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Simões T, Pereira I, Gomes L, Brás S, Nogueira I, Queirós A. Higher risk of preterm twin delivery among shorter nulliparous women. J Gynecol Obstet Hum Reprod 2024; 53:102694. [PMID: 37992965 DOI: 10.1016/j.jogoh.2023.102694] [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: 02/15/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To determine if maternal height in nulliparous women influences pregnancy results in twin pregnancies. MATERIAL AND METHODS Retrospective cohort analysis evaluating twin pregnancies followed at Centro Hospitalar Universitário Lisboa Central, between 1995 and 2020. Of the 2900 pregnancies followed in that period, 886 nulliparous women with dichorionic twin pregnancies were selected. Two groups were considered: A - maternal height <163 cm ( RESULT(S) PTB rates decreased along increasing maternal height. The comparison between group A and group B revealed no statistically significant differences in maternal characteristics (age, mode of conception - spontaneous or ART pregnancies, or BMI). Statistically significant differences were found in mean gestational age at birth (35.1 ± 1.8 vs. 36.0 ± 2.6 wks), PTB rates < 32, 34 and 36 wks, OR: 3.2, 2.3 and 2.4 respectively, p < 0.01. Shorter women had a 1.7× and 2.6× increased risk for significantly low (<2500 g) and very low (<1500 g) newborn birth weight (BW), respectively, and a 40 % increased risk of Cesarian delivery. No significant differences were shown with respect to stillbirths, neonatal and perinatal deaths, which had a low incidence in this study. In ART pregnancies we found the same results regarding PTB rates and newborn birthweight in shorter women. In Logistic Regression analysis, maternal height CONCLUSION Increased pregnancy risk in nulliparous shorter women should be taken into consideration in double embryo transfers.
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Affiliation(s)
- Teresinha Simões
- Department of Maternal-Fetal Medicine, Maternity Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Nova Medical School, Lisbon, Portugal; Department of Reproductive Medicine, Maternity Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Nova Medical School, Lisbon, Portugal.
| | - Inês Pereira
- Department of Maternal-Fetal Medicine, Maternity Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Laura Gomes
- Department of Maternal-Fetal Medicine, Maternity Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Sofia Brás
- Department of Maternal-Fetal Medicine, Maternity Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Isabel Nogueira
- Department of Maternal-Fetal Medicine, Maternity Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Alexandra Queirós
- Department of Maternal-Fetal Medicine, Prenatal Diagnosis Unit Maternity Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Nova Medical School, Lisbon, Portugal
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Fouks Y, Yogev Y. Twinning in ART: Single embryo transfer policy. Best Pract Res Clin Obstet Gynaecol 2022; 84:88-95. [PMID: 35430161 DOI: 10.1016/j.bpobgyn.2022.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/13/2022] [Indexed: 11/16/2022]
Abstract
It is more than thirty years that perinatologists and healthcare personnel aim to reduce the morbidity associated with multiple pregnancy. In many cases, these complications stem from pregnancies achieved through artificial reproductive technologies (ART). Although dramatic measures have been taken to control those risks by increasing the proportion of single embryo transfers, the multiple pregnancy rate still remains relatively high among patient conceived through ART, carrying risks to both mothers and newborns, and is coupled with the related economic burden associated with prematurity. The aim of this review is to provide the current evidence regarding single embryo transfer to assist decision-makers and to promote patient knowledge toward an elective policy to reduce the risk of twinning. Single embryo transfer may aid in the further reduction of multiple pregnancy and, in most cases, will maintain patient autonomy and right of choice.
