Clinical outcomes after assisted reproductive technology in twin pregnancies: chorionicity-based comparison

Abstract

The chorionicity–based evaluation of the perinatal risk in twin pregnancies after assisted reproductive technology (ART) is lacking. A retrospective review was performed of all twin pregnancies monitored prenatally and delivered at our hospital between 2010 and 2014. Chorionicity was diagnosed by ultrasound examination at first trimester and confirmed by postnatal pathology. Pregnancy and perinatal outcomes were prospectively recorded. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated in a logistic regression model. A total of 1153 twin pregnancies were analyzed. The occurrence of preterm premature rupture of membranes (PPROM) was 3 times as frequent in monochorionic diamniotic (MCDA) twin pregnancies after ART as in those spontaneous counterparts (aOR 3.0; 95%CI 1.1–3.2). The prevalence of intrahepatic cholestasis of pregnancies (ICP) was significantly higher in dichorionic diamniotic (DCDA) twin pregnancies following ART compared to spontaneous DCDA pregnancies (aOR 3.3; 95%CI 1.3–5.6). Perinatal outcomes did not differ between two conception methods, either in MCDA or DCDA twin pregnancies. Based on differentiation of chorionicity, ART is associated with the increased risk of PPROM in MCDA twin pregnancies and with a higher rate of ICP in DCDA twin gestations. ART does not increase adversity of perinatal outcomes in twin pregnancies.

Peer Review #1 of "Obstetric and perinatal outcomes of dizygotic twin pregnancies resulting from in vitro fertilization versus spontaneous conception: a retrospective study (v0.1)"

“…However, in the current study, IVF treatments did not show any adverse effects on neonatal outcomes. The conclusion was in agreement with that in several previous studies, which also have failed to find the increased risks when comparing the neonatal outcomes according to mode of conception (Anbazhagan et al, 2014;Pourali et al, 2016;Sun et al, 2016;Vasario et al, 2010). Differences in study population and methodology may account for the conflicting data.…”

“…In the past few years, growing interests has been paid to the role of IVF-ET treatments in obstetric and neonatal outcomes of twin pregnancies, but the results remain to be inconsistent (Geisler et al, 2014;Helmerhorst et al, 2007;McDonald et al, 2005;Moini et al, 2012;Pourali et al, 2016;Qin et al, 2015;Sun et al, 2016;Vasario et al, 2010). The current study compared the obstetric complications and neonatal outcomes of dizygotic twin gestations conceived via IVF with those from SC twin pregnancies.…”

“…The findings are conflicting. Some studies have shown that IVF treatments in dizygotic twin gestations are related to increased risks of obstetric complications, specifically preeclampsia, intrahepatic cholestasis of pregnancies (ICP) (Sun et al, 2016), andGDM (Moini et al, 2012;Pourali et al, 2016). In contrast, this relationship was not observed in several other studies (Anbazhagan et al, 2014;Geisler et al, 2014;Moini et al, 2012;Vasario et al, 2010).…”

“…Data were obtained from medical records, which include maternal age, gestational age, delivery mode, duration of hospitalization, perinatal complications, neonatal birth defects, birthweight, and neonatal intensive care unit (NICU) admission. The medical diagnosis was categorized according to the criteria proposed by Sun et al (Sun et al, 2016).…”

“…Several studies have been performed to explore the exact role of IVF-ET in obstetric and neonatal outcomes of twin pregnancies, but the results remain conflicting (Geisler et al, 2014;Helmerhorst et al, 2007;McDonald et al, 2005;Pourali et al, 2016;Qin et al, 2015;Sun et al, 2016;Vasario et al, 2010). One of the confounding factors in some studies is that monochorionicity among IVF-conceived twin pregnancies is quite rare, when compared with that in SC twin pregnancies (about 2% and 22%, respectively), and monochorionic pregnancies have more adverse effects on obstetric outcomes (Penava et al, 2004).…”