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Kristensen SE, Kvist Ekelund C, Sandager P, Stener Jørgensen F, Hoseth E, Sperling L, Zingenberg HJ, Duelund Hjortshøj T, Gadsbøll K, Wright A, Wright D, McLennan A, Sundberg K, Petersen OB. Triple trouble: uncovering the risks and benefits of early fetal reduction in trichorionic triplets in a large national Danish cohort study. Am J Obstet Gynecol 2023; 229:555.e1-555.e14. [PMID: 37263399 DOI: 10.1016/j.ajog.2023.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/05/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Triplet pregnancies are high risk for both the mother and the infants. The risks for infants include premature birth, low birthweight, and neonatal complications. Therefore, the management of triplet pregnancies involves close monitoring and may include interventions, such as fetal reduction, to prolong the pregnancy and improve outcomes. However, the evidence of benefits and risks associated with fetal reduction is inconsistent. OBJECTIVE This study aimed to compare the outcomes of trichorionic triplet pregnancies with and without fetal reduction and with nonreduced dichorionic twin pregnancies and primary singleton pregnancies. STUDY DESIGN All trichorionic triplet pregnancies in Denmark, including those with fetal reduction, were identified between 2008 and 2018. In Denmark, all couples expecting triplets are informed about and offered fetal reduction. Pregnancies with viable fetuses at the first-trimester ultrasound scan and pregnancies not terminated were included. Adverse pregnancy outcome was defined as a composite of miscarriage before 24 weeks of gestation, stillbirth at 24 weeks of gestation, or intrauterine fetal death of 1 or 2 fetuses. RESULTS The study cohort was composed of 317 trichorionic triplet pregnancies, of which 70.0% of pregnancies underwent fetal reduction to a twin pregnancy, 2.2% of pregnancies were reduced to singleton pregnancies, and 27.8% of pregnancies were not reduced. Nonreduced triplet pregnancies had high risks of adverse pregnancy outcomes (28.4%), which was significantly lower in triplets reduced to twins (9.0%; difference, 19.4%, 95% confidence interval, 8.5%-30.3%). Severe preterm deliveries were significantly higher in nonreduced triplet pregnancies (27.9%) than triplet pregnancies reduced to twin pregnancies (13.1%; difference, 14.9%, 95% confidence interval, 7.9%-21.9%). However, triplet pregnancies reduced to twin pregnancies had an insignificantly higher risk of miscarriage (6.8%) than nonreduced twin pregnancies (1.1%; difference, 5.6%; 95% confidence interval, 0.9%-10.4%). CONCLUSION Triplet pregnancies reduced to twin pregnancies had significantly lower risks of adverse pregnancy outcomes, severe preterm deliveries, and low birthweight than nonreduced triplet pregnancies. However, triplet pregnancies reduced to twin pregnancies were potentially associated with a 5.6% increased risk of miscarriage.
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Affiliation(s)
- Steffen Ernesto Kristensen
- Department of Obstetrics, Center for Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Charlotte Kvist Ekelund
- Department of Obstetrics, Center for Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Puk Sandager
- Department of Obstetrics and Gynecology, Center for Fetal Medicine, Aarhus University Hospital, Aarhus, Denmark; Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Finn Stener Jørgensen
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre and Amager, Hvidovre, Denmark
| | - Eva Hoseth
- Department of Obstetrics and Gynecology, Clinic of Ultrasound, Aalborg University Hospital, Aalborg, Denmark
| | - Lene Sperling
- Department of Obstetrics and Gynecology, Center for Ultrasound and Pregnancy, Odense University Hospital, Odense, Denmark
| | - Helle Jeanette Zingenberg
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Tina Duelund Hjortshøj
- Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kasper Gadsbøll
- Department of Obstetrics, Center for Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alan Wright
- Institute of Health Research, University of Exeter, Exeter, United Kingdom
| | - David Wright
- Institute of Health Research, University of Exeter, Exeter, United Kingdom
| | - Andrew McLennan
- Sydney Ultrasound for Women, Chatswood, New South Wales, Australia; Discipline of Obstetrics, Gynaecology, and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Karin Sundberg
- Department of Obstetrics, Center for Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Olav Bjørn Petersen
- Department of Obstetrics, Center for Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ramadan during pregnancy and neonatal health-Fasting, dietary composition and sleep patterns. PLoS One 2023; 18:e0281051. [PMID: 36791059 PMCID: PMC9931121 DOI: 10.1371/journal.pone.0281051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Large shares of pregnant Muslims worldwide observe the Ramadan fast. Previous research showed that Ramadan during pregnancy is associated with adverse offspring health outcomes lasting throughout the life-course. Evidence on effects on birth outcomes is inconclusive, however, and previous research did not consider the role of dietary composition and sleep patterns during Ramadan. This study systematically documents maternal lifestyle during Ramadan and assesses if diet and sleep adaptations to Ramadan, independent of and in addition to maternal fasting, are associated with neonatal health outcomes. METHODS This study reports a survey of 326 Muslims who delivered their baby in Mainz, Germany, linked to maternal & infant hospital records. Participants reported on fasting, dietary composition and sleep schedules while pregnant during Ramadan. RESULTS Fasting during pregnancy was associated with reduced birthweight, in particular for fasting during the first trimester (-352ˑ92g, 95% CI: -537ˑ38; -168ˑ46). Neither dietary composition nor altered sleep were directly associated with birthweight. However, dietary composition during Ramadan outside of fasting hours seems to moderate the fasting-birthweight association, which disappeared for women switching to high-fat diets. CONCLUSIONS The finding that dietary intake during Ramadan potentially moderates the fasting-birthweight association is of high relevance to pregnant Muslims who wish to fast and their healthcare professionals, since dietary choices outside of fasting hours are often relatively easily modifiable. This is the first study to include information on maternal diet and sleep during Ramadan, and additional research is needed to assess the roles of specific (macro)nutrients and food groups.
