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Pena-Burgos EM, Duyos-Mateo I, Pozo-Kreilinger JJ, Regojo-Zapata RM, Quirós-González V, De La Calle M. Comparison of maternal, fetal, obstetric and neonatal outcomes for 234 triplet pregnancies conceived in vivo versus IVF and ICSI conceptions. Reprod Biomed Online 2024; 48:103419. [PMID: 38194878 DOI: 10.1016/j.rbmo.2023.103419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 01/11/2024]
Abstract
RESEARCH QUESTION Is there a difference in maternal, fetal, obstetric and neonatal outcomes for triplet pregnancies when comparing in vivo conceptions with those conceived by assisted reproductive technology (ART)? DESIGN This single-centre, retrospective cohort study included all triplet pregnancies followed up at La Paz University Hospital, Madrid between 2000 and 2022. The characteristics of the pregnant women, and maternal, fetal, obstetric and perinatal outcomes were examined. Univariate and multivariate statistical analyses were performed. RESULTS In total, 234 triplet pregnancies were analysed: 92 in the natural and assisted insemination conception group (in-vivo conception) and 142 in the in vitro fertilization and intracytoplasmic sperm injection conception group (ART conception). ART triplet pregnancies were more common between 2000 and 2010 (P = 0.003). The percentage of monochorionic triamniotic pregnancies was significantly higher (P = 0.02) in the in-vivo conception group, and the percentage of dichorionic triamniotic pregnancies was significantly higher (P = 0.003) in the ART conception group. After adjusting for confounders, intrauterine growth restriction (IUGR) remained significantly more common in the ART conception group (adjusted odds ratio 8.65, 95% CI 1.66-45.03; P = 0.01). Differences in maternal age (P = 0.61), threatened preterm labour (P = 0.10), Apgar score ≤5 at 5 min (P = 0.99), umbilical cord pH <7.20 (P = 0.99) and fetal death (P = 0.99) disappeared after adjustment for confounders. CONCLUSION ART triplet pregnancies had a higher rate of IUGR than in vivo triplet pregnancies. This could be related to higher maternal age, and higher rates of Apgar score ≤5 at 5 min and umbilical cord pH <7.20 in these pregnancies. In these cases, placental examination could provide valuable information.
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Affiliation(s)
- E M Pena-Burgos
- Pathology Department, La Paz University Hospital, Madrid, Spain.
| | - I Duyos-Mateo
- Obstetrics and Gynaecology Department, La Paz University Hospital, Madrid, Spain
| | | | | | - V Quirós-González
- Strategic Planning Directorate, 12 October University Hospital, Madrid, Spain
| | - M De La Calle
- Obstetrics and Gynaecology Department, La Paz University Hospital, Madrid, Spain
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Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: A Systematic Review of the Literature and Meta-Analysis. J Clin Med 2022; 11:jcm11071871. [PMID: 35407479 PMCID: PMC8999732 DOI: 10.3390/jcm11071871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Triplet pregnancies are rare events that affect approximately 93 in 100,000 deliveries in the world, especially due to the increased use of assisted reproductive techniques and older maternal age. Triplet pregnancies are associated with a higher risk of fetal and maternal morbidity and mortality compared to twins and singletons. Chorionicity has been proposed as a major determinant of perinatal and maternal outcomes in triplet pregnancies, although further evidence is needed to clarify the extent and real influence of this factor. Thus, the aim of this study was to conduct a systematic review of the literature and a meta-analysis of the maternal and perinatal outcomes of triplet pregnancies, evaluating how chorionicity may influence these results. A total of 46 studies with 43,653 triplet pregnancies and 128,145 live births were included. Among the main results of our study, we found a broad spectrum of fetal and maternal complications, especially in the group of monochorionic and dichorionic pregnancies. Risk of admission to NICU, respiratory distress, sepsis, necrotizing enterocolitis, perinatal and intrauterine mortality were all found to be higher in non-TCTA pregnancies than in TCTA pregnancies. To date, our meta-analysis includes the largest population sample and number of studies conducted in this field, evaluating a wide variety of outcome measures. The heterogeneity and retrospective design of the studies included in our research represent the main limitations of this review. More evidence is needed to fully assess outcome measures that could not be studied in this review due to scarcity of publications or insufficient sample size.
