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Outcomes of Very Preterm Neonates Born by Assisted Reproductive Techniques (ART): A Propensity Score Matched Retrospective Cohort Study. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2536-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Netherton J, Ogle R, Hetherington L, Velkov T, Rose R, Baker M. DNA variants are an unlikely explanation for the changing quality of spermatozoa within the same individual. HUM FERTIL 2019; 24:376-388. [PMID: 31642381 DOI: 10.1080/14647273.2019.1679397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
It has recently been suggested that the human sperm genome is highly unstable, which may be a reasonable explanation as to why men, even fertile men, produce defective spermatozoa. Furthermore, an unstable genome may also explain why the semen profile of the same man changes from one ejaculate to the next. As such, we took multiple ejaculates (between 3 and 6) from 7 individuals over a 6-month period and isolated sperm through density gradients. We then compared the DNA of: (i) good and poor-quality spermatozoa within the same ejaculate; and (ii) from multiple ejaculates from the same individual. Our results suggest that on a global level, DNA present within spermatozoa is actually quite stable and similar between both good and poor sperm. This is important information for the assisted reproductive community when it comes to sperm selection.
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Affiliation(s)
- Jacob Netherton
- Department of Environmental and Life Sciences, University of Newcastle , Callaghan , New South Wales , Australia
| | - Rachel Ogle
- Department of Environmental and Life Sciences, University of Newcastle , Callaghan , New South Wales , Australia
| | - Louise Hetherington
- Department of Environmental and Life Sciences, University of Newcastle , Callaghan , New South Wales , Australia
| | - Tony Velkov
- Department of Pharmacology & Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne , Victoria , Australia
| | - Ryan Rose
- Fertility SA, St. Andrews Hospital , Adelaide , South Australia , Australia.,Adelaide Health and Medical Sciences, Robinson Research Institute, The University of Adelaide , Adelaide , South Australia , Australia
| | - Mark Baker
- Department of Environmental and Life Sciences, University of Newcastle , Callaghan , New South Wales , Australia
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Outcomes of preterm infants conceived with in vitro fertilization. J Perinatol 2019; 39:717-722. [PMID: 30723282 DOI: 10.1038/s41372-019-0332-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/12/2018] [Accepted: 01/15/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To determine if there is increased risk of prematurity-related complications for in vitro fertilization (IVF)-conceived preterm infants compared to matched controls. STUDY DESIGN Cohort study of 23-34 weeks' preterm infants from 329 US NICUs discharged from 2009 to 2016. Each IVF patient was matched to three controls. RESULTS We identified 6,756 IVF-conceived preterm infants who were matched with 20,268 controls. IVF-conceived infants had no increase in non-respiratory morbidities but had significantly higher rates of bronchopulmonary dysplasia (8.4% vs 7%, p < 0.001) and significantly greater exposure to common chronic respiratory medications. CONCLUSIONS In this large cohort of IVF-conceived preterm infants we found similar outcomes to controls with the exception of bronchopulmonary dysplasia and respiratory medication exposure. Further research is needed to explore the influence of in vitro fertilization on the development of neonatal respiratory disease.
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Comparison of neonatal outcomes of very low birth weight infants by mode of conception: in vitro fertilization versus natural pregnancy. Fertil Steril 2019; 111:962-970. [PMID: 30922644 DOI: 10.1016/j.fertnstert.2019.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/15/2018] [Accepted: 01/08/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the neonatal outcomes of very low birth weight (VLBW) infants born after IVF with those of VLBW infants born after natural pregnancy (NP). DESIGN Prospective cohort study. SETTING Not applicable. PATIENT(S) A total of 6,871 VLBW infants born from January 2014 to December 2016. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Neonatal mortality and morbidities. RESULT(S) Of the 6,871 VLBW infants enrolled, 4,438 infants were born as singletons (IVF = 271; NP = 4,167), and 2,433 infants were born as multiplets (IVF = 1,301; NP = 1,132). After adjustment for maternal and neonatal baseline characteristics, infants born as singletons earlier than 28 weeks after IVF more frequently had high-stage retinopathy of prematurity than those born after NP, whereas infants born as multiplets between 28 and 31 weeks after IVF had fewer major congenital anomalies, high-grade intraventricular hemorrhage, and periventricular leukomalacia than those born after NP. Otherwise, no differences in mortality and neonatal outcomes were found. CONCLUSION(S) Very low birth weight infants born as singletons after IVF had comparable neonatal outcomes to those born after NP, except for an increased risk of high-stage retinopathy of prematurity. Very low birth weight infants born as multiplets after IVF had fewer neurologic morbidities than those born after NP.