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Tessema ZT, Tebeje TM, Gebrehewet LG. Geographic variation and factors associated with under-five mortality in Ethiopia. A spatial and multilevel analysis of Ethiopian mini demographic and health survey 2019. PLoS One 2022; 17:e0275586. [PMID: 36227894 PMCID: PMC9560495 DOI: 10.1371/journal.pone.0275586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The distribution of under-five mortality (U5M) worldwide is uneven and the burden is higher in Sub-Saharan African countries, which account for more than 53% of the global under-five mortality. In Ethiopia, though U5M decreased substantially between 1990 and 2019, it remains excessively high and unevenly distributed. Therefore, this study aimed to assess geographic variation and factors associated with under-five mortality (U5M) in Ethiopia. METHODS We sourced data from the most recent nationally representative 2019 Ethiopian Mini-Demographic and Health Survey for this study. A sample size of 5,695 total births was considered. Descriptive, analytical analysis and spatial analysis were conducted using STATA version 16. Both multilevel and spatial analyses were employed to ascertain the factors associated with U5M in Ethiopia. RESULTS The U5M was 5.9% with a 95% CI 5.4% to 6.6%. Based on the multivariable multilevel logistic regression model results, the following characteristics were associated with under-five mortality: family size (AOR = 0.92, 95% CI: 0.84,0.99), number of under-five children in the family (AOR = 0.17, 95% CI: 0.14, 0.21), multiple birth (AOR = 14.4, 95% CI: 8.5, 24.3), children who were breastfed for less than 6 months (AOR = 5.04, 95% CI: 3.81, 6.67), people whose main roof is palm (AOR = 0.57, 95% CI: 0.34, 0.96), under-five children who are the sixth or more child to be born (AOR = 2.46, 95% CI: 1.49, 4.06), institutional delivery (AOR = 0.57, 95% CI: 0.41, 0.81), resident of Somali and Afar region (AOR = 3.46, 95% CI: 1.58, 7.55) and (AOR = 2.54, 95% CI: 1.10, 5.85), respectively. Spatial analysis revealed that hot spot areas of under-five mortality were located in the Dire Dawa and Somali regions. CONCLUSION Under-five mortality in Ethiopia is high and unacceptable when compared to the 2030 sustainable development target, which aims for 25 per 1000 live births. Breastfeeding for less than 6 months, twin births, institutional delivery and high-risk areas of under-five mortality (Somali and Dire Dawa) are modifiable risk factors. Therefore, maternal and community education on the advantages of breastfeeding and institutional delivery is highly recommended. Women who deliver twins should be given special attention. An effective strategy should be designed for intervention in under-five mortality hot spot areas such as Somali and Dire Dawa.
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Affiliation(s)
- Zemenu Tadesse Tessema
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Tsion Mulat Tebeje
- Epidemiology and Biostatistics Unit, School of Public Health, Dilla University, Dilla, Ethiopia
| | - Lewi Goytom Gebrehewet
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Hong E, Issarraras A, Matson JL, Montrenes JJ, Weir PA. Examination of multiple birth as a predictor of autism symptom severity and developmental functioning in an early intervention sample. Dev Neurorehabil 2022; 25:444-451. [PMID: 35253597 DOI: 10.1080/17518423.2022.2047120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Multiple birth is one of several perinatal factors associated with increased risk for autism spectrum disorder (ASD); however, complexity in its relationship to ASD symptoms and developmental functioning remains. The present study investigated perinatal risk factors for ASD, primarily focusing on birth status, within a large early intervention sample. In particular, the relationship between ASD, perinatal factors, and the effect of birth status on developmental functioning and ASD symptom severity were examined in youth with and without ASD classification who were born singly or were the product of a multiple birth. Overall, the presence of other perinatal risk factors, including prematurity, low birth weight, and advanced parental age, was primarily related to birth status and not to ASD classification, while severity of ASD symptoms and developmental impairments were primarily related to ASD classification and not to birth status. Study findings and implications for early screening of children with developmental delays are discussed.
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Affiliation(s)
- Esther Hong
- Louisiana State University, Baton Rouge, LA, United States of America
| | | | - Johnny L Matson
- Louisiana State University, Baton Rouge, LA, United States of America
| | | | - Paige A Weir
- Louisiana State University, Baton Rouge, LA, United States of America
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Chen L, Li W, Liu Y, Peng Z, Cai L, Zhang N, Xu J, Wang L, Teng X, Yao Y, Zou Y, Ma M, Liu J, Lu S, Sun H, Yao B. Non-invasive embryo selection strategy for clinical in vitro fertilization to avoid wastage of potentially competent embryos. Reprod Biomed Online 2022; 45:26-34. [DOI: 10.1016/j.rbmo.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/14/2021] [Accepted: 03/07/2022] [Indexed: 12/09/2022]
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Pfeifer LS, Schmitz J, Papadatou-Pastou M, Peterburs J, Paracchini S, Ocklenburg S. Handedness in twins: meta-analyses. BMC Psychol 2022; 10:11. [PMID: 35033205 PMCID: PMC8760823 DOI: 10.1186/s40359-021-00695-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/24/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In the general population, 10.6% of people favor their left hand over the right for motor tasks. Previous research suggests higher prevalence of atypical (left-, mixed-, or non-right-) handedness in (i) twins compared to singletons, and in (ii) monozygotic compared to dizygotic twins. Moreover, (iii) studies have shown a higher rate of handedness concordance in monozygotic compared to dizygotic twins, in line with genetic factors playing a role for handedness. METHODS By means of a systematic review, we identified 59 studies from previous literature and performed three sets of random effects meta-analyses on (i) twin-to-singleton Odds Ratios (21 studies, n = 189,422 individuals) and (ii) monozygotic-to-dizygotic twin Odds Ratios (48 studies, n = 63,295 individuals), both times for prevalence of left-, mixed-, and non-right-handedness. For monozygotic and dizygotic twin pairs we compared (iii) handedness concordance Odds Ratios (44 studies, n = 36,217 twin pairs). We also tested for potential effects of moderating variables, such as sex, age, the method used to assess handedness, and the twins' zygosity. RESULTS We found (i) evidence for higher prevalence of left- (Odds Ratio = 1.40, 95% Confidence Interval = [1.26, 1.57]) and non-right- (Odds Ratio = 1.36, 95% Confidence Interval = [1.22, 1.52]), but not mixed-handedness (Odds Ratio = 1.08, 95% Confidence Interval = [0.52, 2.27]) among twins compared to singletons. We further showed a decrease in Odds Ratios in more recent studies (post-1975: Odds Ratio = 1.30, 95% Confidence Interval = [1.17, 1.45]) compared to earlier studies (pre-1975: Odds Ratio = 1.90, 95% Confidence Interval = [1.59-2.27]). While there was (ii) no difference between monozygotic and dizygotic twins regarding prevalence of left- (Odds Ratio = 0.98, 95% Confidence Interval = [0.89, 1.07]), mixed- (Odds Ratio = 0.96, 95% Confidence Interval = [0.46, 1.99]), or non-right-handedness (Odds Ratio = 1.01, 95% Confidence Interval = [0.91, 1.12]), we found that (iii) handedness concordance was elevated among monozygotic compared to dizygotic twin pairs (Odds Ratio = 1.11, 95% Confidence Interval = [1.06, 1.18]). By means of moderator analyses, we did not find evidence for effects of potentially confounding variables. CONCLUSION We provide the largest and most comprehensive meta-analysis on handedness in twins. Although a raw, unadjusted analysis found a higher prevalence of left- and non-right-, but not mixed-handedness among twins compared to singletons, left-handedness was substantially more prevalent in earlier than in more recent studies. The single large, recent study which included birth weight, Apgar score and gestational age as covariates found no twin-singleton difference in handedness rate, but these covariates could not be included in the present meta-analysis. Together, the secular shift and the influence of covariates probably make it unsafe to conclude that twinning has a genuine relationship to handedness.