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Affiliation(s)
- Yuval Fouks
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Jurado-García E, Botello-Hermosa A, Fernández-Carrasco FJ, Gómez-Salgado J, Navas-Rojano N, Casado-Mejía R. Multiple Gestations and Assisted Reproductive Technologies: Qualitative Study of the Discourse of Health Professionals in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116031. [PMID: 34205229 PMCID: PMC8200015 DOI: 10.3390/ijerph18116031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022]
Abstract
Multiple gestations have become an increasing phenomenon that has impacted public health globally, largely due to the application of assisted reproductive technologies. The objective of this work was to find out the discourse that the health professionals involved in its follow-up have in our context. For this, a qualitative methodology was chosen, with semi-structured interviews recorded in audio, prior authorisation, and transcribed verbatim. It was based on a script designed for this purpose, with the following analysis categories: the current trend of multiple gestations, impact, and follow-up. The content analysis was based on the experiences, knowledge, and perceptions of the professionals interviewed. Professionals stated that the current socioeconomic and legal context hinders a single embryo transfer policy that decreases multiple gestation rates. They emphasised the importance of the psychic impact of such gestations on the couple, on the mother in particular, as well as the economic effect on families, health, and society in general. They expressed the need to create specific protocols to assist these gestations. Midwives, in particular, demanded that the health administration recognise and support the differentiated care they perform with this type of gestation. Work on specific models is needed to adequately size the impact of multiple gestations, as well as to generate social health policies that lead to co-responsible reconciliation measures that favour women having one pregnancy at a time.
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Affiliation(s)
- Estefanía Jurado-García
- Department of Nursing, Escuela Universitaria de Osuna, University of Seville, 41640 Sevilla, Spain
- Correspondence: ; Tel.: +34-955820289
| | - Alicia Botello-Hermosa
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Sevilla, Spain; (A.B.-H.); (R.C.-M.)
| | - Francisco Javier Fernández-Carrasco
- Department of Gynaecology and Obstetrics, Punta de Europa Hospital, 11207 Cádiz, Spain;
- Department of Nursing and Physiotherapy, Faculty of Nursing, University of Cadiz, 11009 Cádiz, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain;
- Safety and Health Postgraduate Programme, Espíritu Santo University, Guayaquil 092301, Ecuador
| | - Nazaret Navas-Rojano
- EIS Methods, Empresa de Base Tecnológica (Spin Off), University of Huelva, 21007 Huelva, Spain;
| | - Rosa Casado-Mejía
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Sevilla, Spain; (A.B.-H.); (R.C.-M.)
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Attawet J, Wang AY, Farquhar CM, Jordan V, Li Z, Sullivan EA. Pregnancy and birth outcomes of single versus multiple embryo transfer in gestational surrogacy arrangements: a systematic review and meta-analysis. HUM FERTIL 2020; 25:217-227. [PMID: 32609023 DOI: 10.1080/14647273.2020.1785643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multiple embryo transfer (MET) is associated with both an increased risk of multiple pregnancy and of live birth. In recent years, MET has become standard practice for most surrogacy arrangements. There is limited review of the use of MET versus single embryo transfer (SET) in surrogacy practice. The present review systematically evaluated the pregnancy outcomes of surrogacy arrangements between MET versus SET among gestational carriers. A systematic search of five computerized databases without restriction to the English language or study type was conducted to evaluate the primary outcomes: (i) clinical pregnancy; (ii) live delivery; and (iii) multiple delivery rates. The search returned 97 articles, five of which met the inclusion criteria. The results showed that clinical pregnancy (RR = 1.21, 95% CI: 1.06-1.39, n = 5, I2 = 41%), live delivery (RR = 1.29, 95% CI: 1.10-1.51, n = 4, I2 = 35%) and multiple delivery rates (RR = 1.42, 95% CI: 6.58-69.73, n = 4, I2 = 54%) were statistically significantly different in MET compared to SET. Adverse events including miscarriage, preterm birth and low birthweight were found following MET. Our findings support the existing evidence that MET results in multiple pregnancy and subsequently more adverse outcomes compared to SET. From a public health perspective, SET should be advocated as the preferred treatment for gestational carriers.
