Twin-to-twin transfusion syndrome and potential applicability to the Barker hypothesis

Twin-to-Twin Transfusion Syndrome (TTTS) carries significant risk of morbidity and mortality in affected monozygotic twin sets. As research into TTTS progresses, the effects of the adverse intrauterine environment on the long-term morbidities of TTTS survivors, is becoming more apparent. In TTTS, there is impaired vascular development and significant cardiac change in both foetuses, leading to high risk of long-term cardiac and neurologic morbidities in survivors. This appears to reflect the Barker Hypothesis of the Developmental Origins of Disease. This review will discuss the Barker Hypothesis and its potential applicability to TTTS. It will outline foetal development in TTTS and subsequent consequences for the neonate. Current TTTS research will be discussed in addition to relevant neonatal care provision. It will become evident that in order to improve long-term outcomes for TTTS survivors, a significant body of research focussing upon the correlation between foetal development in TTTS and associated adult disease states is required.