Umbilical cord anomalies are more frequent in twins after assisted reproduction

Abstract

BACKGROUND: The objective of this study is to analyse differences in cord characteristics between naturally conceived twins and twins born after assisted reproduction. METHODS: Between 1985 and 2004, the East Flanders Prospective Twin Survey (EFPTS) registered 4159 twin pairs. We compared cord characteristics between 2119 naturally conceived dizygotic (DZ) twin members and 2243 DZ twin members originating from assisted reproductive technologies (ART). Data were adjusted for intra-twin correlation, year of birth, maternal age, gestational age, parity, sex of the child and number of placentas. RESULTS: Marginal cord insertion, velamentous cord insertion and single umbilical artery (SUA) occur more frequently in twins following infertility treatment (P < 0.001). The incidence of velamentous cord insertion increases proportionate with 'invasiveness' of reproductive techniques: 3.6% in naturally conceived twins versus 5% in twins after artificial induction of ovulation (AIO) [odds ratio (OR) 1.45; 95% confidence interval (CI) 0.99-2.11], 7.4% in twins after IVF (OR 1.49; 95% CI 1.26-1.77) and 10.4% in twins after ICSI (OR 1.31; 95% CI 1.14-1.51). SUA has the highest incidence in twins after AIO: 1.9% compared with 0.6% in naturally conceived twins (OR 3.19; 95% CI 1.66-6.11). CONCLUSIONS: Umbilical cords of twins born after ART have more pathologic characteristics when compared with cords of naturally conceived twins.

Prenatal diagnosis and management of vasa previa in twin pregnancies: a case series and systematic review

“…7,14 It has been hypothesized these placental and cord anomalies could be due to the inadequate orientation of the IVF blastocyst at the time of implantation or to a higher incidence of vanishing twins in IVF than in spontaneous twins. 10,[14][15][16][17][18] The incidence of VP has been reported to be as high as one in 300 pregnancies conceived after ART. 7,14 These data suggest that the incidence of VP in both singleton and multiple pregnancy gestations is likely to increase in the next decade with the increase use of ART worldwide.…”

The East Flanders Prospective Twin Survey (EFPTS): An Actual Perception

“…Previous results have indicated that this could not be the case (Delbaere et al, 2007;Loos et al, 2001d;Verstraelen et al, 2005). Comparison of DC-MZ, MC-MZ, and DZ twins will allow to evaluate the degree of gene-environment interactions as the prenatal environment is concerned.…”

Characteristics of Spontaneously Conceived Twins Versus Twins After Assisted Conception

“…For a detailed description of applied methods, we refer to the papers concerned (Delbaere et al, 2007;Verstraelen et al, 2005). In brief, Verstraelen et al (2005) compared gestational length and prevalence of preterm birth between 2915 spontaneous twin pairs and 1453 twins born after ART.…”

“…Subsequently, mediating effects were removed by adjusting for posttreatment variables including zygosity, chorionicity, intratwin fetal sex and cesarean section. Delbaere et al (2007) analyzed differences in cord characteristics between 2119 spontaneously conceived dizygotic twins and 2243 dizygotic twins originating from ART. Data were adjusted for intratwin correlation, year of birth, maternal age, gestational age, parity, sex of the child, number of placentas and type of reproductive technology applied.…”

“…Currently, two studies analyzing differences between spontaneously and nonspontaneously conceived twins are based on EFPTS-data (Delbaere et al, 2007;Verstraelen et al, 2005).…”