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Affiliation(s)
- Jutharat Attawet
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Alex Y Wang
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Cindy M Farquhar
- Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Vanessa Jordan
- Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Zhuoyang Li
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, Ultimo, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
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Is guided, targeted information about the risks of twin pregnancy able to increase the acceptance of single embryo transfer among IVF couples? A prospective study. J Assist Reprod Genet 2020; 37:1669-1674. [PMID: 32440931 DOI: 10.1007/s10815-020-01820-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To assess whether receiving information about twin pregnancy in the form of oral presentation given by a physician could affect the acceptance of single embryo transfer (SET) by couples undergoing IVF. STUDY DESIGN Prospective interventional study. SETTING University hospital IVF unit. PATIENTS One hundred and forty patients (70 couples) undergoing IVF. INTERVENTIONS A questionnaire to measure patients' emotions about twin pregnancy was administered to IVF patients just before and immediately after attending a slide presentation in which the risks of twin pregnancy were explained. Patients scored (1 to 6) ten adjectives linked either to positive or negative emotions; scores before and after presentation were compared. The patients' preference between double embryo transfer (DET) and SET was also registered before and after the presentation. RESULTS The presentation about twin pregnancy caused a significant (p < 0.001) shift of the score distribution toward lower values for positive adjectives referred to twin pregnancy and higher values for negative adjectives. Information impacted similarly on women and men. Despite the relevant change in the emotional attitude, after presentation, 45.7% of women and 48.6% of men were still favorable to DET, whereas 24.3% of women and 37.1% of men preferred SET. CONCLUSIONS Oral information on the risks of twin pregnancy can affect the emotional attitude of patients toward twin pregnancy, but the wish of getting pregnant after fresh embryo transfer overcomes all rational consideration, and the majority of patients still prefer DET.
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Muggli M, De Geyter C, Reiter-Theil S. Shall parent / patient wishes be fulfilled in any case? A series of 32 ethics consultations: from reproductive medicine to neonatology. BMC Med Ethics 2019; 20:4. [PMID: 30621671 PMCID: PMC6325683 DOI: 10.1186/s12910-018-0342-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/26/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Questions concerning the parent/ patient's autonomy are seen as one of the most important reasons for requesting Ethics Consultations (ECs). Respecting parent/ patient's autonomy also means respecting the patient's wishes. But those wishes may be controversial and sometimes even go beyond legal requirements. The objective of this case series of 32 ECs was to illustrate ethically challenging parent / patients' wishes during the first stages of life and how the principle of patient's autonomy was handled. METHODS The case series has a qualitative retrospective approach. A documentary sheet was designed de novo and information was gained from EC minutes and medical charts. The cases originate from the following specialties: reproductive medicine, obstetrics and neonatology as well as two interdisciplinary cases. RESULTS Through the structured EC minutes aspects of patient / parents' wishes could be identified explicitly. Overall the patient / parents' wishes were not supported in 61% of the cases. Central reasons for rejection of patient / parent wishes were mainly the protection of the best interest of the unborn / new-born child as well as the rejection of clinical approaches that were regarded as being substandard treatment. CONCLUSION The study shows that treatment decisions in reproductive medicine, obstetrics and neonatology raise substantial ethical questions leading to the request for ethics consultation. The systematic case series presented here gives insight into the ethical reflection carried out to support the clinicians in their decision-making and counselling. It shows that clinicians, after using ethics consultation, make deliberate decisions that do not "automatically" fulfil the treatment requests of the patients and parents (to-be).
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Affiliation(s)
- Mirella Muggli
- Department of Clinical Ethics, Psychiatric Hospitals of the University Basel, University Hospital, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
