Background/Objectives: Twin pregnancies carry substantially elevated perinatal risks, yet tools for first-trimester risk stratification remain limited. This retrospective cohort study evaluated the predictive value of crown–rump length (CRL) and nuchal translucency (NT) discordance for adverse perinatal outcomes in 184 twin pregnancies at Ankara Etlik City Hospital, Turkey (October 2022–January 2024). Methods: CRL discordance ≥ 10% and NT discordance ≥ 20% were assessed for a birth-weight-based proxy of fetal growth restriction (FGR), preeclampsia, and neonatal outcomes using multivariable logistic regression adjusted for chorionicity, body mass index (BMI), and conception mode. Results: CRL discordance ≥ 10% was independently associated with the birth-weight-based FGR proxy (adjusted odds ratio OR 7.79, 95% confidence interval CI 3.95–20.12, p < 0.001; area under the curve AUC 0.736). NT discordance ≥ 20% was also independently associated with the birth-weight-based FGR proxy (OR 3.74, 95% CI 1.91–8.39, p < 0.001; AUC 0.612). Both parameters were associated with lower Apgar scores. IVF conception was independently associated with preeclampsia in an exploratory analysis (OR 5.31, 95% CI 1.41–28.66, p = 0.016). Continuous modelling confirmed a dose–response relationship for CRL discordance (OR per 1% increase = 1.20, 95% CI 1.13–1.32). Conclusions: These findings suggest that first-trimester CRL discordance may provide useful early prognostic information for birth-weight-based adverse growth outcome in twin pregnancies, pending prospective validation in cohorts with Doppler-based FGR ascertainment.
EROĞLU et al. (2026) studied this question.