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The CONTRAST Study: Understanding SFGR

In a new series of articles, we’re learning about the different research studies that are out there, making a change in the world of twins. In this article, we invited Anne Noll, PhD student to tell us more about the CONTRAST Study and selective fetal growth restriction.

About the CONTRAST study:

The CONTRAST study is a prospective multicentre international cohort study on monochorionic twins with sFGR.

Selective fetal growth restriction (sFGR) in monochorionic twins may negatively impact the pregnancy. There is a substantial risk of fetal deterioration resulting in (iatrogenic) preterm birth or even intrauterine demise of one, or both fetuses. There are important unresolved challenges on a diagnostic level and underlying pathophysiological mechanisms of sFGR have not been fully clarified.

The current diagnostic classification system based on three different umbilical artery flow patterns has no increasing scale of severity and the observed flow patterns may be volatile in nature. This hinders optimal diagnostic management and complicates outcome prediction as the survival outcome differs per umbilical artery flow type. Consequently, parents encounter a great deal of uncertainty during the pregnancy. Since there is no treatment available for sFGR, predicting fetal deterioration is key in preventing single or double demise.

selective fetal growth restriction contrast study sfgr taps support

By testing several predictors, we are aiming to improve outcome prediction at the time of  sFGR diagnosis. We furthermore hypothesize that additional ultrasound parameters could be of benefit in making the current classification system more accurate and less variable. Extensive histological placental examinations will shine a light on microscopic abnormalities which can increase our knowledge of the pathophysiology.

Examining neurodevelopment of sFGR twins at two years of age will additionally be of great value for our understanding of the impact of sFGR and contribute to adequate patient counselling. Our study will evaluate the impact of a sFGR pregnancy on parental mental health and parent-to-infant(s) attachment, which has not been carried out this extensively before.

The main objective is to improve outcome prediction in sFGR by developing a prediction model at the time of sFGR diagnosis and by evaluating specific ultrasound parameters throughout the pregnancy. Secondary objectives assess several outcomes, such as increasing our pathophysiological knowledge of the development of sFGR, fetal and neonatal survival, neonatal morbidity, neurodevelopment outcomes of sFGR twin pregnancies as well as psychological impact of a sFGR pregnancy on the parents.

Current status:

What initially began as a collaborative effort among three countries (LUMC Leiden, UZ Leuven, and Karolinska University Hospital Stockholm) has evolved into a more extensive initiative, with three additional expert centers joining the project (BCNatal Barcelona, Mount Sinai Hospital Toronto, and Boston Children’s Hospital). This development is very exciting, and we anticipate that it will significantly enhance the study’s overall quality and impact.

The CONTRAST Study: Understanding SFGR

Currently, patient recruitment is underway at LUMC, UZ Leuven, and BCNatal, while preparations for patient inclusion at the other centers are in progress and expected to commence shortly. The study is scheduled to span over a period of two years, with an additional two-year follow-up phase.

More info on the study (in Dutch) can be found here:

TAPS Support would like to sincerely thank Anne Noll, who kindly wrote this article for our website. Anne is currently completing her PhD on Selective Fetal Growth Restriction and her research is part of a joint project between the Karolinska Institute (Sweden), UZ Leuven (Belgium) and the Leiden University Medical Center (The Netherlands). Learn more about her here.

For more information on the CONTRAST Study, please visit this link for contact details.

The TAPS Support Foundation remains committed to supporting research that will improve outcomes for monochorionic twins worldwide, and helping families to understand their diagnosis. Learn more about our mission on our foundation’s website.

Want to share your research or story with us? Please get in touch with us here.