Impact of Obesity on Pregnancies Undergoing Laser Therapy for Twin-Twin Transfusion Syndrome

Abstract

<b><i>Introduction:</i></b> We sought to determine if maternal obesity, defined by body mass index (BMI) 30–34.9 or BMI ≥35, negatively impacts the technical aspects and pregnancy outcomes in women treated with selective laser photocoagulation of placental communicating vessels for twin-twin transfusion syndrome (TTTS). <b><i>Methods:</i></b> Retrospective review of women undergoing laser for TTTS from January 2010 to December 2021. Outcomes were stratified based on maternal BMI &#x3c;30, 30–34.9, and ≥35. Data obtained included maternal age, parity, ethnicity, gestational age at laser, placental location, Quintero stage, CHOP cardiovascular score, operative and anesthesia times, procedure-to-delivery interval, gestational age at delivery, survival to birth, survival to discharge, and the presence of residual anastomoses. Statistical analysis included the χ² or Fisher’s exact test for categorical variables and the Mann-Whitney U test for continuous variables with <i>p</i> &#x3c; 0.05 being significant. <b><i>Results:</i></b> A total of 434 women underwent laser for TTTS during the study period. Of those, 274 (63%) had a BMI of &#x3c;30, 92 (21.2%) had a BMI between 30 and 34.9, and 68 (15.7%) had a BMI ≥ 35. There were no differences in maternal age, parity or ethnicity, Quintero stage, CHOP cardiovascular score, placental location, operative time, laser-to-delivery interval, gestational age at delivery, survival outcomes, or the presence of residual anastomoses between the three groups. Patients with a BMI of 30–34.9 were operated on at a slightly later gestational age, and those with a BMI &#x3e; 35 had longer operative and anesthesia times. There were no technical failures as a result of BMI ≥ 30 or 35. <b><i>Conclusion:</i></b> Using appropriate technical adjustments, outcomes for obese women undergoing laser for TTTS are similar to nonobese women, although patients with BMI ≥35 have longer operative and anesthesia times.