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Tseng KT, Peng CC, Chang JH, Hsu CH, Lin CY, Jim WT, Chang HY. The impact of advanced maternal age on the outcomes of very low birth weight preterm infants. Medicine (Baltimore) 2019; 98:e14336. [PMID: 30702619 PMCID: PMC6380823 DOI: 10.1097/md.0000000000014336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The association between advanced maternal age and neonatal outcomes remains controversial. This study attempted to determine the short-term and long-term outcomes of very low birth weight (VLBW, <1500 g) preterm infants, born to mothers of advanced age (≥35 years).In this retrospective cohort study, VLBW infants were divided into the advanced maternal age group and comparison group. We compared the pregnancy complications, demographic factors, short-term morbidities, and neurodevelopmental outcomes using the Bayley Scales of Infant Development-Third Edition, at 24 months of corrected age between the 2 groups.The study comprised of 536 VLBW infants born to 483 mothers. Mothers of advanced age had a significantly lower rate of primiparity compared to the comparison group (45.8% vs 65.2%, P < .001), and were more likely to have gestational diabetes (13.7% vs 5.5%, P = .002) and to undergo in vitro fertilization (IVF; 18.4% vs 9.9%, P = .01). No significant differences were found between the 2 groups in terms of short-term outcomes. At 2 years of corrected age, advanced maternal age was associated with a higher incidence of severe speech delay (11.3% vs 5.7%, P = .04), neurodevelopmental impairment (NDI; 28.8% vs 18.4%, P = .02), and adverse composite outcome (37.4% vs 27.3%, P = .02). However, the differences in NDI and composite adverse outcomes were not statistically significant between the groups after adjustments for potential confounders.Advanced maternal age was not associated with major morbidities and long-term NDI among VLBW preterm infants. The association between advanced maternal age and severe speech delay in the infant needs further investigation.
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Affiliation(s)
- Kai-Ti Tseng
- Department of Neonatology, MacKay Children's Hospital, Taipei
| | - Chun-Chih Peng
- Department of Neonatology, MacKay Children's Hospital, Taipei
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Jui-Hsing Chang
- Department of Neonatology, MacKay Children's Hospital, Taipei
| | - Chyong-Hsin Hsu
- Department of Neonatology, MacKay Children's Hospital, Taipei
| | - Chia-Ying Lin
- Department of Neonatology, MacKay Children's Hospital, Taipei
| | - Wai-Tim Jim
- Department of Neonatology, MacKay Children's Hospital, Taipei
| | - Hung-Yang Chang
- Department of Neonatology, MacKay Children's Hospital, Taipei
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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Effects of advanced maternal age on cognitive and emotional development in offspring rats. Behav Brain Res 2018; 353:218-226. [DOI: 10.1016/j.bbr.2018.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/29/2017] [Accepted: 04/03/2018] [Indexed: 11/23/2022]
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Corchia C, Da Frè M, Di Lallo D, Gagliardi L, Macagno F, Carnielli V, Miniaci S, Cuttini M. Mortality and major morbidities in very preterm infants born from assisted conception or naturally conceived: results of the area-based ACTION study. BMC Pregnancy Childbirth 2014; 14:307. [PMID: 25193062 PMCID: PMC4177255 DOI: 10.1186/1471-2393-14-307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 07/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of assisted conception (AC) has been associated with higher risk of adverse perinatal outcome. Few data are available on the outcome of AC-neonates when pregnancy ends before 32 weeks of gestational age.The aim of this study was to compare the short-term outcome of AC- and naturally conceived preterm infants <32 weeks gestation. METHODS The area-based cohort study ACTION collected data on births 22-31 weeks gestation occurred in 2003-05 in 6 Italian regions. Infants born to 2529 mothers with known mode of conception were studied. The main outcomes were hospital mortality and survival free from major morbidities (IVH grade 3-4, cPVL, ROP stage ≥3, BPD), and were assessed separately for single and multiple infants. Other outcomes were also investigated. Multivariable logistic analyses were used to adjust for maternal and infants' characteristics. To account for the correlation of observations within intensive care units, robust variance and standard error estimates of regression parameters were computed. RESULTS AC was used in 6.4% of mothers. Infants were 2934; 314 (10.7%) were born after AC. Multiples were 86.0% among AC and 21.7% among non-AC babies. In multivariable analysis no