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Wang C, Tang F, Song B, Li G, Xing Q, Cao Y. The clinical outcomes of selective and spontaneous fetal reduction of twins to a singleton pregnancy in the first trimester: a retrospective study of 10 years. Reprod Biol Endocrinol 2022; 20:71. [PMID: 35459181 PMCID: PMC9028118 DOI: 10.1186/s12958-022-00935-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Singleton pregnancy is encouraged to reduce pregnancy complications. In addition to single embryo transfer (SET), selective and spontaneous fetal reduction (SEFR and SPFR) can also achieve singleton pregnancies. After SEFR or SPFR, an inanimate fetus remains in the uterus. It is unclear whether the inanimate fetus would adversely affect another fetus or the mother. Previous studies have focused on the differences between pre- and post-reduction. However, studies focusing on the influence of SEFR and SPFR on the remaining fetal development and maintenance of pregnancy are rare. METHODS Materials from 5922 patients whose embryo transfer dates ranged from March 2011 to January 2021 were collected. Both the SEFR group (n = 390) and SPFR group (n = 865) had double embryos transferred (DET) and got twin pregnancies, but subsequent selective or spontaneous fetal reduction occurred. The SET group (n = 4667) had only one embryo transferred. All were singleton pregnancies on the 65th day after embryo transfer. Clinical outcomes, including pregnancy outcomes, pregnancy complications, and newborn outcomes, were compared among the three groups. RESULTS After adjusting for age, infertility duration, types of infertility, states of embryos, body mass index, and factors affecting SET or DET decisions, multivariate regression analysis revealed that SEFR increased the risk of miscarriage (OR 2.368, 95% CI 1.423-3.939) and preterm birth (OR 1.515, 95% CI 1.114-2.060), and reduced the gestational age (βeta -0.342, 95% CI -0.544- -0.140). SPFR increased the risk of gestational diabetes mellitus (GDM) (OR 1.657, 95% CI 1.215-2.261), preterm premature rupture of membranes (PPROM) (OR 1.649, 95% CI 1.057-2.574), and abnormal amniotic fluid volume (OR 1.687, 95% CI 1.075-2.648). Both SEFR and SPFR were associated with reduced live birth rate (OR 0.522, 95% CI 0.330-0.825; OR 0.671, 95% CI 0.459-0.981), newborn birth weight (βeta -177.412, 95% CI -235.115--119.709; βeta -42.165, 95% CI -83.104--1.226) as well as an increased risk of low-birth-weight newborns (OR 2.222, 95% CI 1.490-3.313; OR 1.510, 95% CI 1.092-2.087). CONCLUSIONS DET with subsequent fetal reduction was related to poor clinical outcomes. We recommend that DET with subsequent fetal reduction should only be considered as a rescue method for multiple pregnancy patients with potential complications, and SET is more advisable.
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Affiliation(s)
- Chao Wang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Fei Tang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Bing Song
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Guanjian Li
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Qiong Xing
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Yunxia Cao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.
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