Barbara Luke1, Daksha Gopal2, Howard Cabral2, Judy E Stern3, Hafsatou Diop4. 1. Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI. Electronic address: lukeb@msu.edu. 2. Department of Biostatistics, Boston University School of Public Health, Boston, MA. 3. Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Lebanon, NH. 4. Massachusetts Department of Public Health, Boston, MA.
Abstract
BACKGROUND: It is unknown whether the risk of adverse outcomes in twin pregnancies among subfertile women, conceived with and without in vitro fertilization, differs from those conceived spontaneously. OBJECTIVE: We sought to evaluate the effects of fertility status on adverse perinatal outcomes in twin pregnancies on a population basis. STUDY DESIGN: All twin live births of ≥22 weeks' gestation and ≥350 g birthweight to Massachusetts resident women in 2004 through 2010 were linked to hospital discharge records, vital records, and in vitro fertilization cycles. Women were categorized by their fertility status as in vitro fertilization, subfertile, or fertile, and by twin pair genders (all, like, unlike). Women whose births linked to in vitro fertilization cycles were classified as in vitro fertilization; those with indicators of subfertility but without in vitro fertilization treatment were classified as subfertile; all others were classified as fertile. Risks of 6 adverse pregnancy outcomes (gestational diabetes, pregnancy hypertension, uterine bleeding, placental complications [placenta abruptio, placenta previa, and vasa previa], prenatal hospitalizations, and primary cesarean) and 9 adverse infant outcomes (very low birthweight, low birthweight, small-for-gestation birthweight, large-for-gestation birthweight, very preterm [<32 weeks], preterm, birth defects, neonatal death, and infant death) were modeled by fertility status with the fertile group as reference, using multivariate log binomial regression and reported as adjusted relative risk ratios and 95% confidence intervals. RESULTS: The study population included 10,352 women with twin pregnancies (6090 fertile, 724 subfertile, and 3538 in vitro fertilization). Among all twins, the risks for all 6 adverse pregnancy outcomes were significantly increased for the subfertile and in vitro fertilization groups, with highest risks for uterine bleeding (adjusted relative risk ratios, 1.92 and 2.58, respectively) and placental complications (adjusted relative risk ratios, 2.07 and 1.83, respectively). Among all twins, the risks for those born to subfertile women were significantly increased for very preterm birth and neonatal and infant death (adjusted relative risk ratios, 1.36, 1.89, and 1.87, respectively). Risks were significantly increased among in vitro fertilization twins for very preterm birth, preterm birth, and birth defects (adjusted relative risk ratios, 1.28, 1.07, and 1.26, respectively). CONCLUSION: Risks of all maternal and most infant adverse outcomes were increased for subfertile and in vitro fertilization twins. Among all twins, the highest risks were for uterine bleeding and placental complications for the subfertile and in vitro fertilization groups, and neonatal and infant death in the subfertile group. These findings provide further evidence supporting single embryo transfer and more cautious use of ovulation induction.