statistically significant difference in hospital mortality and survival without major morbidities was found between AC and non-AC infants. The risk of BPD was lower in AC than in non-AC multiples (aOR 0.41, CI 0.20-0.87), and this finding did not change after controlling for mechanical ventilation (aOR 0.42, CI 0.20-0.85) or presence of a patent ductus arteriosus (aOR 0.39, CI 0.18-0.84). CONCLUSION When the analysis is restricted to very preterm infants and stratified by multiplicity, no significant associations between AC and increased risk of short-term mortality and survival without major morbidities emerge. This result is consistent with previous studies, and may confirm the hypothesis that the adverse effects of AC are mediated by preterm birth. However, larger appropriately powered studies are needed before definitely excluding the possibility of adverse events linked to AC in infants born before 32 weeks gestation.
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Affiliation(s)
- Carlo Corchia
- ICBD, International Centre on Birth Defects and Prematurity, via Carlo Mirabello 14, 00195 Rome, Italy.
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Fauser BCJM, Devroey P, Diedrich K, Balaban B, Bonduelle M, Delemarre-van de Waal HA, Estella C, Ezcurra D, Geraedts JPM, Howles CM, Lerner-Geva L, Serna J, Wells D. Health outcomes of children born after IVF/ICSI: a review of current expert opinion and literature. Reprod Biomed Online 2013; 28:162-82. [PMID: 24365026 DOI: 10.1016/j.rbmo.2013.10.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 10/03/2013] [Accepted: 10/08/2013] [Indexed: 01/28/2023]
Abstract
The Sixth Evian Annual Reproduction (EVAR) Workshop Group Meeting was held to evaluate the impact of IVF/intracytoplasmic sperm injection on the health of assisted-conception children. Epidemiologists, reproductive endocrinologists, embryologists and geneticists presented data from published literature and ongoing research on the incidence of genetic and epigenetic abnormalities and congenital malformations in assisted-conception versus naturally conceived children to reach a consensus on the reasons for potential differences in outcomes between these two groups. IVF-conceived children have lower birthweights and higher peripheral fat, blood pressure and fasting glucose concentrations than controls. Growth, development and cognitive function in assisted-conception children are similar to controls. The absolute risk of imprinting disorders after assisted reproduction is less than 1%. A direct link between assisted reproduction and health-related outcomes in assisted-conception children could not be established. Women undergoing assisted reproduction are often older, increasing the chances of obtaining abnormal gametes that may cause deviations in outcomes between assisted-conception and naturally conceived children. However, after taking into account these factors, it is not clear to what extent poorer outcomes are due to the assisted reproduction procedures themselves. Large-scale, multicentre, prospective epidemiological studies are needed to investigate this further and to confirm long-term health consequences in assisted-conception children. Assisted reproduction treatment is a general term used to describe methods of achieving pregnancy by artificial means and includes IVF and sperm implantation. The effect of assisted reproduction treatment on the health of children born using these artificial methods is not fully understood. In April 2011, fertility research experts met to give presentations based on research in this area and to look carefully at the evidence for the effects of assisted reproduction treatment on children's health. The purpose of this review was to reach an agreement on whether there are differences in the health of assisted-conception children with naturally conceived children. The researchers discovered no increased risk in birth defects in assisted-conception children compared with naturally conceived children. They found that IVF-conceived children have lower birth weights and higher fat under the skin, higher blood pressure and higher fasting glucose concentrations than naturally conceived children; however, growth, development and cognitive function are similar between groups. A very low risk of disorders of genetic control was observed in assisted-conception children. Overall, there did not appear to be a direct link between assisted reproduction treatment and children's health. The researchers concluded that the cause of some differences in the health of children conceived using assisted reproduction treatment may be due to the age of the woman receiving treatment. Large-scale, research studies are needed to study the long-term health of children conceived using assisted reproduction treatment.
