{
  "abstract": "Introduction Selective fetal growth restriction (sFGR) is a major cause of perinatal morbidity and mortality in monochorionic diamniotic (MCDA) twin pregnancies. Current management relies on umbilical artery Doppler patterns in the smaller twin. These patterns are, however, inconsistent and do not represent a reliable severity scale, complicating clinical decision-making and parental counselling. This study aims to improve risk stratification by identifying predictors of adverse outcomes, while also evaluating the pathophysiology and multi-organ impact of sFGR in early childhood.Methods and analysis This is a prospective, international, multicentre cohort study conducted in six tertiary fetal medicine centres with expertise in complicated twin pregnancies. Recruitment began in March 2023 and will continue until December 2026, targeting 274 MCDA twin pairs with complete follow-up to develop a prediction model for adverse perinatal outcomes in sFGR at the time of diagnosis. Standardised data collection includes serial ultrasound examinations, advanced fetal imaging (cardiac, cerebral and 3D volumetric), fetal brain MRI and detailed placental phenotyping. Maternal and parental well-being are assessed during pregnancy and after birth. Neurodevelopmental outcome is evaluated up to 2 years after birth using validated tools. The statistical analysis plan includes predictive modelling with internal validation.Ethics and dissemination The study has been approved by the ethical review boards of all participating centres. Findings will be disseminated through peer-reviewed publications, international conferences and engagement with clinical guideline committees.Trial registration number NCT05952583.",
  "authors": [
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Division of Fetal Medicine, Leiden Universitair Medisch Centrum, Leiden, The Netherlands",
        "Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium",
        "Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden"
      ],
      "name": "Anne Noll"
    },
    {
      "affiliations": [
        "Maternal Fetal Care Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Ali Javinani"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Division of Fetal Medicine, Leiden Universitair Medisch Centrum, Leiden, The Netherlands"
      ],
      "name": "Femke Slaghekke"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Division of Fetal Medicine, Leiden Universitair Medisch Centrum, Leiden, The Netherlands"
      ],
      "name": "Monique C Haak"
    },
    {
      "affiliations": [
        "Neonatology, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands"
      ],
      "name": "Jeanine van Klink"
    },
    {
      "affiliations": [
        "Department of Pathology, Leiden Universitair Medisch Centrum, Leiden, The Netherlands",
        "Department of Pathology, Erasmus MC Universitair Medisch Centrum Rotterdam, Rotterdam, The Netherlands"
      ],
      "name": "Lotte Van der Meeren"
    },
    {
      "affiliations": [
        "Neonatology, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands"
      ],
      "name": "Enrico Lopriore"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium",
        "Department of Development and Regeneration, Biomedical Sciences, KU leuven, Leuven, Belgium"
      ],
      "name": "Francesca Russo"
    },
    {
      "affiliations": [
        "Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium"
      ],
      "name": "Michael Aertsen"
    },
    {
      "affiliations": [
        "Maternal Fetal Care Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Alireza Shamshirsaz"
    },
    {
      "affiliations": [
        "Ontario Fetal Center, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "S Shinar"
    },
    {
      "affiliations": [
        "BCNatal, Hospital Clinic and Hospital Sant Joan de Deu, Barcelona, Spain"
      ],
      "name": "Mar Bennasar"
    },
    {
      "affiliations": [
        "Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden"
      ],
      "name": "Eleonor Tiblad"
    },
    {
      "affiliations": [
        "Center for Fetal Medicine, Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden",
        "Department of Clinical Science, Intervention and Technology, Karolinksa Institutet, Stockholm, Sweden"
      ],
      "name": "Lotta Herling"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium",
        "Department of Development and Regeneration, Biomedical Sciences, KU leuven, Leuven, Belgium"
      ],
      "name": "Liesbeth Lewi"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Division of Fetal Medicine, Leiden Universitair Medisch Centrum, Leiden, The Netherlands"
      ],
      "name": "EJT (Joanne) Verweij"
    },
    {
      "affiliations": [],
      "name": "CONTRAST Study Group"
    }
  ],
  "title": "Predicting outcomes in selective fetal growth restriction of monoChOrioNic Twins: an inteRnAtional observational cohort STudy protocol (CONTRAST study)",
  "uid": "eb65cb73-2428-5a82-9b4b-822f2e9aab8f"
}