Assisted reproductive technology and risk of adverse obstetric outcomes in dichorionic twin pregnancies: a systematic review and meta-analysis

Qin, Jiabi; Wang, Hua; Sheng, Xiaoqi; Xiao, Qiang; Gao, Shiyou

doi:10.1016/j.fertnstert.2015.12.131

Cited by 90 publications

(88 citation statements)

References 62 publications

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“…In all meta-analytic data [16, 17, 22, 23] perinatal mortality was not increased. A recent cohort study [24], however, reported an adjusted risk of perinatal death for twins 45 and 85 % lower among ART births than fertile or subfertile births, respectively.…”

Section: Resultsmentioning

confidence: 95%

“…To this regard, a recent meta-analysis [23] including 15 cohort studies and involving 6,420 dichorionic twins after ART and 13,650 dichorionic NC twins confirmed a risk of placenta previa (RR 2.99, 95 % CI 1.51 to 5.92), PTB (RR 1.13, 95 % CI 1.00 to 1.29), VPTB (RR 1.39, 95 % CI 1.07 to 1.82), LBW (RR 1.11, 95 % CI 1.00 to 1.23), and elective cesarean sections (RR 1.79, 95 % CI 1.49 to 2.16) significantly increased in ART pregnancies. Very recently, a nationwide registry based study demonstrated in women who conceived dizygotic twins after IVF/ICSI rates of PIH lower than after NC (aOR 0.74, 95 % CI 0.66 to 0.83) [27].…”

Section: Resultsmentioning

confidence: 99%

“…when estimating the effect of ART singletons on obstetric outcomes.- Patients who achieved a pregnancy with OI and IUI have been considered in the NC category.- Substantial heterogeneity among studies for association between ART singleton pregnancies and obstetric risks.- A number of the outcomes, especially for pregnancy-related complications, relied on between 2 and 7 of the 50 total studies.Cromi et al, 2016 [21]Case–control studyThe study reports the experience of a tertiary referral center; therefore, this factor may have inflated the observed rates of peripartum hysterectomy.The control populations have not been separated into two groups (normal fertile couples and infertile couples who conceive without treatment) to determine the degree to which observed associations are specifically related to the ART procedures vs. infertility per se.- Detailed information on the infertility treatments was not available.- Small study number.Pandey et al, 2012 [18]Review of 20 matched cohort studies and 10 unmatched cohort studiesAscertainment bias with the findings of increased complications with IVF/ICSI; i.e. women may be more anxious following fertility treatment and therefore more likely to report problems.The quality of most of the studies was high and they have adjusted for most important confounders of age and parity.- Some authors excluded pregnancies resulting from ovulation induction whereas others were not able to identify them from all non-IVF/ICSI conceptions.- The review cannot determine whether the increased risk is due to the inherent infertility itself or the process of ovarian stimulation and/or embryo culture.Qin et al, 2015 [22]Meta-analysis of 39 cohort studies- No evidence of publication bias among studies of ART and risk of adverse outcomes.- All the included original studies used a cohort study design, which minimizes recall and selection biases.- Some included studies have considered pregnancies arising after OI and IUI to be in the spontaneously generated category.- A number of the outcomes, especially for pregnancy-related complications, relied on between 1 and 8 of the 39 total studies.- The study population consisted of monochorionic and dichorionic twins, and monochorionic twins are known to be at high risk than dichorionic twins.- Residual confounding is a concern, although restricting analysis to studies that have matched or adjusted confounding factors did not materially alter the combined risk estimate.Qin et al, 2016 [23]Meta-analysis of 15 cohort studiesNo evidence of publication bias.26.7 % of the studies did not adjust and/or match any factorswhen estimating the effect of ART on obstetric outcomes indichorionic twin pregnancies.- More than half of the included studies had a small sample size.- Most of included studies belonged to retrospective cohort design.- There was substantial heterogeneity among studies for association between ART and obstetric risks in dichorionictwin pregnancies.- A number of the outcomes, especially for maternal complications, relied on between 2 and 7 of the 15 total studies.Pinborg et al, 2013 [9]Meta-analysis of 3 studies (for the considered outcome: PTB in SET vs. DET)Subfertility per se is a bias and it cannot be p...…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Risk of adverse pregnancy and perinatal outcomes after high technology infertility treatment: a comprehensive systematic review

Palomba

Homburg

Santagni

et al. 2016

Reprod Biol Endocrinol

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In the literature, there is growing evidence that subfertile patients who conceived after infertility treatments have an increased risk of pregnancy and perinatal complications and this is particularly true for patients who conceived through use of high technology infertility treatments. Moreover, high technology infertility treatments include many concomitant clinical and biological risk factors. This review aims to summarize in a systematic fashion the current evidence regarding the relative effect of the different procedures for high technology infertility treatments on the risk of adverse pregnancy and perinatal outcome. A literature search up to August 2016 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar and an evidence-based hierarchy was used to determine which articles to include and analyze. Data on prepregnancy maternal factors, low technology interventions, specific procedures for male factor, ovarian tissue/ovary and uterus transplantation, and chromosomal abnormalities and malformations of the offspring were excluded. The available evidences were analyzed assessing the level and the quality of evidence according to the Oxford Centre for Evidence-Based Medicine guidelines and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. Current review highlights that every single procedure of high technology infertility treatments can play a crucial role in increasing the risk of pregnancy and perinatal complications. Due to the suboptimal level and quality of the current evidence, further well-designed studies are needed.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Risk of adverse pregnancy and perinatal outcomes after high technology infertility treatment: a comprehensive systematic review