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Affiliation(s)
- B C J M Fauser
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - P Devroey
- Center for Reproductive Medicine, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - K Diedrich
- Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany
| | - B Balaban
- Assisted Reproduction Unit, American Hospital of Istanbul, Guzelbahce Sokak No 20, Nisantasi, Istanbul 34365, Turkey
| | - M Bonduelle
- Centre for Medical Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | | | - C Estella
- Fundación Instituto Valenciano de Infertilidad (FIVI), Valencia University, and Instituto Universitario IVI/INCLIVA, Parc Científic Universitat de València C/Catedrático Agustín Escardino n(o) 9, Edificio 3, 46980 Paterna, Spain; Departamento de Biología Molecular and Centro de Biología Molecular 'Severo Ochoa' (CSIC-UAM), Universidad Autónoma de Madrid, Madrid, Spain
| | - D Ezcurra
- Global Development and Medical Unit, Merck Serono SA Geneva, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - J P M Geraedts
- Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - C M Howles
- Global Development and Medical Unit, Merck Serono SA Geneva, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - L Lerner-Geva
- Woman and Child Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer 52621, Israel
| | - J Serna
- Instituto Valenciano de Infertilidad (IVI) Zaragoza, C/María Zambrano, 31, 50018 Zaragoza, Spain
| | - D Wells
- University of Oxford, Nuffield Department of Obstetrics and Gynaecology, Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Relationship of mode of conception and sex concordance with mortality/morbidity in preterm twins. Twin Res Hum Genet 2013; 16:985-93. [PMID: 23985382 DOI: 10.1017/thg.2013.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the association of mode of conception and sex concordance with neonatal outcomes in very preterm twins. STUDY DESIGN Twin pairs born at gestational age ≤ 32 weeks and admitted to a Level 3 neonatal intensive care unit (NICU) in 2010-2011 were retrospectively identified from the Canadian Neonatal Network™ database. A composite outcome representing neonatal mortality or any severe morbidity (intraventricular hemorrhage grades ≥ 3 or periventricular leukomalacia, retinopathy of prematurity stages ≥ 3, bronchopulmonary dysplasia, or necrotizing enterocolitis stages ≥ 2) was compared between twins conceived using assisted reproduction technologies (ARTs) or spontaneously (SP), and tested for association with sex concordance in individual-level and pair-wise multivariable logistic regression analyses. RESULTS Study subjects included 1,508 twins from 216 ART (53 [25%] male-male, 104 [48%] male-female, and 59 [27%] female-female) and 538 SP (192 [36%] male-male, 123 [23%] male-female, and 223 [41%] female-female) pairs. No statistically significant association was detected between mode of conception and the composite outcome of mortality/morbidities. The composite outcome was significantly higher in same-sex than in opposite-sex twins (OR = 1.68; 95% CI = [1.09, 2.59]). This relationship was most pronounced in ART pairs (OR = 2.25; 95% CI = [1.02, 4.98]), with increased rates in one or both twins from male-male versus opposite-sex ART pairs (OR = 3.0; 95% CI = [1.07, 8.36]). CONCLUSION Same-sex pairing was associated with higher mortality/morbidities in very preterm twins admitted to the NICU, and can be used in clinical practice to identify twins at higher risk of adverse neonatal outcomes.
