Perinatal and Peripartum Outcomes in Vanishing Twin Pregnancies Achieved by In Vitro Fertilization

Romanski, Phillip A.; Carusi, Daniela; Farland, Leslie V.; Missmer, Stacey A.; Kaser, Daniel J.; Walsh, Brian W.; Racowsky, Catherine; Brady, Paula C.

doi:10.1097/aog.0000000000002595

Cited by 16 publications

(27 citation statements)

References 28 publications

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“…Besides, it is also suggested in previous results that, the early death of a pair of twins may improve the pregnancy outcomes. But there may be more adverse complications when continuing the twin pregnancy [20]. Analysis by Timur H et al indicated that VTS patients were more likely to develop LBW, very low birthweight (VLBW), intrauterine growth restriction and pre-eclampsia [21–23].…”

Section: Discussionmentioning

confidence: 99%

Neonatal outcomes of singleton live births with vanishing twin syndrome following double embryos transfer in assisted reproductive technology: a retrospective cohort study

et al. 2019

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Background Women with vanishing twin syndrome are associated with increased risks of adverse neonatal outcomes, such as preterm birth (PTB) and low birthweight (LBW), compared with those in singleton live births following single embryo transfer (SET) in assisted reproductive technology (ART). Methods Anonymized data on all cycles performed in China were obtained from the Reproductive Medicine Department at the Third Affiliated Hospital of Zhengzhou University, which had involved 127597 cycles following double embryos transfer (DET), including 54585 fresh embryos transfer (ET) cycles and 73012 frozen embryos transfer (FET) cycles. In addition, the obstetric outcomes, such as gestation age, PTB, small for gestation age (SGA), birthweight (BW), LBW, congenital malformation, pediatric admission and Neonatal Intensive Care Unit (NICU) admission in the fresh ET and FET cycles, were analyzed. Moreover, logistic regression analysis was performed to adjust the confounders, including age of women, body weight index (BMI), value of AMH, infertile years, current cycle, antral follicles, cause of infertility, number of oocytes retrieved, endometrial thickness at the date of transplantation, number of high-quality embryos, and embryo stage. Results In the fresh ET cycles, the BW and gestational age in study group were lower than those in control group, which were (2962.4 ± 563.1vs. 3104.9 ± 498. 5, p = 0.000) and (262.8 ± 8.4 vs. 268.9 ± 13.9, p = 0.000), respectively. Relative to control group, the study group was linked with increased risks of PTB (adjusted odds ratio (aOR) 2.45, 95% CI:1.98–3.03, adjusted p = 0.000), LBW (aOR2.11, 95% CI:1.67–2.65, adjusted p = 0.000), pediatric admission (aOR 2.55, 95% CI2.07–3.13, adjusted p = 0.000), and NICU admission (aOR 1.98, 95% CI1.32–2.96, adjusted p = 0.001), but there were no statistically significant differences in the risks of SGA (aOR 1.09, 95% CI0.82–1.45, adjusted p = 0.960) and congenital malformation (aOR 0.94, 95% CI0.53–1.68, adjusted p = 0.640) between the two groups. In the FET cycles, the gestational age and BW in study group were lower than those in control group, which were (263.0 ± 15.7vs. 273.0 ± 10.5, p = 0.000) and (3099 ± 662.1vs. 3352 ± 671.5), respectively. The study group was associated with increased risks of PTB (aOR2. 45, 95% CI: 2.23–3.43, adjusted p = 0.000), LBW (aOR 2.67, 95% CI: 2.13–3.34, adjusted p = 0.000), pediatric admission (aOR2.62, 95% CI2.14–3.21, adjusted p = 0.000), and NICU admission (aOR 2.22, 95% CI1.43, 3.46, adjusted p = 0.001) compared with those in control group, but differences in the risks of SGA (aOR 0.98, 95...

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Section: Discussionmentioning

confidence: 99%

Neonatal outcomes of singleton live births with vanishing twin syndrome following double embryos transfer in assisted reproductive technology: a retrospective cohort study

et al. 2019

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“…Hence, blood flow towards the surviving twin might be decreased temporarily, inducing a relative placental insufficiency, which could delay placental expansion and retard fetal growth. Interestingly, we did not find that the vanishing fetus had any significant influence on the rate of preterm birth either in the IVF/ICSI group or in the spontaneous group, a result which contrasts with other epidemiological and observational studies [28], [34], but confirms still other studies [22], [27], [63]. In relation to low birth weight and preterm birth, the perinatal outcome of VT after ART has been found similar to singletons and better than twin pregnancies in other retrospective studies [63], [64].…”