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Affiliation(s)
- Lena Sophie Pfeifer
- Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Universitätsstraße 150, 44780, Bochum, Germany.
| | - Judith Schmitz
- School of Medicine, University of St Andrews, St Andrews, Scotland
| | - Marietta Papadatou-Pastou
- School of Education, Department of Primary Education, National and Kapodistrian University of Athens, Athens, Greece
- Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Jutta Peterburs
- Institute of Systems Medicine and Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
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Sarno L, Tagliaferri S, Carlea A, Talhami F, Migliorini S, Maruotti GM, Campanile M, Guida M. Maternal haemodynamic profile in pregnancy after assisted reproductive technology: A pilot study. Pregnancy Hypertens 2021; 26:62-64. [PMID: 34536701 DOI: 10.1016/j.preghy.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/20/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
Singleton pregnancies obtained by assisted reproductive technology (ART) are at increased risk of adverse pregnancy outcome. Aim of this pilot study was to compare maternal hemodynamic profile in ART and spontaneous singleton pregnancies. Patients were enrollered during a third trimester routine obstetric examination. Maternal haemodynamic assessment was carried out by a single trained operator using an UltraSonic Cardiac Output Monitor in standardized conditions. Our pilot data suggests that women conceived after ART may have significantly lower Cardiac Output and significantly higher Systemic Vascular Resistance when compared to those conceiving spontaneously. These differences, if confirmed in larger studies, might explain the increased prevalence of adverse outcome, especially hypertensive disorders of pregnancy, in singleton ART pregnancies.
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Affiliation(s)
- Laura Sarno
- Department of Neurosciences, Reproductive Science and Dentistry, University Federico II of Naples, Via Pansini, 5-80131 Naples, Italy.
| | - Salvatore Tagliaferri
- Department of Neurosciences, Reproductive Science and Dentistry, University Federico II of Naples, Via Pansini, 5-80131 Naples, Italy
| | - Annunziata Carlea
- Department of Neurosciences, Reproductive Science and Dentistry, University Federico II of Naples, Via Pansini, 5-80131 Naples, Italy
| | - Farid Talhami
- Department of Neurosciences, Reproductive Science and Dentistry, University Federico II of Naples, Via Pansini, 5-80131 Naples, Italy
| | - Sonia Migliorini
- Department of Neurosciences, Reproductive Science and Dentistry, University Federico II of Naples, Via Pansini, 5-80131 Naples, Italy
| | - Giuseppe Maria Maruotti
- Department of Neurosciences, Reproductive Science and Dentistry, University Federico II of Naples, Via Pansini, 5-80131 Naples, Italy
| | - Marta Campanile
- Department of Neurosciences, Reproductive Science and Dentistry, University Federico II of Naples, Via Pansini, 5-80131 Naples, Italy
| | - Maurizio Guida
- Department of Neurosciences, Reproductive Science and Dentistry, University Federico II of Naples, Via Pansini, 5-80131 Naples, Italy
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Kim MS, Kang S, Kim Y, Kang JY, Moon MJ, Baek MJ. Transabdominal fetal reduction: a report of 124 cases. J OBSTET GYNAECOL 2020; 41:32-37. [PMID: 32705924 DOI: 10.1080/01443615.2019.1677577] [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: 10/23/2022]
Abstract
To prevent fetal loss, preterm delivery, and perinatal morbidity of multifetal pregnancies (MPs), fetal reduction (FR) is offered to some patients. We retrospectively analysed the data of 124 MPs that underwent transabdominal FR to twin (n = 63) and singleton (n = 61) pregnancies at a mean gestational age of 12 + 6 weeks between December 2006 and January 2018. FR was performed transabdominally with the injection of potassium chloride into the intracardiac or intrathoracic space of the fetus or fetuses after ultrasound screening for nuchal translucency and anatomical defects. The initial number of embryos were 48 twins, 63 triplets, 11 quadruplets, and 2 quintuplets. The procedure-related pregnancy loss rate was 0.8% (1/124), the overall pregnancy loss rate was 2.4% (3/124), the fetal loss rate was 1.6% (2/124), and the neonatal death rate was 0.8% (1/124). The baby take-home rates were 96% for twin pregnancies and 96.7% for singletons. This study shows that transabdominal FR is an effective and safe procedure with a pregnancy loss rate of 2.4%.Impact statementWhat is already known on this subject? The incidence of multifetal pregnancies has increased over the years. Because multifetal pregnancies increase perinatal morbidity and mortality due to prematurity, fetal reduction is offed to some patients.What the results of this study add? The results of this study add to the growing body of research on fetal reduction. The study showed that transabdominal fetal reduction is a safe procedure with a pregnancy loss rate of 2.4%.What the implications are of these findings for clinical practice and/or further research? The results of this study can be used in counselling couples with multifetal pregnancies who are considering fetal reduction. Further research is needed to confirm the current findings.
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Affiliation(s)
- Mi Sun Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam-si, Republic of Korea
| | - Sukho Kang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam-si, Republic of Korea
| | - Youngri Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam-si, Republic of Korea
| | - Ji Yeon Kang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam-si, Republic of Korea
| | - Myoung Jin Moon
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam-si, Republic of Korea
| | - Min Jung Baek
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam-si, Republic of Korea
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Gowling SA, McKenzie-McHarg K, Gordon C, Harrison LK. 'Our relationship is different': exploring mothers' early experiences of bonding to their twins. J Reprod Infant Psychol 2020; 39:475-485. [PMID: 32037874 DOI: 10.1080/02646838.2020.1726307] [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
Objective: The aim of this research was to explore mothers' lived experience of early bonding with their twins.Background: Research has suggested that the process of bonding with twins may differ from that of bonding with singletons. However, there is limited research exploring this experience from the mother's perspective.Method: An IPA study involved six participants in semi-structured interviews.Results: Two superordinate themes emerged; 'Twin guilt and shame' and 'I missed out … they miss out'. Results suggested the experience of bonding with two infants simultaneously generated guilt for the mothers, who at points felt that they and their infants had missed out and had had to adapt.Conclusion: The experience of bonding with twins can be complex and take longer than anticipated, with mothers reporting the experience as being different from their expectations. Having a greater understanding and information about the complexities of bonding with twins would be beneficial for both mothers and professionals working with them.