BACKGROUND: It is unknown whether the risk of adverse outcomes in twin pregnancies among subfertile women, conceived with and without in vitro fertilization, differs from those conceived spontaneously. OBJECTIVE: We sought to evaluate the effects of fertility status on adverse perinatal outcomes in twin pregnancies on a population basis. STUDY DESIGN: All twin live births of ≥22 weeks' gestation and ≥350 g birthweight to Massachusetts resident women in 2004 through 2010 were linked to hospital discharge records, vital records, and in vitro fertilization cycles. Women were categorized by their fertility status as in vitro fertilization, subfertile, or fertile, and by twin pair genders (all, like, unlike). Women whose births linked to in vitro fertilization cycles were classified as in vitro fertilization; those with indicators of subfertility but without in vitro fertilization treatment were classified as subfertile; all others were classified as fertile. Risks of 6 adverse pregnancy outcomes (gestational diabetes, pregnancy hypertension, uterine bleeding, placental complications [placenta abruptio, placenta previa, and vasa previa], prenatal hospitalizations, and primary cesarean) and 9 adverse infant outcomes (very low birthweight, low birthweight, small-for-gestation birthweight, large-for-gestation birthweight, very preterm [<32 weeks], preterm, birth defects, neonatal death, and infantdeath) were modeled by fertility status with the fertile group as reference, using multivariate log binomial regression and reported as adjusted relative risk ratios and 95% confidence intervals. RESULTS: The study population included 10,352 women with twin pregnancies (6090 fertile, 724 subfertile, and 3538 in vitro fertilization). Among all twins, the risks for all 6 adverse pregnancy outcomes were significantly increased for the subfertile and in vitro fertilization groups, with highest risks for uterine bleeding (adjusted relative risk ratios, 1.92 and 2.58, respectively) and placental complications (adjusted relative risk ratios, 2.07 and 1.83, respectively). Among all twins, the risks for those born to subfertile women were significantly increased for very preterm birth and neonatal and infantdeath (adjusted relative risk ratios, 1.36, 1.89, and 1.87, respectively). Risks were significantly increased among in vitro fertilization twins for very preterm birth, preterm birth, and birth defects (adjusted relative risk ratios, 1.28, 1.07, and 1.26, respectively). CONCLUSION: Risks of all maternal and most infant adverse outcomes were increased for subfertile and in vitro fertilization twins. Among all twins, the highest risks were for uterine bleeding and placental complications for the subfertile and in vitro fertilization groups, and neonatal and infantdeath in the subfertile group. These findings provide further evidence supporting single embryo transfer and more cautious use of ovulation induction.
Authors: Barbara Luke; Judy E Stern; Milton Kotelchuck; Eugene R Declercq; Mark D Hornstein; Daksha Gopal; Lan Hoang; Hafsatou Diop Journal: Fertil Steril Date: 2015-05-05 Impact factor: 7.329
Authors: Michael F G Murphy; Rachel E Neale; Kate Hey; Valerie A Seagroatt; Michael J Goldacre; Martin P Vessey; Bryony M Willis; J Douglas Ellis; David H Barlow Journal: Twin Res Hum Genet Date: 2006-04 Impact factor: 1.587
Authors: Tom Witteveen; Thomas Van Den Akker; Joost J Zwart; Kitty W Bloemenkamp; Jos Van Roosmalen Journal: Am J Obstet Gynecol Date: 2015-11-11 Impact factor: 8.661
Authors: Barbara Luke; Mary L Hediger; Clark Nugent; Roger B Newman; Jill G Mauldin; Frank R Witter; Mary Jo O'Sullivan Journal: J Reprod Med Date: 2003-04 Impact factor: 0.142
Authors: Judy E Stern; Chia-Ling Liu; Howard J Cabral; Elliott G Richards; Charles C Coddington; Stacey A Missmer; Hafsatou Diop Journal: Fertil Steril Date: 2018-08 Impact factor: 7.329
Authors: Michael L Eisenberg; Barbara Luke; Katherine Cameron; Gary M Shaw; Allan A Pacey; Alastair G Sutcliffe; Carrie Williams; Julian Gardiner; Richard A Anderson; Valerie L Baker Journal: J Assist Reprod Genet Date: 2020-09-30 Impact factor: 3.412
Authors: Barbara Luke; Morton B Brown; Mary K Ethen; Mark A Canfield; Stephanie Watkins; Ethan Wantman; Kevin J Doody Journal: Fertil Steril Date: 2020-05-11 Impact factor: 7.329
Authors: Barbara Luke; Morton B Brown; Ethan Wantman; David B Seifer; Amy T Sparks; Paul C Lin; Kevin J Doody; Bradley J Van Voorhis; Logan G Spector Journal: J Assist Reprod Genet Date: 2018-10-17 Impact factor: 3.412