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Badreldin N, Peress DA, Yee LM, Battarbee AN. Neonatal Outcomes of Triplet Pregnancies Conceived via In Vitro Fertilization versus Other Methods of Conception. Am J Perinatol 2021; 38:810-815. [PMID: 31910461 DOI: 10.1055/s-0039-3402720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aims to investigate neonatal outcomes of triplet gestations conceived via in vitro fertilization (IVF) compared with those not conceived by IVF. STUDY DESIGN This is a retrospective cohort study of women who delivered a triplet gestation ≥24 weeks at a large academic center (2005-2016). Women with unknown mode of conception were excluded. Women who conceived via IVF were compared with those conceiving spontaneously or through non-IVF fertility treatments. The primary outcome was a composite severe neonatal morbidity (respiratory distress syndrome, necrotizing enterocolitis, severe intraventricular hemorrhage, retinopathy of prematurity, neonatal sepsis, or death). Bivariate comparisons were made by mode of conception and unadjusted generalized estimating equations were used to estimate odds ratios (OR) after accounting for the clustering of neonate by mother. RESULTS Among 82 women included in this analysis, 51 (62%) conceived via IVF. Women who conceived via IVF were older (35.2 vs. 30.7, p < 0.001) and more likely to be of non-Hispanic white race/ethnicity (91.8 vs. 70.0%, p < 0.01) and married (100 vs. 90.0%, p = 0.02) when compared with women who did not conceive via IVF. Although women who conceived via IVF delivered at an earlier gestational age than those who did not (32.9 ± 3.0 vs. 33.7 ± 2.6 weeks, p = 0.02), there was no significant difference in composite neonatal morbidity (34.0 vs. 28.0%, p = 0.32; OR: 1.33, 95% CI: 0.60-2.91). Additionally, there were no significant differences between the groups with regard to other neonatal outcomes examined, including fetal growth restriction, birthweight, umbilical artery pH <7, neonatal intensive care unit admissions, duration in the NICU, need for mechanical ventilation, or duration of mechanical ventilation. CONCLUSION Neonatal outcomes among triplet gestations did not differ by IVF in this well-characterized, single-center cohort.
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Affiliation(s)
- Nevert Badreldin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Danielle A Peress
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ashley N Battarbee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama
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Guido Campuzano M, Fernández Carrocera L, Sandoval Hernández T, García Alonso-Themann P. Resultados maternos y neonatales de trillizos nacidos por diferentes métodos de embarazo. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2017. [DOI: 10.1016/j.rprh.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Qin JB, Sheng XQ, Wang H, Chen GC, Yang J, Yu H, Yang TB. Worldwide prevalence of adverse pregnancy outcomes associated with in vitro fertilization/intracytoplasmic sperm injection among multiple births: a systematic review and meta-analysis based on cohort studies. Arch Gynecol Obstet 2017; 295:577-597. [DOI: 10.1007/s00404-017-4291-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
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Combs CA, Schuit E, Caritis SN, Lim AC, Garite TJ, Maurel K, Rouse D, Thom E, Tita AT, Mol B. 17-Hydroxyprogesterone caproate in triplet pregnancy: an individual patient data meta-analysis. BJOG 2015; 123:682-90. [PMID: 26663620 DOI: 10.1111/1471-0528.13779] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preterm birth complicates almost all triplet pregnancies and no preventive strategy has proven effective. OBJECTIVE To determine, using individual patient data (IPD) meta-analysis, whether the outcome of triplet pregnancy is affected by prophylactic administration of 17-hydroxyprogesterone caproate (17OHPc). SEARCH STRATEGY We searched literature databases, trial registries and references in published articles. SELECTION CRITERIA Randomised controlled trials (RCTs) of progestogens versus control that included women with triplet pregnancies. DATA COLLECTION AND ANALYSIS Investigators from identified RCTs collaborated on the protocol and contributed their IPD. The primary outcome was a composite measure of adverse perinatal outcome. The secondary outcome was the rate of birth before 32 weeks of gestation. Other pre-specified outcomes included randomisation-to-delivery interval and rates of birth at <24, <28 and <34 weeks of gestation. MAIN RESULTS Three RCTs of 17OHPc versus placebo included 232 mothers with triplet pregnancies and their 696 offspring. Risk-of-bias scores and between-study heterogeneity