Impact of monozygotic twinning on multiple births resulting from in vitro fertilization in the United States, 2006-2010

Reproductive coercion and abuse among pregnancy counselling clients in Australia: trends and directions

BACKGROUND

Reproductive coercion and abuse (RCA) interferes with a person's reproductive autonomy and can be classified into behaviours that are pregnancy promoting or pregnancy preventing (including coerced abortion). However, prevalence data are lacking, and little is known about whether particular forms of RCA are more or less common. The aims of our study were to explore how frequently people seeking pregnancy counselling reported RCA, the proportions reporting the different forms of RCA, and whether there were different trends based on a range of demographic factors.

METHODS

Data were collected from 5107 clients seeking counselling support for their pregnancy between January 2018 and December 2020 from two leading providers of pregnancy counselling and sexual and reproductive health services in Australia, Marie Stopes Australia and Children by Choice. Counsellors identified and recorded the presence of RCA and whether the behaviour was pregnancy promoting and/or pregnancy preventing. Demographic factors included age, and whether the person identified as being from a migrant or refugee community or as an Aboriginal and/or Torres Strait Islander person.

RESULTS

RCA was identified in 15.4% of clients, with similar proportions disclosing RCA towards pregnancy (6%) and towards pregnancy prevention or abortion (7.5%), and 1.9% experiencing RCA towards pregnancy and abortion concurrently. There were no differences based on age or whether the person identified as being from a migrant or refugee background, though people who identified as Aboriginal and/or Torres Strait Islander experienced RCA that was significantly more likely to be pregnancy promoting.

CONCLUSIONS

RCA is commonly disclosed by people seeking support in a pregnancy counselling context, and coercion and abuse is equally likely to be towards pregnancy promotion or pregnancy prevention/abortion. Given the prevalence and negative impacts of RCA, regardless of age and background, we recommend sensitive and culturally respectful enquiry around experiences of RCA be embedded in healthcare, health education, and health research.

Preterm neonatal mortality in China during 2009-2018: A retrospective study

In this retrospective analysis, we aimed to analyze the epidemic characteristics of neonatal mortality due to preterm birth at 28-36 weeks gestation in different regions from 2009 to 2018. Data were obtained from China's Under-5 Child Mortality Surveillance System (U5CMSS). The χ2 trend test, Poisson regression and the Cochran-Mantel-Haenszel method were used in this study. We found that 51.3%, 42.0% and 44.5% of neonate deaths were preterm infants, and immaturity was mainly attributed to 60.1%, 64.1% and 69.5% of these deaths, in the eastern, central and western regions, respectively. The preterm neonatal mortality rate due to immaturity dropped from 149.2, 216.5 and 339.5 in 2009 to 47.4, 83.8 and 170.1 per 100 000 live births in 2018, giving an average annual decline rate of 12.1%, 11.6% and 6.3% in the eastern, central and western regions, respectively, during the studying period. The relative risk of preterm neonatal mortality due to immaturity were 1.3 and 2.3 for the central regions and western regions in 2009-2010, ascending to 2.2 and 3.9 in 2017-2018. The proportion of preterm neonatal deaths with a gestational age <32 weeks was highest among the eastern region. There were significantly more preterm neonatal infants who were not delivered at medical institutions in the western region than in the eastern and central regions. The preterm infant, especially with gestational age <32 weeks, should receive the most attention through enhanced policies and programs to improve child survival. Priority interventions should be region-specific, depending on the availability of economic and healthcare resources.

Neonatal mortality and leading causes of deaths: a descriptive study in China, 2014-2018

OBJECTIVE

The present study estimated the national and urban-rural levels and causes of neonatal deaths in China annually between 2014 and 2018 to provide data support for the further end of preventable neonatal deaths for China and other low-income and middle-income countries.

METHODS

The study was based on data from the National Maternal and Child Health Surveillance System. All neonates of surveillance districts (gestational week: ≥28 weeks) who died after delivery have been involved in the study. The mortality rate and the leading causes of death for neonates were analysed.

RESULTS

The neonatal mortality rate (NMR) of China has steadily decreased from 5.9 deaths per 1000 live births in 2014 to 3.9 deaths per 1000 live births in 2018. The NMR in 2018 of urban and rural areas was 2.2 deaths per 1000 live births and 4.7 deaths per 1000 live births, respectively. The leading preventable causes of neonatal deaths are the same in the urban and rural areas were same, which were preterm birth, intrapartum complications and pneumonia. Mortality rates of these three causes fell significantly between 2014 and 2018 but contributed to a higher proportion of deaths in rural areas than urban areas. The proportion of preventable deaths accounted for 74.6% in 2018.

CONCLUSIONS

The NMR of China has decreased steadily from 2014 to 2018. However, the inequality between urban and rural areas still exists. The goal of government interventions should be to reduce the health inequality of neonates and further take targeted measures to eliminate preventable neonatal death.

