Importance:
Twin pregnancy is a common occurrence in pregnancies conceived with in vitro fertilization (IVF), but the absolute risk of adverse obstetric outcomes stratified by IVF, twin or singleton pregnancy, and maternal age are unknown.
Objective:
To estimate the absolute risk of adverse obstetric outcomes at each maternal age among twin pregnancies conceived with IVF.
Design, Setting, And Participants:
This retrospective cohort study included pregnant women with infants born from January 1, 2013, to December 31, 2018, based on the Hospital Quality Monitoring System in China. Data were analyzed from September 1, 2020, to June 30, 2021.
Exposures:
Twin pregnancy with IVF (IVF-T), singleton pregnancy with IVF (IVF-S), twin pregnancy with non-IVF (nIVF-T), and singleton pregnancy with non-IVF (nIVF-S).
Main Outcomes And Measures:
Sixteen obstetric outcomes, including 10 maternal complications (gestational hypertension, eclampsia and preeclampsia, gestational diabetes, placenta previa, placental abruption, placenta accreta, preterm birth, dystocia, cesarean delivery, and postpartum hemorrhage) and 6 neonatal complications (fetal growth restriction, low birth weight, very low birth weight, macrosomia, malformation, and stillbirth).
Results:
Among 16 879 728 pregnant women aged 20 to 49 years (mean [SD] age, 29.2 [4.7] years), the twin-pregnancy rates were 32.1% in the IVF group and 1.5% in the non-IVF group (relative risk, 20.8; 95% CI, 20.6-20.9). The most common adverse obstetric outcomes after pregnancy conceived with IVF were cesarean delivery (88.8%), low birth weight (43.8%), preterm birth (39.6%), gestational diabetes (20.5%), gestational hypertension and preeclampsia and eclampsia (17.5%), dystocia (16.8%), and postpartum hemorrhage (11.9%). The absolute risk of most adverse obstetric outcomes in each subgroup presented in 2 dominant patterns: Pattern A indicated the absolute risk ranging from IVF-T to nIVF-T to IVF-S to nIVF-S, and pattern B indicated the absolute risk ranging from IVF-T to IVF-S to nIVF-T to nIVF-S. Both patterns showed an elevated obstetric risk with increasing maternal age in each subgroup.
Conclusions And Relevance:
In this cohort study, twin pregnancy, IVF, and advanced maternal age were independently associated with adverse obstetric outcomes. Given these findings, promotion of the elective single embryo transfer strategy is needed to reduce multiple pregnancies following IVF technologies. Unnecessary cesarean delivery shouldh be avoided in all pregnant women.
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PMID: 39809177
PMC: 11596586.
DOI: 10.1097/MD.0000000000040630.
PD-1-Enhanced Treg Cell Senescence in Advanced Maternal Age.
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PMC: 11809324.
DOI: 10.1002/advs.202411613.
Independent factors associated with intracytoplasmic sperm injection outcomes in patients with complete azoospermia factor c microdeletions.
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PMID: 39697610
PMC: 11652272.
DOI: 10.1093/hropen/hoae071.
[Obstetric and neonatal outcomes in pregnancies conceived by assisted reproductive technology in an Argentine cohort].
Diez Brito M, Sevillano G, Negri F, Mongelos M, Izbizky G
Rev Fac Cien Med Univ Nac Cordoba. 2024; 81(4):734-751.
PMID: 39670905
PMC: 11905777.
DOI: 10.31053/1853.0605.v81.n4.44425.
Maternal and Neonatal Perinatal Outcomes of Singleton Pregnancies in Advanced-Age Women Undergoing IVF/ICSI-ET Compared with Spontaneous Conception: A Retrospective Propensity Score Matched Cohort Study.
Mao J, Yang G, Su Q, Zeng Z, Lin J, Kong L
Int J Gen Med. 2024; 17:5249-5259.
PMID: 39554873
PMC: 11569707.
DOI: 10.2147/IJGM.S490959.
Risk assessment of patients with underlying health conditions who present for IVF treatment.
Papathanasiou A, Hindmarsh D, Searle B
J Assist Reprod Genet. 2024; 41(12):3251-3259.
PMID: 39249603
PMC: 11707091.
DOI: 10.1007/s10815-024-03249-9.
How can China tackle its declining fertility rate?.
Wang Y, Kong F, Fu Y, Qiao J
BMJ. 2024; 386:e078635.
PMID: 39214553
PMC: 11359724.
DOI: 10.1136/bmj-2023-078635.
Maternal and perinatal outcomes in twin pregnancies following assisted reproduction: a systematic review and meta-analysis involving 802 462 pregnancies.
Marleen S, Kodithuwakku W, Nandasena R, Mohideen S, Allotey J, Fernandez-Garcia S
Hum Reprod Update. 2024; 30(3):309-322.