- Institute of Reproductive Medicine and Gynaecological Endocrinology (RME), University Hospital, University of Basel, Vogesenstrasse 134, CH-4031 Basel, Switzerland
| | - Christian De Geyter
- Institute of Reproductive Medicine and Gynaecological Endocrinology (RME), University Hospital, University of Basel, Vogesenstrasse 134, CH-4031 Basel, Switzerland
| | - Stella Reiter-Theil
- Department of Clinical Ethics, Psychiatric Hospitals of the University Basel, University Hospital, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
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Cutting R. Single embryo transfer for all. Best Pract Res Clin Obstet Gynaecol 2018; 53:30-37. [DOI: 10.1016/j.bpobgyn.2018.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
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Mehta VP, Patel JA, Gupta RH, Shah SI, Banker MR. One Plus One Is Better Than Two: Cumulative Reproductive Outcomes Are Better after Two Elective Single Blastocyst Embryo Transfers Compared to One Double Blastocyst Embryo Transfer. J Hum Reprod Sci 2018; 11:161-168. [PMID: 30158813 PMCID: PMC6094541 DOI: 10.4103/jhrs.jhrs_117_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims The aim of this study is to compare cumulative in vitro fertilization-intracytoplasmic sperm injection outcomes following two elective single embryo transfer (eSET) versus one double embryo transfer (DET) using blastocyst(s). Settings and Design This was retrospective observational study. Study Period The study was conducted during January 2015-December 2015. Subjects and Methods Forty-one fresh + 25 frozen eSET versus 123 DET using self-oocytes and 68 fresh + 35 frozen eSET versus 184 DET using donor-oocytes were included in the study. All failing to achieve live birth after first eSET underwent frozen embryo transfer cycle with second blastocyst. Cumulative outcome after two eSET were compared with one DET. Statistical Analysis Used The analysis was performed by Chi-square and t-test. Results In self-oocytes group, higher but statistically nonsignificant cumulative clinical pregnancy rate (CPR) (58.5% vs. 57.7%, P = 0.92) and live birth rate (LBR) (48.7% vs. 44.7%, P = 0.65) with significantly lower multiple pregnancy rate (MPR) (4.2% vs. 45%, P = 0.0002) were obtained; whereas in donor-oocytes group, comparable cumulative CPR (73.5% vs. 65.7%, P = 0.24), significantly higher LBR (64.7% vs. 48.9%, P = 0.02) and significantly lower MPR (4% vs. 51.2%, P = 0.00005) were obtained after two eSET vs. one DET. In self-oocytes group, the incidence of prematurity (10% vs. 21.4%, P > 0.05) and low birth weight (25% vs. 45.6%, P > 0.05) were lower but statistically nonsignificant, whereas in donor-oocytes group, incidence of prematurity was lower but statistically nonsignificant (26.7% vs. 38.8%, P > 0.05) while of low birth weight was significantly lower (32.7% vs. 51.2%, P = 0.0038) after two eSET versus one DET. Conclusion Cumulative LBR was higher with lower incidence of multiple births, prematurity and low birth weight after two eSET versus one DET using self- or donor-oocytes. Higher use of eSET improves reproductive outcomes in patients with good prognosis.
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Affiliation(s)
- Vidhisha P Mehta
- Department of Reproductive Medicine, Nova IVI Fertility and Pulse Women's Hospital, Ahmedabad, Gujarat, India
| | - Jayesh A Patel
- Department of Reproductive Medicine, Nova IVI Fertility and Pulse Women's Hospital, Ahmedabad, Gujarat, India
| | - Reena H Gupta
- Department of Reproductive Medicine, Nova IVI Fertility and Pulse Women's Hospital, Ahmedabad, Gujarat, India
| | - Sandeep I Shah
- Department of Reproductive Medicine, Nova IVI Fertility and Pulse Women's Hospital, Ahmedabad, Gujarat, India
| | - Manish R Banker
- Department of Reproductive Medicine, Nova IVI Fertility and Pulse Women's Hospital, Ahmedabad, Gujarat, India
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Liu J, Wu Y, Xu S, Su D, Han Y, Wu X. Retrospective evaluation of pregnancy outcomes and clinical implications of 34 Han Chinese women with unicornuate uterus who received IVF-ET or ICSI-ET treatment. J OBSTET GYNAECOL 2017; 37:1020-1024. [PMID: 28657383 DOI: 10.1080/01443615.2017.1318266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Junfen Liu
- Center for Reproductive Medicine, Shanxi Women and Children Hospital, Taiyuan, Shanxi, P. R. China
| | - Yuanxia Wu
- Center for Reproductive Medicine, Shanxi Women and Children Hospital, Taiyuan, Shanxi, P. R. China
| | - Suming Xu
- Center for Reproductive Medicine, Shanxi Women and Children Hospital, Taiyuan, Shanxi, P. R. China
| | - Dan Su