Outcomes of elective cryopreserved single or double embryo transfers following failure to conceive after fresh single embryo transfer

The main adverse effect of IVF is the high multiple pregnancy rate resulting from the transfer of two or more embryos. The objective was to evaluate pregnancy rates in infertile women with a good prognosis who failed to conceive in a fresh elective single embryo transfer (eSET) and had a second cycle with elective double vitrified-warmed embryo transfer (eDFET) compared with elective single vitrified-warmed embryo transfer (eSFET). A total of 142 intracytoplasmic sperm injection cycles using a conventional protocol were evaluated. Good-prognosis patients underwent eSET in a fresh cycle, and those who failed to conceive underwent a second vitrified-warmed embryo transfer: eDFET (n = 102) or eSFET (n = 40). Embryos were transferred and vitrified on day 5 of development. Patients who received eDFET had fewer implantations (30.9%) than eSFET (52.5%; P = 0.004); pregnancy rates were similar (eDFET: 35.3%, eSFET: 42.5%). Patients with the eSFET had one monozygotic twin (5.9%), and 22.2% of eDFET patients had multiple pregnancies. Patients with a good prognosis who failed to conceive in the first fresh eSET did not have an advantage when receiving eDFET in the second cycle, as pregnancy rates were similar; 22.2% of patients in the eDFET group had multiple pregnancies.

Risk of Monozygotic Twins After Assisted Reproduction: A Population-Based Approach

BACKGROUND

Recent studies have suggested that ovarian stimulation and assisted reproductive techniques (ART) may increase the frequency of monozygotic twins. In this article, we present the analysis of the estimated frequency of twin deliveries following in vitro fertilization (IVF) in Lombardy during the period 2010-2014 for a total of 450,949 pregnancies.

METHOD

This is a population-based study using data from the regional data base of Lombardy, a northern Italian region with a population of about 10 million inhabitants. During the considered period, a total of 461,424 single or multiple births were registered in Lombardy. After exclusion of triplets or more pregnancies, the total number of twin deliveries, in separate strata of like and unlike sex pregnancies twin deliveries, were obtained and the rate of twin deliveries was computed according to spontaneous and non-spontaneous conception and type of ART. Further, estimates of dizygotic or monozygotic twin births were calculated using Weinberg's methods.

RESULTS

The frequency of twins deliveries was 1.24/100 deliveries after natural conception and 20.05 after assisted conception. The estimated rates of monozygotic twins was 0.45 and 0.72/100 (95% CI: 0.58-0.91) deliveries after natural and assisted conception, respectively. This difference was statistically significant (p < .05).

CONCLUSION

the present population based study suggests that the risk of monozygotic twin is about 60% higher among assisted than after natural conception.

Estimating the Risk of Monochorionic Twins in IVF Pregnancies From the Perspective of a Prenatal Diagnosis Unit

The aim of the present work was to estimate the risk of monochorionic twin (MCT) pregnancies in in vitro fertilization (IVF) cycles using data from a prenatal diagnosis unit. This was a retrospective cross-sectional study reporting on the frequency of IVF pregnancies among women attending a prenatal diagnosis service specifically dedicated to the management of monochorionic pregnancies. The observed rate was compared with the local regional rate of IVF births (2.2%). A binomial distribution model was used to calculate the 95% CI of proportions. One hundred and forty-five monochorionic pregnancies were selected. Ten of these were achieved with IVF, corresponding to a rate of 6.9% (95% CI: 3.5–11.8), significantly higher than the background rate in the local population of 2.2%. When considering exclusively monochorionic pregnancies achieving delivery of two viable newborns (n = 132), the number of IVF pregnancies was nine (6.8%, 95% CI: 3.7–12.5). We did not detect major differences in pregnancy outcome between IVF and natural monochorionic pregnancies, with the exception of the proportion of newborns with a neonatal birth < 2,500 g (100% vs. 80%, p = .03). In conclusion, data obtained from the perspective of a prenatal diagnosis unit suggest that women undergoing IVF face a 3- to 4-fold increased risk of monochorionic pregnancies.

Outcome of monochorionic twins conceived by assisted reproduction

OBJECTIVE

To evaluate monochorionic twins conceived by assisted reproductive technology (ART).

DESIGN

We compared perinatal outcomes of monochorionic twins conceived by ART with their dichorionic counterparts and with spontaneous monochorionic twins.

SETTING

Referral center.

PATIENT(S)

Mothers to monochorionic and dichorionic twins conceived by ART and spontaneous monochorionic twins.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Maternal characteristics, pregnancy complications, and perinatal outcomes.

RESULT(S)

Monochorionic twin pregnancies (n = 25) comprise 7.2% of all ART twins and 4.9% of all monochorionic twins in this data set. Monochorionic pairs have a significantly worse outcome compared with dichorionic sets in terms of lower gestational age and birth weight. ART appears to increase the already high risk of monochorionicity compared with spontaneous conception: odds ratio (OR), 2.9 (1.1-7.3) for preterm birth at <32 weeks and OR, 5.9 (2.5-1.49) for birth weight <1,500 g.

CONCLUSION(S)

Monochorionic twins after ART are at increased risk of adverse perinatal outcomes compared with spontaneous monochorionic twins and with dichorionic twins conceived by ART.