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Affiliation(s)
- Sarah A Gowling
- Department of Clinical Psychology, University of Coventry, Coventry, UK.,Department of Psychology, University of Warwick, Coventry, UK
| | | | - Carolyn Gordon
- Department of Clinical Psychology, University of Coventry, Coventry, UK
| | - Lesley K Harrison
- Department of Clinical Psychology, University of Coventry, Coventry, UK
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Zemet R, Haas J, Bart Y, Barzilay E, Zloto K, Argaman N, Schwartz N, Weisz B, Yinon Y, Mazaki-Tovi S, Lipitz S. Pregnancy outcome after multifetal pregnancy reduction of triplets to twins versus reduction to singletons. Reprod Biomed Online 2019; 40:445-452. [PMID: 32067870 DOI: 10.1016/j.rbmo.2019.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/12/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION Does fetal reduction of triplet pregnancies to singleton result in superior obstetric and neonatal outcomes compared with triplets reduced to twins? DESIGN A historical cohort study including 285 trichorionic and dichorionic triplet pregnancies that underwent abdominal fetal reduction at 11-14 weeks in a single tertiary referral centre. The study population comprised two groups: reduction to twins (n = 223) and singletons (n = 62). Main outcome measures were rates of pregnancy complications, preterm delivery and neonatal outcomes. Non-parametric statistical methods were employed. RESULTS Triplet pregnancies reduced to twins delivered earlier (36 versus 39 weeks, P < 0.001) with higher prevalence of Caesarean section (71.1% versus 32.2%, P < 0.001) compared with triplets reduced to singletons. Preterm delivery rates were significantly higher in twins compared with singletons prior to 37 weeks (56.9% versus 13.6%, P < 0.001), 34 weeks (20.2% versus 3.4%, P = 0.002) and 32 weeks (9.6% versus 0%, P = 0.01). No significant difference was found in the rate of pregnancy loss before 24 weeks (1.3% in twins versus 4.8% in singletons, P = 0.12) or in the rate of intrauterine fetal death after 24 weeks (0.4% versus 0%, P = 1.0). Both groups had comparable obstetrical complications and neonatal outcomes, except for higher rates of neonatal intensive care unit admission in twins (31.9% versus 6.8%, P < 0.001). CONCLUSIONS Reduction of triplets to singletons rather than twins resulted in superior obstetric outcomes without increasing the procedure-related complications. However, because the rate of extreme prematurity in pregnancies reduced to twins was low, the overall outcome of those pregnancies was favourable. Therefore, the option of reduction to singletons should be considered in cases where the risk of prematurity seems exceptionally high.
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Affiliation(s)
- Roni Zemet
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Bart
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Keren Zloto
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natan Argaman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Schwartz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Yinon
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Lipitz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kim MS, Moon MJ, Kang S, Jung SH, Chang SW, Ki HJ, Kim B, Ahn E. Obstetrical Outcomes of Amniocentesis or Chorionic Villus Sampling in Dichorionic Twin Pregnancies. J Korean Med Sci 2019; 34:e142. [PMID: 31074255 PMCID: PMC6509361 DOI: 10.3346/jkms.2019.34.e142] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/24/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Under certain situations, women with twin pregnancies may be counseled to undergo invasive prenatal diagnostic testing. Chorionic villus sampling and amniocentesis are the two generally performed invasive prenatal diagnostic tests. Studies comparing procedure-related fetal loss between first-trimester chorionic villus sampling and second-trimester amniocentesis in twin pregnancies are limited. This study aimed to evaluate the procedure-related fetal loss and the obstetrical outcomes of these two procedures, chorionic villus sampling and amniocentesis in twin pregnancies. METHODS The data from dichorionic-diamniotic twin pregnancies on which first-trimester chorionic villus sampling (n = 54) or second-trimester amniocentesis (n = 170) was performed between December 2006 and January 2017 in a single center were retrospectively analyzed. The procedure-related fetal loss was classified as loss of one or all fetuses within 4 weeks of procedure, and overall fetal loss was classified as loss of one or all fetuses during the gestation. The groups were compared with respect to the procedure-related and obstetrical outcomes. RESULTS The difference in proportion of procedure-related fetal loss rate (1.9% for chorionic villus sampling vs. 1.8% for amniocentesis; P = 1.000) and the overall fetal loss rate (7.4% for chorionic villus sampling vs. 4.7% for amniocentesis; P = 0.489) between the two groups was not significant. The mean gestational ages at delivery were not statistically significant. CONCLUSION Both the overall fetal loss rate and the procedure-related fetal loss rate of chorionic villus sampling and amniocentesis in dichorionic twin pregnancies had no statistical significance. Both procedures can be safely used individually.
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Affiliation(s)
- Mi Sun Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Korea
| | - Myoung Jin Moon
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Korea
| | - Sukho Kang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Korea
| | - Sang Hee Jung
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Korea
| | - Sung Woon Chang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Korea
| | - Hyo Jin Ki
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Korea
| | - Bohye Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Korea
| | - Eunhee Ahn
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Korea.
