Health of the Russian Federation. Clinical guidelines. Premature birth. Moscow; 2024. 28 p. (in Russian)].
Received 26.01.2026
Accepted 09.06.2026
About the Authors
Kristina A. Gladkova, PhD, Senior Researcher at the Department of Fetal Medicine, Institute of Obstetrics, Head of the 1st Obstetric Department of Pregnancy Pathology, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Ak. Oparina str., Moscow 117997, Russia, +7(495)438-07-88, +7(916)321-10-07, k_gladkova@oparina4.ru, https://orcid.org/0000-0001-8131-4682Anastasia O. Kiryanova, 6th year student at N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 8-2 Trubetskaya str., Moscow, 119048, Russia, +7(963)380-89-16, anastasia.kiryanova2002@gmail.com
Victoria A. Sakalo, PhD, Researcher at the Department of Obstetrics and Extragenital Pathology, Institute of Obstetrics, obstetrician-gynecologist at the 1st Obstetric Department of Pregnancy Pathology, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Ak. Oparina str., Moscow, 117997, Russia, +7(495)438-07-88, +7(929)588-72-08, v_sakalo@oparina4.ru, https://orcid.org/0000-0002-5870-4655
Valentina V. Vtorushina, PhD, Doctor of Clinical Laboratory Diagnostics at the Laboratory of Clinical Immunology, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Ak. Oparina str., Moscow, 117997, Russia, +7(495)438-11-83, v_vtorushina@oparina4.ru
Corresponding author: Kristina A. Gladkova, k_gladkova@oparina4.ru
Similar Articles