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Turker G, Doger E, Arısoy AE, Günlemez A, Gökalp AS. The effect of IVF pregnancies on mortality and morbidity in tertiary unit. Ital J Pediatr 2013; 39:17. [PMID: 23497498 PMCID: PMC3626728 DOI: 10.1186/1824-7288-39-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 02/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are several studies that have shown an increased risk of premature birth and developmental abnormalities with in vitro fertilization (IVF); however, the data on preterm mortality and morbidity are limited. AIM Our aim is to investigate whether IVF had an effect on the mortality and morbidity in neonates admitted to the neonatal intensive care unit. METHODS A total of 940 term and preterm babies who were admitted to the intensive care unit over a period of 2 years were enrolled. Of these, 121 babies were born after IVF and 810 were born after a natural conception and 9 were born after ovulation induction. Of these, 112 preterm babies were born after IVF and 405 preterm babies were born after a natural conception. RESULTS In the IVF group, the gestational age and birth weight were significantly lower than in the non-IVF group. Additionally, in the IVF group, multiple births were significantly higher than in the non-IVF group. IVF pregnancies increase preterm delivery but did not increase preterm mortality, and preterm morbidity did not differ among groups, except for intraventricular hemorrhage (IVH). Gestational age was shown to be the primary risk factor for IVH using a logistic regression analysis. Also when newborns at gestational age <32 weeks were compared using regression analysis, gestational age was the major risk factor for IVH. CONCLUSION IVF appears to be associated with premature delivery and the known risks associated with prematurity.
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Affiliation(s)
- Gülcan Turker
- Department of Pediatrics, Neonatology Division, Faculty of Medicine, Kocaeli University, Umuttepe Campus, Kocaeli 41380, Turkey.
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Hansen M, Kurinczuk JJ, Milne E, de Klerk N, Bower C. Assisted reproductive technology and birth defects: a systematic review and meta-analysis. Hum Reprod Update 2013; 19:330-53. [DOI: 10.1093/humupd/dmt006] [Citation(s) in RCA: 248] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Picaud JC, Chalies S, Combes C, Mercier G, Dechaud H, Cambonie G. Neonatal mortality and morbidity in preterm infants born from assisted reproductive technologies. Acta Paediatr 2012; 101:846-51. [PMID: 22519364 DOI: 10.1111/j.1651-2227.2012.02713.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Premature birth is frequent in infants conceived with assisted reproductive technologies (ART). We sought to determine whether neonatal outcome in ART preterm infants differs from that of spontaneously conceived (SC) preterm infants. METHODS Data were prospectively collected in infants born ≤ 32 weeks after ART or SC. We calculated a composite index of severe morbidity (based on occurrences of severe necrotizing enterocolitis, severe intraventricular haemorrhage, periventricular leukomalacia or bronchopulmonary dysplasia). Survival rate without severe morbidity was compared between the two groups. RESULTS Six hundred and twelve preterm infants were hospitalized in our tertiary care centre: 81 in ART group and 521 in SC group. In the ART group, twin pregnancy (69.1% vs. 15.9%, p < 0.001) and inborn delivery (98.8% vs. 90.0%, p < 0.01) were more frequent. Gestational age (29 vs. 28 weeks, p < 0.05) and birth weight (1100 vs. 1020 g, p < 0.001) were also higher. Survival without severe morbidity was significantly higher in ART infants (76.5% vs. 55.2%, p < 0.001), with the difference mainly observed in infants born ≤ 28 weeks (22.9% vs. 55.7%, p < 0.001). CONCLUSION Assisted reproductive technologies was not associated with adverse neonatal outcome. Differences in pregnancy and neonatal characteristics probably explain the increased survival without severe morbidity in ART infants.