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Jaspal R, Prior T, Denton J, Salim R, Banerjee J, Christoph Lees. The impact of cross-border IVF on maternal and neonatal outcomes in multiple pregnancies: Experience from a UK fetal medicine service. Eur J Obstet Gynecol Reprod Biol 2019; 238:63-67. [PMID: 31112853 DOI: 10.1016/j.ejogrb.2019.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/22/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether women seeking NHS care for IVF multiple pregnancies were more likely to have sought IVF treatment overseas and whether this was associated with different maternal and neonatal outcomes. STUDY DESIGN A single large tertiary centre, for perinatal care in northwest London. Sixty-five women were referred to our fetal medicine centre, between 2012-2016, with IVF conceived multiple pregnancies. INCLUSION CRITERIA In Vitro fertilisation and conception of twins/ triplets/quadruplets. EXCLUSION CRITERIA Intra-uterine insemination, ovulation induction, Clomid-conception and singleton pregnancies. The primary outcome measure was the Country where IVF treatment was performed. The secondary outcomes measures included the specifics of IVF treatment (e.g. number of embryos transferred), subsequent pregnancy outcomes (e.g. live-births and prematurity) and neonatal outcomes (e.g. length and cost of care). RESULTS AND CONCLUSION Thirty-eight women had IVF overseas; they were older and had more pre-existing medical conditions. Eleven pregnancies used donor embryos, of which ten were from overseas treatment. 75% of women treated overseas conceived a triplet or higher order pregnancy compared to fewer than 10% of women who conceived in the UK. Almost half of all women treated overseas had more than two embryos transferred. Overseas IVF pregnancies had poorer obstetric and neonatal outcomes: 24% of live born babies died in the neonatal period compared to 0% in the UK group. The average neonatal costs per baby born from overseas IVF were £20, 600: two-and-a-half times higher than for those whose mothers conceived in the UK. Higher order multiple pregnancies are greatly over-represented by those undergoing IVF in overseas clinics. These are associated with poorer obstetric and neonatal outcomes. Perhaps paradoxically, improving NHS provision of fertility services might improve outcomes for the mother and babies while reducing the long-term burden to both fertility patients and the NHS.
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Affiliation(s)
- Raj Jaspal
- Centre for Fetal Care, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS trust, London, United Kingdom; Wolfson Fertility Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Thomas Prior
- Centre for Fetal Care, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS trust, London, United Kingdom
| | - Jane Denton
- Centre for Fetal Care, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS trust, London, United Kingdom
| | - Rehan Salim
- Wolfson Fertility Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jayanta Banerjee
- Neonatal Unit, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial College London, United Kingdom
| | - Christoph Lees
- Centre for Fetal Care, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS trust, London, United Kingdom; Imperial College London, United Kingdom.
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13
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Kim MS, Choi DH, Kwon H, Ahn E, Cho HY, Baek MJ, Shin JE, Moon MJ. Procedural and obstetric outcomes after embryo reduction vs fetal reduction in multifetal pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:214-218. [PMID: 29418029 DOI: 10.1002/uog.19024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/28/2018] [Accepted: 02/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the obstetric outcome and incidence of procedure-related adverse events after embryo reduction (ER) vs fetal reduction (FR), in multifetal pregnancies undergoing reduction to twins or singletons. METHODS We analyzed retrospectively data from multifetal pregnancies that underwent transvaginal ER (n = 181) at a mean gestational age of 7.6 weeks or transabdominal FR (n = 115) at a mean gestational age of 12.9 weeks between December 2006 and January 2017. FR was performed after a detailed fetal anomaly scan. The two groups were compared with respect to obstetric outcomes, such as incidence of miscarriage, early or late preterm delivery, maternal complications and fetal loss, and procedure-related adverse events, including incidence of subchorionic hematoma and procedure-related fetal loss. RESULTS Compared with pregnancies that underwent ER, the incidence of procedure-related fetal loss was lower in the FR group (7.2% vs 0.9%; P = 0.039; odds ratio (OR), 0.12; 95% CI, 0.02-0.89). Mean gestational age at delivery for twins was 34.2 weeks in the ER group and 35.7 weeks in the FR group (P = 0.014). Compared with the ER group, the FR group had lower miscarriage (8.8% vs 2.6%; P = 0.045; OR, 0.28; 95% CI, 0.08-0.97) and overall fetal loss (13.3% vs 5.2%; P = 0.031; OR, 0.36; 95% CI, 0.14-0.91) rates. CONCLUSIONS The FR procedure is, overall, a better and safer approach to reducing morbidity and mortality in multifetal pregnancies. Spontaneous demise of one fetus may occur after ER, and FR has the advantage that chorionic villus sampling and ultrasound screening for increased nuchal translucency and anatomical defects can be conducted before the procedure. The ER approach is still reasonable when a patient's religious or other ethical concerns are of primary importance. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M S Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - D H Choi
- Fertility Center of CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - H Kwon
- Fertility Center of CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - E Ahn
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - H Y Cho
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - M J Baek
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - J E Shin
- Fertility Center of CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - M J Moon
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
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14
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Velez MP, Hamel C, Hutton B, Gaudet L, Walker M, Thuku M, Cobey KD, Pratt M, Skidmore B, Smith GN. Care plans for women pregnant using assisted reproductive technologies: a systematic review. Reprod Health 2019; 16:9. [PMID: 30696452 PMCID: PMC6352361 DOI: 10.1186/s12978-019-0667-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background Between 1 and 5% of children in industrialized countries are conceived through Assisted Reproductive Technologies (ART). As infertility and the use of ART may be associated with adverse perinatal outcomes, care plans specific to these pregnancies are needed. We conducted a systematic review to examine the existing care plans specific to women pregnant following Assisted Reproductive Technologies (ART). Methods MEDLINE, Embase and the Cochrane Library were searched by a senior information specialist. The population of interest included women becoming pregnant with ART (e.g., Intra-Uterine Insemination, In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), and surrogacy). All proposed care plans were sought that pertained to any aspect of care during pregnancy and delivery. Only Clinical Practice Guidelines (CPGs) addressing the recommendations and plans for the care of ART pregnant women were included. The search was restricted to the publication dates 2007 to June 12, 2017 when the search was run. The search was not restricted by language, however only English and French language guidelines were considered for inclusion. Results After screening 2078 citations, a total of ten CPGs were included. The following key clinical messages were prevalent: (1) although there was no supporting evidence, antenatal care for ART pregnancies should be provided by specialist with knowledge in obstetrics; (2) high-order multiple pregnancies are the greatest risk of ART and selective reduction options should be discussed; (3) there is some evidence of increased risk of congenital abnormalities and prenatal genetic and anatomic screening is recommended, especially in IVF-ICSI pregnancies; (4) due to a lack of or conflicting evidence, treatment of venous thromboembolism, antithrombotic therapy, treatment for hypothyroidism, and women with positive thyroid antibodies is recommended to be the same as in spontaneous pregnancies; and lastly (5) since an increased level of distress is a recognized feature in these pregnancies, psychosocial care and counselling should be considered. Conclusions There is a lack of CPGs specific to ART pregnancies. While we identified a small number of recommendations for ART pregnancies, specific interventions and models of care aiming at decreasing adverse maternal and perinatal outcomes following ART should be developed, implemented, and evaluated. Electronic supplementary material The online version of this article (10.1186/s12978-019-0667-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria P Velez
- Department of Obstetrics and Gynecology, Queen's University, Kingston General Hospital, Kingston, Ontario, K7L 2V7, Canada. .,Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, Ontario, K7L 3N6, Canada.