Palomba

Homburg

Santagni

et al. 2016

Reprod Biol Endocrinol

View full text Add to dashboard Cite

show abstract

“…If whether or not twin pregnancies constitute an undesirable outcome of IVF were to be the sole question, the answer would be simple: Following IVF or natural conception, twin pregnancies are, indeed, best avoided 15–19. Ours, after all, is a mono-ovulatory uniparous species that is ill-suited to concurrent multiple progeny 20.…”

Section: Yes: Twins Constitute An Adverse Outcome Of Ivfmentioning

confidence: 99%

Is a Blanket Elective Single Embryo Transfer Policy Defensible?

Adashi¹,

Gleicher²

2017

Rambam Maimonides Med J

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For the purpose of reducing maternal and neonatal morbidity, elective single transfer (eSET) in in vitro fertilization (IVF) was first proposed in 1999. The purpose of this review is to summarize recent oral debate between a proponent and an opponent of expanded eSET utilization in an attempt to determine whether a blanket eSET policy, as is increasingly considered, is defensible. While eSET is preferable when possible, and agreed upon by provider and patient, selective double embryo transfer (DET) must be seriously entertained if deemed more appropriate or is desired by the patient. Patient autonomy, let alone prolonged infertility and advancing age, demand nothing less. Importantly, IVF-generated twins represent only 15.7% of the national twin birth rate in the United States. Non-IVF fertility treatments have been identified as the main cause of all multiple births for quite some time. However, educational and regulatory efforts over the last decade, paradoxically, have exclusively only been directed at the practice of IVF, although IVF patient populations are rapidly aging. It is difficult to understand why non-IVF fertility treatments, usually applied to younger women, have so far escaped attention. This debate on eSET utilization in association with IVF may contribute to a redirection of priorities.

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“…These pregnancies have great maternal and fetal risks due to many complications that occur during or after the course of pregnancy [2] [3].…”

Section: Introductionmentioning

confidence: 99%

Prophylactic Cervical Cerclage versus Vaginal Progesterone in Triplet Pregnancy—A Randomized Prospective Comparative Study

Al-Gergawy¹,

Gamal²

2017

OJOG

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Objective: To compare the effect of prophylactic cervical cerclage with vaginal progesterone in triplet (with normal cervical measurements) to evaluate its efficacy in improving pregnancy outcome and prolonging gestation. Design: A randomized prospective comparative study. Setting: At Tanta university hospitals and outpatient clinics. Patients: 51 selected cases of triplet pregnancy were recruited and classified into 2 groups randomly, progesterone group (n = 28 cases) and cerclage group (n = 23 cases). Interventions: Transvaginal ultrasound was done for number of fetuses, viability, cervical measurements, vaginal progesterone for progesterone starting at 20 weeks, and applying McDonald cerclage at 14 -16 weeks for cerclage group. Main Outcome Measures: Time of occurrence of preterm labor, premature rupture of membranes (PROM), stitch removal, gestational age at delivery, mode of delivery, and neonatal complications. Results: Preterm labor occurred in 9, 8 cases and PROM in 4, and 3 cases in progesterone and cerclage groups respectively. The mean gestational age was 33.57 ± 2.97 and 31.74 ± 3.21 weeks in progesterone and cerclage groups; mean birth weight was 2049 ± 591 gm, and 1686 ± 512 gm in progesterone and cerclage groups respectively; Apgar score 7 or more was found in 52 (60.8%), and 39 (56.3%) newborn in progesterone and cerclage group respectively. Perinatal mortality was lower in progesterone group 26.1% (3 IUFD+19 neonatal) than in cerclage group 30.4% (2 IUFD + 19 neonatal). Respiratory distress syndrome (RDS) occurred in 43.9%, 49.76%, while need of mechanical ventilation occurred in 12.2%, 16.41% of progesterone and cerclage groups respectively and neonatal jaundice was found in 49.38%, 53.7% of progesterone and cerclage groups respectively. Conclusion: Vaginal progesterone seems to be more effective than prophylactic cerclage in reducing preterm delivery in triplet pregnancies with normal cervical measurements even in those with prior history of preterm labour and minimizing neonatal morbidity and mortality.

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Assisted reproductive technology and risk of adverse obstetric outcomes in dichorionic twin pregnancies: a systematic review and meta-analysis

Abstract: The rates of placenta previa, elective cesarean section, preterm birth, very preterm birth, low birth weight, and congenital malformations were significantly higher in dichorionic twin pregnancies after ART.

Cited by 90 publications

References 62 publications

Risk of adverse pregnancy and perinatal outcomes after high technology infertility treatment: a comprehensive systematic review

Risk of adverse pregnancy and perinatal outcomes after high technology infertility treatment: a comprehensive systematic review

Is a Blanket Elective Single Embryo Transfer Policy Defensible?

Prophylactic Cervical Cerclage versus Vaginal Progesterone in Triplet Pregnancy—A Randomized Prospective Comparative Study

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