- Center for Reproductive Medicine, Shanxi Women and Children Hospital, Taiyuan, Shanxi, P. R. China
| | - Yingli Han
- Center for Reproductive Medicine, Shanxi Women and Children Hospital, Taiyuan, Shanxi, P. R. China
| | - Xueqing Wu
- Center for Reproductive Medicine, Shanxi Women and Children Hospital, Taiyuan, Shanxi, P. R. China
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Kliebisch TK, Bielfeld AP, Krüssel JS, Baston-Büst DM. The German Middleway as Precursor for Single Embryo Transfer. A Retrospective Data-analysis of the Düsseldorf University Hospital's Interdisciplinary Fertility Centre - UniKiD. Geburtshilfe Frauenheilkd 2016; 76:690-698. [PMID: 27365539 DOI: 10.1055/s-0042-105747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Introduction: Patients receiving fertility treatment in Germany appear to be disadvantaged in comparison to those in other countries due to the restrictive Embryo Protection Act ("Embryonenschutzgesetz, ESchG"), which prohibits the selection of a "top" embryo. The so-called German Middleway ("Deutscher Mittelweg, DMW") now provides for a liberal interpretation of the ESchG by allowing the culture of numerous pronuclear stages (2PN stage). Materials and Methods: Retrospective cohort study of 2 assisted reproduction treatment cycles in n = 400 patients between the ages of 21 and 45 years, either treated 2× conservatively or 1× conservatively and 1× liberally according to DMW. Results: Pregnancy was achieved in 35 % of patients in the DMW group and 31 % of controls. The birth rate among controls was 28.5 % and 30.5 % in the DMW group. Most pregnancies resulted from the culture of 4 × 2PN stages. Conclusion: Patients in the DMW group had significantly higher pregnancy and birth rates compared to their previous cycles despite significantly increased age and significantly fewer transferred embryos. Key factors were the number of 2PNs generated and the quality of embryos transferred. Thus it can be assumed that particularly older patients with adequate ovarian reserves will benefit from DMW, i.e. the transfer of fewer embryos of the best possible quality.
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Affiliation(s)
- T K Kliebisch
- Medical Research School der Medizinischen Fakultät der Heinrich-Heine-Universität, Düsseldorf
| | - A P Bielfeld
- Medical Center University of Düsseldorf, Dept. of OB/GYN/REI, Düsseldorf
| | - J S Krüssel
- Medical Center University of Düsseldorf, Dept. of OB/GYN/REI, Düsseldorf
| | - D M Baston-Büst
- Medical Center University of Düsseldorf, Dept. of OB/GYN/REI, Düsseldorf
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van den Akker O, Postavaru GI, Purewal S. Maternal psychosocial consequences of twins and multiple births following assisted and natural conception: a meta-analysis. Reprod Biomed Online 2016; 33:1-14. [PMID: 27156004 DOI: 10.1016/j.rbmo.2016.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/14/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
The aim of this meta-analysis is to provide new evidence on the effects on maternal health of multiple births due to assisted reproductive technology (ART). A bibliographic search was undertaken using PubMed, PsycINFO, CINAHL and Science Direct. Data extraction was completed using Cochrane Review recommendations, and the review was performed following PRISMA and MOOSE guidelines. Meta-analytic data were analysed using random effects models. Eight papers (2993 mothers) were included. Mothers of ART multiple births were significantly more likely to experience depression (standardized mean difference [SMD] d = 0.198, 95% CI 0.050 - 0.345, z = 2.623, P = 0.009; heterogeneity I(2) = 36.47%), and stress (SMD d = 0.177, 95% CI 0.049 - 0.305, P = 0.007; heterogeneity I(2) = 0.01%) than mothers of ART singletons. No difference in psychosocial distress (combined stress and depression) (SMD d = 0.371, 95% CI -0.153 - 0.895; I(2) = 86.962%, P = 0.001) or depression (d = 0.152, 95% CI -0.179 - 0.483: z = 0.901; I(2) = 36.918%) were found between mothers of ART and naturally conceived multiple births. In conclusion, mothers of ART multiple births were significantly more likely to have depression and stress than mothers of ART singletons, but were no different from mothers of naturally conceived multiples.
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Affiliation(s)
- Olga van den Akker
- Department of Psychology, School of Science and Technology, Middlesex University, Hendon, London, NW44BT, UK.
| | - Gianina-Ioana Postavaru
- Centre for Sustainable Working Life, Birkbeck, University of London, Malet Street, Bloomsbury, London, WC1E 7HX, UK
| | - Satvinder Purewal
- Institute of Psychology, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, WV1 1AD, UK
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