PMID: 38345641
PMC: 11063550.
DOI: 10.1093/humupd/dmae002.
Maternal and neonatal outcomes of dichorionic twin pregnancies achieved with assisted reproductive technology: meta-analysis of contemporary data.
Chen L, Dong Q, Weng R
J Assist Reprod Genet. 2024; 41(3):581-589.
PMID: 38285318
PMC: 10957850.
DOI: 10.1007/s10815-024-03035-7.
How does the need for IVF affect pregnancy complications among multiple gestations? The study of a large American population database including almost 100,000 multiple gestations.
Mandourah S, Badeghiesh A, Baghlaf H, Dahan M
Eur J Obstet Gynecol Reprod Biol X. 2023; 21:100270.
PMID: 38125711
PMC: 10733110.
DOI: 10.1016/j.eurox.2023.100270.
Long-term outcomes of offspring from multiple gestations: a two-sample Mendelian randomization study on multi-system diseases using UK Biobank and FinnGen databases.
Jiang Y, Du Y, Su R, Zhou X, Wei L, Zhang J
J Transl Med. 2023; 21(1):608.
PMID: 37684631
PMC: 10492369.
DOI: 10.1186/s12967-023-04423-w.
Retrospective Study of First Trimester Metrorrhagia: Pregnancy Follow-Up and Relationship with the Appearance of Gestational Complications.
Banos Candenas L, Abehsera Davo D, Castano Frias L, Gonzalez Mesa E
Medicina (Kaunas). 2023; 59(8).
PMID: 37629660
PMC: 10456544.
DOI: 10.3390/medicina59081370.
Comparison of frozen-thaw blastocyst transfer strategies in women aged 35-40 years: a retrospective study.
Wu Y, Lu X, Chen H, Fu Y, Zhao J
Front Endocrinol (Lausanne). 2023; 14:1141605.
PMID: 37404307
PMC: 10315647.
DOI: 10.3389/fendo.2023.1141605.
Association between serum lipid profile during the first and second trimester of pregnancy as well as their dynamic changes and gestational diabetes mellitus in twin pregnancies: a retrospective cohort study.
Zhang K, Zheng W, Yuan X, Wang J, Yang R, Ma Y
Diabetol Metab Syndr. 2023; 15(1):125.
PMID: 37308962
PMC: 10259052.
DOI: 10.1186/s13098-023-01095-w.
Eclampsia, fertilization and the risk of preterm birth: a retrospective cohort study based on 2,880,759 samples.
Wang J, Yin J, Xue M, Sun W, Wan Y
Transl Pediatr. 2023; 12(5):1017-1027.
PMID: 37305730
PMC: 10248933.
DOI: 10.21037/tp-23-234.
Evaluation of Cesarean Rates for Term, Singleton, Live Vertex Deliveries in China in 2020 Among Women With No Prior Cesarean Delivery.
Yin S, Chen L, Zhou Y, Yuan P, Guo X, Lu J
JAMA Netw Open. 2023; 6(3):e234521.
PMID: 36951859
PMC: 10037159.
DOI: 10.1001/jamanetworkopen.2023.4521.
Impact of prepregnancy body mass index on adverse pregnancy outcomes: analysis from the Longitudinal Indian Family hEalth cohort study.
Gudipally M, Farooq F, Basany K, Haggerty C, Tang G, Kusneniwar G
AJOG Glob Rep. 2023; 3(1):100134.
PMID: 36691397
PMC: 9860159.
DOI: 10.1016/j.xagr.2022.100134.
Prolonging the time of progesterone supplementation to improve the pregnancy outcomes of single day 6 blastocyst transfer in frozen-thawed cycles: study protocol for a randomized controlled trial.
Xu M, Yan Y, Shen X, Sun H, Yan G, Kong N
Trials. 2022; 23(1):1024.
PMID: 36536470
PMC: 9764536.
DOI: 10.1186/s13063-022-07013-1.
Association between Abnormal Echocardiography and Adverse Obstetric Outcomes in Low-Risk Pregnant Women.
Hennessey K, Ali T, Choi E, Ortengren A, Hickerson L, Lee J
J Cardiovasc Dev Dis. 2022; 9(11).
PMID: 36421929
PMC: 9695319.
DOI: 10.3390/jcdd9110394.
Pregnancy outcomes and risk factors for preeclampsia in dichorionic twin pregnancies after in vitro fertilization: a five-year retrospective study.
Dai F, Pan S, Lan Y, Tan H, Li J, Hua Y
BMC Pregnancy Childbirth. 2022; 22(1):830.
PMID: 36357833
PMC: 9650878.
DOI: 10.1186/s12884-022-05184-y.