| | - Candyce Hamel
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Laura Gaudet
- Department of Obstetrics, Gynecology & Newborn Care, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.,OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Mark Walker
- Department of Obstetrics, Gynecology & Newborn Care, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.,OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Micere Thuku
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Kelly D Cobey
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Misty Pratt
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Queen's University, Kingston General Hospital, Kingston, Ontario, K7L 2V7, Canada
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Butti N, Montirosso R, Borgatti R, Urgesi C. Maternal sensitivity is associated with configural processing of infant's cues in preterm and full-term mothers. Early Hum Dev 2018; 125:35-45. [PMID: 30199717 DOI: 10.1016/j.earlhumdev.2018.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prematurity may affect mother-infant bonding and alter maternal sensitivity to infant's cues. Efficient perception of infants' facial and bodily cues is a crucial aspect of maternal sensitivity and may be challenged by prematurity, as infants' signals may not be easily intelligible. However, it is still unexplored how premature birth impacts the maternal ability to perceive infants' signals. AIMS To investigate whether prematurity influences the perceptual sensitivity of mothers to infants' cues and, in particular, the configural processing of the faces and bodies of familiar and unfamiliar infants. STUDY DESIGN The inversion effect paradigm was used to evaluate the configural vs. detail-based processing of the face and body of own or others' infants. Preterm mothers were compared to full-term mothers with either low or high maternal sensitivity. PARTICIPANTS Forty-three healthy full-term and twenty-one preterm mothers of infants aged about six months. OUTCOME MEASURES Maternal sensitivity during dyadic interaction, gestational age, accuracy and reaction time in a delayed matching-to-sample task of upright vs. inverted body and face stimuli (i.e., inversion effect). RESULTS Preterm mothers were found to be less sensitive than the full-term ones. Higher maternal sensitivity during dyadic interaction was associated with lower inversion effect for unfamiliar as compared to own infants' bodies. However, preterm mothers and full-term mothers with low sensitivity showed comparable inversion effect in perceiving unfamiliar infants' faces or bodies. CONCLUSIONS Preterm birth per se does not directly affect body configural processing, but it may be associated to reduced maternal sensitivity, ultimately leading to a less refined perception of own infant's cues.
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Affiliation(s)
- Niccolò Butti
- Neuropsychiatry and Neurorehabilitation Unit - Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Rosario Montirosso
- 0-3 Centre for the at-Risk Infant - Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy.
| | - Renato Borgatti
- Neuropsychiatry and Neurorehabilitation Unit - Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Cosimo Urgesi
- Neuropsychiatry and Neurorehabilitation Unit - Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy; Laboratory of Cognitive Neuroscience, Department of Languages and Literatures, Communication, Education and Society, University of Udine and Scientific Institute, IRCCS Eugenio Medea, San Vito al Tagliamento, Pordenone, Italy
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16
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An Assessment and Postnatal Cost Analysis of Multiple Pregnancies after Assisted Reproductive Techniques. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2018. [DOI: 10.21673/anadoluklin.397410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Li J, Du M, Zhang Z, Guan Y, Wang X, Zhang X, Liu J, Pan Z, Wang B, Liu W. Does a poor-quality embryo have an adverse impact on a good-quality embryo when transferred together? J Ovarian Res 2018; 11:78. [PMID: 30180866 PMCID: PMC6122748 DOI: 10.1186/s13048-018-0452-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In some in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles, we may consider transferring one poor-quality embryo with one good-quality embryo. Previous studies have indicated that the poor-quality embryo transferred with a good-quality embryo does not negatively affect the clinical pregnancy rate or live birth rate. The purpose of this study was to evaluate pregnancy outcomes and neonatal outcomes in this context. METHODS This was a retrospective study that included 1646 cycles from our centre. Patients were divided into two groups (group A: one good-quality embryo was transferred with one poor-quality embryo; group B: two good-quality embryos were transferred). The primary outcomes were the clinical pregnancy rate and live birth rate. Additionally, we investigated the implantation rate, ectopic pregnancy rate, abortion rate, multiple pregnancy rate, birthweight and gestational age. RESULTS We found that there were no differences in the clinical pregnancy rate and live birth rate between group A and group B. However, the implantation rate and multiple pregnancy rate were higher in group B than in group A. CONCLUSIONS The poor-quality embryo does not have a significant influence on the good-quality embryo when transferred together.
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Affiliation(s)
- Jiaheng Li
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Mingze Du
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Zhan Zhang
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China.
| | - Yichun Guan
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xingling Wang
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xiao Zhang
- Waterstone Clinic, Lotamore House, Tivoli, Cork, Ireland
| | - Jing Liu
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Zhouhui Pan
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Bijun Wang
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Wenxia Liu
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
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18
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Being a mother of preterm multiples in the context of socioeconomic disadvantage: perceived stress and psychological symptoms. J Pediatr (Rio J) 2018; 94:491-497. [PMID: 29121494 DOI: 10.1016/j.jped.2017.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/10/2017] [Accepted: 08/02/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study aimed to examine the differences between mothers of preterm multiples and mothers of preterm singletons regarding perceived stress and maternal psychological symptoms, and to explore the putative adverse amplified effect of socioeconomic disadvantage. METHOD Ninety-five mothers of 1-year-olds born preterm participated in this cross-sectional study. Data collection was carried out in two public hospitals from Northern Portugal. To assess maternal perceived daily stress and psychological symptoms, mothers completed two questionnaires. Mothers reported on socioeconomic factors, including family poverty, parent unemployment, and low education, and two groups of family socioeconomic disadvantage were created. A child medical risk index was calculated. RESULTS Results indicated that mothers of preterm multiples reported higher levels of stress than mothers of preterm singletons. Moreover, and specifically regarding psychological functioning, mothers of preterm multiples reported more symptoms than mothers of preterm singletons, but only when living in a context of socioeconomic adversity. CONCLUSIONS The results of the present study have important implications for practice. Mothers of preterm multiples are at higher risk to present mental health difficulties, in comparison to mothers of singletons, especially when exposed to socioeconomic adversities. The development of psychosocial intervention programs and public policies are of decisive importance in helping mothers of multiples adjust to parenthood.