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Affiliation(s)
- J C Picaud
- Service de Neonatologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
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Shah V, Alwassia H, Shah K, Yoon W, Shah P. Neonatal outcomes among multiple births ≤ 32 weeks gestational age: does mode of conception have an impact? A cohort study. BMC Pediatr 2011; 11:54. [PMID: 21672239 PMCID: PMC3125335 DOI: 10.1186/1471-2431-11-54] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 06/14/2011] [Indexed: 11/25/2022] Open
Abstract
Background Studies comparing perinatal outcomes in multiples conceived following the use of artificial reproductive technologies (ART) vs. spontaneous conception (SC) have reported conflicting results in terms of mortality and morbidity. Therefore, the objective of our study was to compare composite outcome of mortality and severe neonatal morbidities amongst preterm multiple births ≤ 32 weeks gestation infant born following ART vs. SC. Methods We conducted a single center cohort study at Mount Sinai Hospital, Toronto, Ontario, Canada. Data on all preterm multiple births (≤ 32 weeks GA) discharged between July 2005 and June 2008 were retrospectively collected from a prospective database at our centre. Details regarding mode of conception were collected retrospectively from maternal health records. Preterm multiple births were categorized into those born following ART vs. SC. Composite outcome was defined as combination of death or any of the three neonatal morbidities (grade 3/4 intraventricular hemorrhage or periventricular leukomalacia; retinopathy of prematurity > stage 2 or chronic lung disease). Univariate and multivariate regression analysis were preformed after adjustment of confounders (maternal age, parity, triplets, gestational age, sex, and small for gestational age). Results One hundred and thirty seven neonates were born following use of ART and 233 following SC. The unadjusted composite outcome rate was significantly higher in preterm multiples born following ART vs. SC [43.1% vs. 26.6%, p = 0.001; OR 1.98 (95% CI 1.13, 3.45)]; however, when adjusted for confounders the difference between groups was not statistically significant [OR 1.39, 95% CI 0.67, 2.89]. Conclusion In our population of preterm multiple births, the mode of conception had no detectable effect on the adjusted composite neonatal outcome of mortality and/or three neonatal morbidities.
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Affiliation(s)
- Vibhuti Shah
- Department of Paediatrics, Room 775A, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
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Black M, Bhattacharya S. Epidemiology of multiple pregnancy and the effect of assisted conception. Semin Fetal Neonatal Med 2010; 15:306-12. [PMID: 20630816 DOI: 10.1016/j.siny.2010.06.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multiple pregnancy is one of the greatest perinatal challenges facing clinicians today. In a society of rising expectations among fertility and maternity service users, the potential for adverse outcomes associated with multiple pregnancy is a source of concern. This article examines the impact of assisted conception on the incidence of multiple pregnancies and associated complications. It explores some of the reasons for the strong association between assisted reproductive technology and multiple pregnancies and suggests possible ways of addressing this continuing problem.
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Affiliation(s)
- Mairead Black
- Department of Obstetrics & Gynaecology, University of Aberdeen, School of Medicine, Aberdeen Maternity Hospital, Aberdeen AB25 2ZL, UK.
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Vohr BR, Tyson JE, Wright LL, Perritt RL, Li L, Poole WK. Maternal age, multiple birth, and extremely low birth weight infants. J Pediatr 2009; 154:498-503.e2. [PMID: 19111322 PMCID: PMC2834530 DOI: 10.1016/j.jpeds.2008.10.044] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 09/23/2008] [Accepted: 10/29/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the rates of adverse neurodevelopmental outcome or death at 18 to 22 months among extremely low birth weight (ELBW) infants born to mothers >or=4 0 years to the corresponding rates among infants of younger mothers. STUDY DESIGN Prospective evaluation of ELBW infants to quantify the relative risks of maternal age and multiple birth for death or adverse neurodevelopmental outcome. RESULTS The sample consisted of 14 671 live ELBW births divided into maternal age groups: <20, 20 to 29, 30 to 39, and >or= 40 years. Of infants born to mothers >or= 40 years, 20% were multiples. Mothers >or= 40 years had high rates of obstetric interventions and medical morbidities compared with mothers <40 years. ELBW live births of mothers >or= 40 years were 22% more likely to survive and had a 13% decreased risk of neurodevelopmental impairment or death compared with mothers <20. Multiple birth, however, was associated with a 10% greater risk of neurodevelopmental impairment or death. CONCLUSION Although mothers >or= 40 years had high pregnancy-related morbidities, we found no overall increased risk of the composite outcome of death or NDI. Multiple birth, however, was a predictor of all adverse outcomes examined, regardless of maternal age.
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Affiliation(s)
- Betty R. Vohr
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jon E. Tyson
- University of Texas Medical School at Houston, Houston, TX
| | - Linda L Wright
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | | | - Lei Li
- RTI International, Research Triangle Park, NC
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Current World Literature. Curr Opin Obstet Gynecol 2007; 19:289-96. [PMID: 17495648 DOI: 10.1097/gco.0b013e3281fc29db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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