were low. Baseline characteristics were comparable between 17OHPc and placebo groups. The rate of the composite adverse perinatal outcome was similar among those treated with 17OHPc and those treated with placebo (34 and 35%, respectively; risk ratio [RR] 0.98, 95% confidence interval [95% CI] 0.79-1.2). The rate of birth at <32 weeks was also similar in the two groups (35 and 38%, respectively; RR 0.92, 95% CI 0.55-1.56). There were no significant between-group differences in perinatal mortality rate, randomisation-to-delivery interval, or other specified outcomes. CONCLUSION Prophylactic 17OHPc given to mothers with triplet pregnancies had no significant impact on perinatal outcome or pregnancy duration. TWEETABLE ABSTRACT 17-Hydroxyprogesterone caproate had no significant impact on the outcome or duration of triplet pregnancy.
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Affiliation(s)
- C A Combs
- Obstetrix Collaborative Research Network, the Center for Research, Education, and Quality, Mednax National Medical Group, Sunrise, FL, USA
| | - E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.,Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - S N Caritis
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - A C Lim
- Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands
| | - T J Garite
- Obstetrix Collaborative Research Network, the Center for Research, Education, and Quality, Mednax National Medical Group, Sunrise, FL, USA.,Department of Obstetrics and Gynecology, University of California Irvine, Irvine, CA, USA
| | - K Maurel
- Obstetrix Collaborative Research Network, the Center for Research, Education, and Quality, Mednax National Medical Group, Sunrise, FL, USA
| | - D Rouse
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Maternal-Fetal Medicine Units Network (MFMU), Bethesda, MD, USA.,Department of Obstetrics and Gynecology, Alpert Medical School, Women & Infants Hospital, Brown University, Providence, RI, USA.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - E Thom
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Maternal-Fetal Medicine Units Network (MFMU), Bethesda, MD, USA.,The Biostatistics Center, George Washington University, Washington, DC, USA
| | - A T Tita
- Department of Obstetrics and Gynecology, Alpert Medical School, Women & Infants Hospital, Brown University, Providence, RI, USA.,Department of Obstetrics and Gynecology and Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bwj Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands.,The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, and The South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Pregnancy-related complications and adverse pregnancy outcomes in multiple pregnancies resulting from assisted reproductive technology: a meta-analysis of cohort studies. Fertil Steril 2015; 103:1492-508.e1-7. [DOI: 10.1016/j.fertnstert.2015.03.018] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/02/2015] [Accepted: 03/16/2015] [Indexed: 11/21/2022]
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Morency AM, Shah PS, Seaward PGR, Whittle W, Murphy KE. Obstetrical and neonatal outcomes of triplet births - spontaneous versus assisted reproductive technology conception. J Matern Fetal Neonatal Med 2015; 29:938-43. [PMID: 25902395 DOI: 10.3109/14767058.2015.1024649] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the average gestational age at birth and to compare obstetrical and neonatal outcomes of triplet births conceived spontaneously versus via assisted reproductive technology (ART). METHODS A retrospective chart review of triplet pregnancies that resulted in three live babies was conducted at Mount Sinai Hospital (Toronto, Canada) from January 2000 to June 2013. RESULTS A total of 230 women and 690 fetuses were identified. The mean gestational age at birth was 32.0 ± 3.8 weeks. Obstetrical outcomes included preterm premature rupture of the membranes in 29%, preterm labor in 26%, preeclampsia or HELLP syndrome in 19% and gestational diabetes in 10%. The mean birth weight of infants born after 24 weeks was 1655 ± 550 g and the rate of small for gestational age was 28%. The neonatal mortality rate prior to discharge was 7%. Aside from respiratory distress syndrome (30.6 versus 46.6%; p = 0.02), there were no differences in gestational age at birth, obstetrical or neonatal outcomes between spontaneous versus ART triplet conception. Monochorionicity carried a higher risk of small for gestational age, congenital anomalies and neonatal mortality compared to trichorionicity. CONCLUSION Rates of preterm birth and related complications remain high in triplet gestation. However, obstetrical and neonatal outcomes were similar for triplets conceived spontaneously versus via ART.