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Baptista J, Moutinho V, Mateus V, Guimarães H, Clemente F, Almeida S, Andrade MA, Dias CP, Freitas A, Martins C, Soares I. Being a mother of preterm multiples in the context of socioeconomic disadvantage: perceived stress and psychological symptoms. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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20
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Valenzuela-Alcaraz B, Cruz-Lemini M, Rodríguez-López M, Goncé A, García-Otero L, Ayuso H, Sitges M, Bijnens B, Balasch J, Gratacós E, Crispi F. Fetal cardiac remodeling in twin pregnancy conceived by assisted reproductive technology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:94-100. [PMID: 28508519 DOI: 10.1002/uog.17527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 04/20/2017] [Accepted: 05/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Recent data suggest that singleton fetuses conceived by assisted reproductive technology (ART) present cardiovascular remodeling that may persist postnatally. Twin pregnancies are more frequent in the ART population and are associated with increased adverse perinatal outcomes, such as hypertensive disorders, gestational diabetes and preterm birth. However, it is unknown whether cardiac remodeling is also present in twin pregnancies conceived by ART. Our aim was to assess the presence of fetal cardiac remodeling and dysfunction in twin pregnancies conceived by ART as compared with those conceived spontaneously (SC). METHODS This was a prospective cohort study including 50 dichorionic twin fetuses conceived by ART and 50 SC twin fetuses. The study protocol included collection of baseline/perinatal data and a fetal ultrasound examination at 28-30 weeks' gestation, including assessment of estimated fetal weight, fetoplacental Doppler and fetal echocardiography. Measurements of atrial area, atrial/heart ratio, ventricular sphericity index, free wall thickness, mitral and tricuspid annular plane systolic excursions, and systolic and early diastolic peak velocities were assessed. Multilevel analyses were used to compare perinatal and ultrasonographic parameters. Comparisons of echocardiographic variables were adjusted for parental age, paternal body mass index and incidence of pre-eclampsia. RESULTS Compared with SC twins, ART twin fetuses showed significant cardiac changes, predominantly affecting the right heart, such as dilated atria (right atrial/heart area: 15.7 ± 3.1 vs 18.4 ± 3.2, P < 0.001), more globular ventricles (right ventricular sphericity index: 1.57 ± 0.25 vs 1.41 ± 0.23, P = 0.001) and thicker myocardial walls (septal wall thickness: 2.57 ± 0.45 mm vs 2.84 ± 0.41 mm, P = 0.034) together with reduced longitudinal motion (tricuspid annular plane systolic excursion: 6.36 ± 0.89 mm vs 5.18 ± 0.93 mm, P < 0.001). CONCLUSIONS ART twin fetuses present signs of cardiac remodeling and dysfunction. These changes are similar to those observed in ART singletons and reinforce the concept of fetal cardiac programing in ART. These results open opportunities for early detection and intervention in infants conceived by ART. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- B Valenzuela-Alcaraz
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
- Fetal Medicine Mexico, Fetal Medicine and Surgery Research Unit, Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Querétaro, Mexico
| | - M Cruz-Lemini
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
- Fetal Medicine Mexico, Fetal Medicine and Surgery Research Unit, Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Querétaro, Mexico
| | - M Rodríguez-López
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - A Goncé
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - L García-Otero
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - H Ayuso
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - M Sitges
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - B Bijnens
- ICREA, Barcelona, Spain
- PhySense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - J Balasch
- Institut Clínic de Ginecologia Obstetricia i Neonataologia, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - E Gratacós
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Chughtai AA, Wang AY, Hilder L, Li Z, Lui K, Farquhar C, Sullivan EA. Gestational age-specific perinatal mortality rates for assisted reproductive technology (ART) and other births. Hum Reprod 2017; 33:320-327. [DOI: 10.1093/humrep/dex340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/21/2017] [Indexed: 11/13/2022] Open
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Haas J, Barzilay E, Hourvitz A, Dor J, Lipitz S, Yinon Y, Shlomi M, Shulman A. Outcome of early versus late multifetal pregnancy reduction. Reprod Biomed Online 2016; 33:629-634. [DOI: 10.1016/j.rbmo.2016.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/14/2016] [Accepted: 08/16/2016] [Indexed: 11/17/2022]
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Prino LE, Rollè L, Sechi C, Patteri L, Ambrosoli A, Caldarera AM, Gerino E, Brustia P. Parental Relationship with Twins from Pregnancy to 3 Months: The Relation Among Parenting Stress, Infant Temperament, and Well-Being. Front Psychol 2016; 7:1628. [PMID: 27818641 PMCID: PMC5073235 DOI: 10.3389/fpsyg.2016.01628] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/05/2016] [Indexed: 11/30/2022] Open
Abstract
Objective: The transition to parenthood, from pregnancy to postpartum period, is a critical process, particularly for couples expecting twins. There is very little literature regarding the links between anxiety, depression, dyadic adjustment, parental stress, and infant temperament spanning from pregnancy to postpartum. This study has two aims: first, to examine whether mothers' and fathers' anxiety, depression, and dyadic adjustment, assessed at the sixth month of pregnancy and 3 months postpartum, are associated with infants' negative affectivity (NA) and parenting stress; second, to examine whether there is any difference between fathers' and mothers' levels of parenting stress and perception of the twins' temperament, as well as to evaluate, separately for mothers and fathers, whether the levels of parenting stress and perception of child temperament differ for each twin. Method: The study participants were 58 parents (29 couples) and their healthy 58 twin babies (51.7% boys, 48.3% girls). Mothers' ages ranged from 30 to 44 years, (MAge = 36.3 years, SD = 3.2 years), and fathers' ages ranged from 32 to 52 years, (MAge = 38.2 years, SD = 4.4 years). The parents, during the pregnancy period and 3 months after delivery, filled out the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory, and the Dyadic Adjustment Scale. Three months after delivery they also filled out the Parenting Stress Index-Short Form and the Infant Behavior Questionnaire Revised. Results: The analyses showed a significant correlation between parental anxiety/depression symptoms and infants' NA and parenting stress (in both mothers and fathers). Moreover, compared to fathers, mothers reported higher scores on specific dimensions of the infants' NA, [t(28) = -2.62 and p < 0.05; t(28) = 2.09 and p < 0.05], and parenting stress, [t(28) = 2.19 and p < 0.05; t(28) = 2.23 and p < 0.05], but only for Twin 2. Finally, the results showed that mothers' perceptions of child temperament vary between two twins, [e.g., distress to limitations: t(28) = 2.08 and p < 0.05]. Discussion: This study highlights the peculiarity of twin parenthood during the fourth trimester. In particular, the differences between twins' mothers' and fathers' perceptions are relevant from a clinical perspective and for perinatal professionals. It would be interesting to study the long-term impact of mothers' and fathers' differing perceptions of their twins.
