Pregnancy Outcome Among Twins Conceived After Subfertility Treatment Compared With Natural Twins: A Population-Based Study

Murphy, Michael; Neale, Rachel E.; Hey, Kate; Seagroatt, Valerie; Goldacre, Michael J; Vessey, Martin; Willis, B.; Ellis, Douglas J.; Barlow, David H.

doi:10.1375/183242706776382437

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…In general, most studies show little difference in perinatal outcomes in spontaneously-conceived and subfertile or IVF twins, partially due to failure to control for monozygosity and monochorionicity (16, 49, 55–57). Two-thirds of twins are dizygotic, with 50% being like gender and 50% unlike gender.…”

Section: Discussionmentioning

confidence: 99%

Adverse pregnancy, birth, and infant outcomes in twins: effects of maternal fertility status and infant gender combinations; the Massachusetts Outcomes Study of Assisted Reproductive Technology

Luke

Gopal

Cabral

et al. 2017

American Journal of Obstetrics and Gynecology

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Background It is unknown whether the risk of adverse outcomes in twin pregnancies among subfertile women, conceived with and without in vitro fertilization (IVF), differ from those conceived spontaneously. Objective 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 grams birthweight to Massachusetts resident women in 2004–10 were linked to hospital discharge records, vital records, and IVF cycles. Women were categorized by their fertility status as in vitro fertilization (IVF), subfertile, or fertile, and by twin pair genders (all, like, unlike). Women whose births linked to IVF cycles were classified as IVF; those with indicators of subfertility but without IVF treatment were classified as subfertile; all others were classified as fertile. Risks of six adverse pregnancy outcomes (gestational diabetes, pregnancy hypertension, uterine bleeding, placental complications (placenta abruptio, placenta previa, and vasa previa), prenatal hospitalizations, primary cesarean), and nine 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 (ARRs) and 95% confidence intervals (CI). Results The study population included 10,352 women with twin pregnancies (6,090 fertile, 724 subfertile, and 3,538 IVF). Among all twins, the risks for all six adverse pregnancy outcomes were significantly increased for the subfertile and IVF groups, with highest risks for uterine bleeding (ARR 1.92, 2.58, respectively), and placental complications (ARR 2.07and 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 (ARR 1.36, 1.89, and 1.87, respectively); risks were significantly increased among IVF twins for very preterm birth, preterm birth, and birth defects (ARR 1.28, 1.07, and 1.26, respectively). Conclusions Risks of all maternal and most infant adverse outcomes are increased for subfertile and IVF twins. Among all twins, the highest risks were for uterine bleeding and placental complications for the subfertile and IVF 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.

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Section: Discussionmentioning

confidence: 99%

Adverse pregnancy, birth, and infant outcomes in twins: effects of maternal fertility status and infant gender combinations; the Massachusetts Outcomes Study of Assisted Reproductive Technology

Luke

Gopal

Cabral

et al. 2017

American Journal of Obstetrics and Gynecology

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“…Bromocriptine carries a class B pregnancy label and was first approved by the FDA for hyperprolactinemiaassociated dysfunctions, acromegaly, and Parkinson disease; it later gained approval for glycemic control in patients with diabetes [83]. Based on its oral availability and documented use as a fertility treatment (and therefore its use in early pregnancy) [84], further investigation into the mechanism of action and evaluation of efficacy in vivo may be warranted. However, the high concentrations needed for its antiviral activity may be difficult to achieve clinically.…”

Section: Ns2b-ns3 Proteasementioning

confidence: 99%

Therapeutic Approaches for Zika Virus Infection of the Nervous System

2017

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Zika virus has spread rapidly in the Americas and has caused devastation of human populations affected in these regions. The virus causes teratogenic effects involving the nervous system, and in adults and children can cause a neuropathy similar to Guillain-Barré syndrome, an anterior myelitis, or, rarely, an encephalitis. While major efforts have been undertaken to control mosquito populations that spread the virus and to develop a vaccine, drug development that directly targets the virus in an infected individual to prevent or treat the neurological manifestations is necessary. Rational and targeted drug development is possible since the viral life cycle and the structure of the key viral proteins are now well understood. While several groups have identified therapeutic candidates, their approaches differ in the types of screening processes and viral assays used. Animal studies are available for only a few compounds. Here we provide an exhaustive review and compare each of the classes of drugs discovered, the methods used for drug discovery, and their potential use in humans for the prevention or treatment of neurological complications of Zika virus infection.

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Perinatal outcomes associated with assisted reproductive technology: the Massachusetts Outcomes Study of Assisted Reproductive Technologies (MOSART)

Declercq

Luke

Belanoff

et al. 2015

Fertility and Sterility

150

115

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Objective To compare on a population basis the birth outcomes of women treated with Assisted Reproductive Technologies (ART), women with indicators of subfertility but without ART, and fertile women. Design Longitudinal cohort study Setting Massachusetts Participants 334,628 births and fetal deaths to Massachusetts mothers giving birth in a Massachusetts hospital between July 1, 2004-December 31, 2008, subdivided into three subgroups for comparison: ART 11,271, subfertile 6,609, and fertile 316,748. Intervention None Main Outcome Measures Four outcomes: preterm birth, low birthweight, small for gestational age and perinatal death, were modeled separately for singletons and twins using logistic regression with the primary comparison between ART births and those to the newly created population based subgroup of births to women with indicators of subfertility but no ART. Results Singletons: The risks for both preterm birth and low birthweight were higher for the ART group (AOR 1.23 and 1.26, respectively) compared to the subfertile group and risks in both the ART and subfertile groups were higher than those among fertile births. Twins: the risk of perinatal death was significantly lower among ART births than fertile (AOR 0.55) or subfertile (AOR 0.15) births. Conclusions The use of a population based comparison group of subfertile births without ART demonstrated significantly higher rates of preterm birth and low birthweight in ART singleton births, but these differences are smaller than differences between ART and fertile births. Further refinement of the measurement of subfertile births and examination of the independent risks of subfertile births is warranted.

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Pregnancy Outcome Among Twins Conceived After Subfertility Treatment Compared With Natural Twins: A Population-Based Study

Cited by 4 publications

References 28 publications

Adverse pregnancy, birth, and infant outcomes in twins: effects of maternal fertility status and infant gender combinations; the Massachusetts Outcomes Study of Assisted Reproductive Technology

Adverse pregnancy, birth, and infant outcomes in twins: effects of maternal fertility status and infant gender combinations; the Massachusetts Outcomes Study of Assisted Reproductive Technology

Therapeutic Approaches for Zika Virus Infection of the Nervous System

Perinatal outcomes associated with assisted reproductive technology: the Massachusetts Outcomes Study of Assisted Reproductive Technologies (MOSART)

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