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Affiliation(s)
- Anne-Maude Morency
- a Department of Obstetrics & Gynaecology , Maternal-Fetal Medicine Division, Mount Sinai Hospital , Toronto , Ontario , Canada
| | - Prakesh S Shah
- b Department of Paediatrics , Mount Sinai Hospital , Toronto , Ontario , Canada , and.,c Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto , Ontario , Canada
| | - P Gareth R Seaward
- a Department of Obstetrics & Gynaecology , Maternal-Fetal Medicine Division, Mount Sinai Hospital , Toronto , Ontario , Canada .,c Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto , Ontario , Canada
| | - Wendy Whittle
- a Department of Obstetrics & Gynaecology , Maternal-Fetal Medicine Division, Mount Sinai Hospital , Toronto , Ontario , Canada
| | - Kellie E Murphy
- a Department of Obstetrics & Gynaecology , Maternal-Fetal Medicine Division, Mount Sinai Hospital , Toronto , Ontario , Canada
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Murray SR, Norman JE. Multiple pregnancies following assisted reproductive technologies--a happy consequence or double trouble? Semin Fetal Neonatal Med 2014; 19:222-7. [PMID: 24685368 DOI: 10.1016/j.siny.2014.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The association between assisted reproduction technologies (ART) and multiple pregnancy is well-established, with a multiple birth rate of 24% in ART pregnancies. Multiple pregnancy is associated with significantly increased maternal and perinatal morbidity and mortality, as well as increased costs to the National Health Service. Evidence relating to the obstetric outcomes of ART twins versus naturally conceived twins is discussed in this review. Methods to reduce the risk of multiple births including elective single embryo transfer and multifetal pregnancy reduction are also discussed.
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Affiliation(s)
- S R Murray
- Simpson Centre for Reproductive Health, Royal Infirmary Edinburgh, 47 Little France Crescent, UK.
| | - J E Norman
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, UK
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Chibber R, Fouda M, Shishtawy W, Al-Dossary M, Al-Hijji J, Amen A, Mohammed AT. Maternal and neonatal outcome in triplet, quadruplet and quintuplet gestations following ART: a 11-year study. Arch Gynecol Obstet 2013; 288:759-67. [DOI: 10.1007/s00404-013-2796-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/09/2013] [Indexed: 10/27/2022]
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Revello R, De la Calle M, Moreno E, Duyos I, Salas P, Zapardiel I. Maternal morbidity on 147 triplets: single institution experience. J Matern Fetal Neonatal Med 2012; 26:193-6. [DOI: 10.3109/14767058.2012.722723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zuppa AA, Alighieri G, Catenazzi P, Scorrano A, Romagnoli C. Toward a bioethical issue: induced multiple pregnancies and neonatal outcomes. Ital J Pediatr 2010; 36:74. [PMID: 21070661 PMCID: PMC2995785 DOI: 10.1186/1824-7288-36-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 11/11/2010] [Indexed: 12/02/2022] Open
Abstract
Assisted reproductive technology has made great progress during the last three decades. After the initial enthusiasm, many ethical, legal and social issues related to the application of these procedures began to evolve. Multifetal pregnancy and fetal reduction, embryo cryopreservation, preimplantation genetic diagnosis, risks of birth defects and other adverse outcome associated with assisted reproductive technology are issues that have to be addressed building future collaborative studies and continuing the debate on related ethical issues.
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Affiliation(s)
- Antonio A Zuppa
- Department of Pediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo Gemelli, 00168 Roma, Italy.
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