Section: Discussion Of Specific Results and Comparison With Other Studiescontrasting

confidence: 90%

Associated obstetric and perinatal determinants of vanishing twin pregnancies

Márton

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A retrospective cohort study was carried out to reveal the characteristics and the perinatal outcome of vanishing twin pregnancies after spontaneous conception and after assisted reproductive techniques (ART). Vanishing twin (VT) syndrome, defined as the disappearance of one of two embryos with the survival of the co-twin during the first trimester, has been known for more than four decades. Due to the high and ever growing number of assisted reproductive treatments, the incidence of twin pregnancies and thus of vanishing twin syndrome is high. Recent studies have only examined vanishing twins after ART, but we hypothesized that there is a difference in perinatal outcomes between VT pregnancies, depending on the mode of conception, possibly reflecting the potential differences between underlying pathomechanisms. Our study consisted of two parts. We initiated the first study to compare obstetric and neonatal outcomes between the survivors of VT pregnancies and matched originally singleton control pregnancies, and a second study to evaluate whether VT pregnancies after spontaneous conception have a more adverse perinatal outcome than those conceived after assisted reproductive techniques. The study involved 316 VT pregnancies: 81 after in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and 235 after spontaneous conception. Their data were derived from databases in a 22-year study period at the Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary. Our results proved that the frequency of VT pregnancies was significantly higher after natural conception than after ART. A comparison of VT pregnancies demonstrated a higher rate in pregestational and gestational diabetes mellitus (GDM) in IVF/ICSI cases than in spontaneously conceived VT pregnancies. Significant differences in the prevalences of pregnancies and intrapartum complications, and adverse neonatal outcomes were observed in vanishing twins born after IVF/ICSI as compared with those born after implantation without medical assistance, suggesting that adverse perinatal outcome in IVF/ICSI VT pregnancies may be more related to ART or infertility and underlying chronic diseases. Previous induced abortion and second-trimester fetal loss indicated an increased risk of VT pregnancies, while GDM and prematurity of previous pregnancies predicted VT and growth retardation, particularly in the spontaneously conceived VT group. Diabetes is classically defined as being associated with a higher miscarriage rate. We observed a higher recurrence rate of gestational diabetes and increased incidence of pregestational and gestational diabetes mostly in IVF/ICSI VT pregnancies, suggesting that diabetes may share a pathomechanism with VT. After identifying the causes that lead to vanishing twin syndrome, GDM, chronic maternal diseases, advanced maternal age and placentation anomalies all represented independent risk factors for VT following IVF/ICSI. It can be established that the VT phenomenon was a major prognosticator of intrauterine growth restriction for the remaining fetus in VT pregnancies after ART. In conclusion, according to our results, VT is quite frequent. VT pregnancies had a lower prevalence and a worse perinatal outcome following IVF/ICSI as compared with those of their spontaneously conceived counterparts.

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“…A few studies reported an increased risk of preterm birth before 37 weeks [3,6,15], 34 weeks [5,6], 32 weeks [3,15] and 28 weeks [5] of gestation. However, La Sala and Phillip reported that the preterm birth was not increased in vanishing twin [7,11]. Recently, a meta-analysis of the obstetric outcome of vanishing twin has been performed [16], and preterm birth less than 34 weeks was significantly increased in vanishing twin group.…”

Section: Plos Onementioning

confidence: 97%

“…Traditionally, it was believed that this vanishing twin phenomenon do not affect the pregnancy outcomes of the remained co-twin [4]. However, a few recent studies described adverse obstetric outcomes such as preterm birth and low birth weight in vanishing twin [5][6][7][8][9], whereas other studies did not find differences between singleton pregnancy and vanishing twin [7,10,11]. In addition, there is a paucity of information regarding the risk of spontaneous preterm birth (sPTB) and indicated spontaneous preterm birth (iPTB) although it is plausible that vanishing twin might increase the risk of sPTB by an inflammatory condition [12].…”

Section: Introductionmentioning

confidence: 99%

The risk of preterm birth in vanishing twin: A multicenter prospective cohort study

et al. 2020

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ObjectiveTo evaluate not only the risk of total preterm birth (PTB) but also spontaneous preterm birth (sPTB) and indicated preterm birth (iPTB) in vanishing twin (VT). Study designThis is a secondary analysis of a multicenter prospective cohort study. In 12 different healthcare institutions, women with singleton pregnancies were enrolled in early pregnancy and followed up till delivery. ResultsA total of 4,746 women were included in the final analysis, and. the frequency of VT was 1.1% (54/4746). VT group had a higher risk for total PTB (PTB<34 weeks, 2.1% vs. 14.8%, p<0.001; PTB<32 weeks, 1.6% vs. 13.0%, p<0.001; PTB<28 weeks, 0.9% vs. 13.0%, p<0.001) than singleton group. The VT group had increased risk for both sPTB and iPTB (<34 weeks, <32 weeks, and <28 weeks), and this increased risk for sPTB and iPTB in VT group remained significant even after controlling for confounders such as maternal age, parity, pre-pregnancy BMI, and mode of conception.

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Perinatal and Peripartum Outcomes in Vanishing Twin Pregnancies Achieved by In Vitro Fertilization

Abstract: In pregnancies conceived by in vitro fertilization that progress to at least 24 weeks of gestation, vanishing twin and singleton pregnancies had similar perinatal and peripartum outcomes. Both were significantly better than twin pregnancies.

Cited by 16 publications

References 28 publications

Neonatal outcomes of singleton live births with vanishing twin syndrome following double embryos transfer in assisted reproductive technology: a retrospective cohort study

Neonatal outcomes of singleton live births with vanishing twin syndrome following double embryos transfer in assisted reproductive technology: a retrospective cohort study

Associated obstetric and perinatal determinants of vanishing twin pregnancies

The risk of preterm birth in vanishing twin: A multicenter prospective cohort study

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