Does Maternal Subfertility Impact Outcomes in Twin Pregnancies?
BACKGROUND AND PURPOSE:
Multiple gestation associated with assisted reproductive technology (ART) is declining but still accounts for approximately 40% of all twin births.
There is a greater risk of adverse outcomes in twin vs. singleton pregnancies
There is ongoing controversy if adverse outcomes using ART is related to the treatment or parental characteristics such as subfertility and limited data in twin vs. singleton pregnancies
This study by Luke et al. (AJOG, 2017) sought to determine if a mother’s fertility status impacts the risk of adverse outcomes in twin pregnancies
Longitudinal Retrospective Cohort Study
10,352 women with twin pregnancies were included in the study
6,090 ‘fertile’ women who conceived twins naturally
724 ‘subfertile’ women (e.g., use of fertility drugs or ART, diagnosis of infertility) who conceived twins without IVF
3,538 women who conceived twins with IVF
Adverse pregnancy and infant outcomes were examined
Women in the subfertile and IVF group were older and had more chronic health conditions
There were higher rates of gestational diabetes, gestational hypertension, uterine bleeding, placental complications, prenatal hospitalizations, and primary C-sections among the subfertile and IVF groups
Uterine bleeding (adjusted relative risk ratios, 1.92 for subfertile and 2.58 for IVF) and placental complications (adjusted relative risk ratios, 2.07 for subfertile and 1.83 for IVF) were the highest risks
Subfertile women had increased risk for very preterm birth (< 32 weeks) and neonatal and infant death (adjusted relative risk ratios, 1.36, 1.89, and 1.87, respectively)
In the IVF group, women were at increased risk for very preterm birth, preterm birth (<37 weeks), and birth defects (adjusted relative risk ratios, 1.28, 1.07, and 1.26, respectively)
The risk of adverse maternal and infant outcomes was increased among subfertile and IVF twins
Especially increased risk of bleeding and placental complications is a consistent finding among studies
These data are in keeping with guidelines promoting single embryo transfer and cautious use of ovulation induction to limit multiple gestation with ART
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