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Affiliation(s)
- Laura E. Prino
- Department of Psychology, University of TorinoTorino, Italy
| | - Luca Rollè
- Department of Psychology, University of TorinoTorino, Italy
| | - Cristina Sechi
- Department of Pedagogy, Psychology, and Philosophy, University of CagliariCagliari, Italy
| | | | - Anna Ambrosoli
- Department of Psychology, University of TorinoTorino, Italy
| | | | - Eva Gerino
- Department of Psychology, University of TorinoTorino, Italy
| | - Piera Brustia
- Department of Psychology, University of TorinoTorino, Italy
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Abstract
Patients with a range of medical disorders, including diabetes mellitus, are increasingly seeking access to assisted reproductive technology (ART). With appropriate patient selection, monitoring and counselling, these technologies may be applied successfully. Diabetes in the female is associated with disturbed ovarian function but strict metabolic control may encourage resumption of ovulation and allow ovarian stimulation for ART. Insulin metabolism appears intimately involved with ovarian function, through mechanisms encompassing the actions of insulin-like growth factors, but is not yet fully understood. Diabetes has minimal effects on spermatogenesis but may severely disrupt erectile and/or ejaculatory function; the techniques of epididymal sperm aspiration and intracytoplasmic sperm injection (ICSI) are particularly useful in such cases. Well-controlled diabetes is not associated with recurrent miscarriage but diabetes is a risk factor for pregnancy-induced hypertension and, poorly controlled, is associated with neonatal macrosomia. In reproduction, as in general health, good metabolic control is key to a successful outcome.
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Affiliation(s)
- Clare T Taylor
- Mechanisms of Drug Toxicity Group, School of Pharmacy, Aston University, Birmingham, B4 7ET, UK,
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Dizygotic twin pregnancies after medically assisted reproduction and after natural conception: maternal and perinatal outcomes. Fertil Steril 2016; 106:371-377.e2. [PMID: 27108393 DOI: 10.1016/j.fertnstert.2016.03.042] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/15/2016] [Accepted: 03/29/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare maternal and perinatal outcomes in dizygotic twin pregnancies conceived after medically assisted reproduction (MAR) with outcomes after natural conception (NC). DESIGN Nationwide registry based study. SETTING Academic medical center. PATIENT(S) Primiparous women who delivered opposite sex twins between January 2000 and December 2012 in the Netherlands, comprising dizygotic twin pregnancies: 6,694 women, 470 after ovulation induction (OI), 511 after intrauterine insemination with controlled ovarian hyperstimulation (IUI-COH), 2,437 after in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI), and 3,276 after NC. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Multivariable logistic regression and generalized linear mixed models to evaluate differences in outcomes: maternal outcomes of hypertension, preeclampsia, preterm delivery, hemorrhage, and delivery mode, perinatal outcomes including small for gestational age (SGA) with birth weight <10th percentile, birth weight <1,500 g, 5-minute Apgar score <7, admission to neonatal intensive care unit, congenital anomalies, and perinatal mortality. RESULT(S) We found no statistically significant differences in maternal or perinatal outcomes after OI compared with NC. Women pregnant after IVF-ICSI had a lower risk for hypertension (adjusted odds ratio [aOR] 0.74; 95% confidence interval [CI], 0.66-0.83) compared with women pregnant after NC. After IUI-COH more children had Apgar scores <7 (adjusted odds ratio (aOR) 1.38; 95% confidence interval (CI) 1.05-1.81) and perinatal mortality rates were higher (aOR 1.56; 95% CI, 1.04-2.33) compared with NC. We found no differences in perinatal outcomes after IVF-ICSI compared with NC. CONCLUSION(S) Overall, maternal and perinatal risks other than those due to multiplicity are similar for twin pregnancies conceived after MAR and after NC.
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Pregnancy outcome of early multifetal pregnancy reduction: triplets to twins versus triplets to singletons. Reprod Biomed Online 2014; 29:717-21. [DOI: 10.1016/j.rbmo.2014.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 08/13/2014] [Accepted: 09/03/2014] [Indexed: 11/19/2022]
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Haas J, Mohr Sasson A, Barzilay E, Mazaki Tovi S, Orvieto R, Weisz B, Lipitz S, Yinon Y. Perinatal outcome after fetal reduction from twin to singleton: to reduce or not to reduce? Fertil Steril 2014; 103:428-32. [PMID: 25455874 DOI: 10.1016/j.fertnstert.2014.10.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 10/14/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine whether reduction of twin gestation to singleton pregnancy is associated with improved perinatal outcome. DESIGN A retrospective cohort study. SETTING Single tertiary care medical center. PATIENT(S) A cohort of 63 singleton pregnancies after reduction from dichorionic-diamniotic twins gestation and 62 dichorionic-diamniotic nonreduced twins. INTERVENTION(S) Fetal reduction between 11 and 14 weeks of gestation. MAIN OUTCOME MEASURE(S) Obstetric outcome. RESULT(S) The rates of preterm delivery at <34 weeks (1.6% in pregnancies after reduction vs. 11.7% in nonreduced twins) and at <37 weeks of gestation (9.5% vs. 56.7%) were significantly lower in patients whose pregnancies were reduced to singletons. The rates of miscarriage of one twin (0% vs. 4.8%) and early pregnancy loss before 24 weeks of gestation as well as the rates of gestational diabetes (11.1% vs. 10%), hypertensive diseases of pregnancy (6.3% vs. 15%), and intrauterine growth restriction (0% vs. 3.3%) were similar in both groups. CONCLUSION(S) Fetal reduction of twins to singleton is associated with a lower risk of prematurity and superior perinatal outcome compared with nonreduced twins. Therefore, the option of fetal reduction should be considered in certain cases of twin pregnancies, where the risk for adverse outcome seems exceptionally high.
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Affiliation(s)
- Jigal Haas
- Department of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.
| | - Aya Mohr Sasson
- Department of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Shali Mazaki Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Shlomo Lipitz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Yoav Yinon
- Department of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
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Chambers GM, Lee E, Hoang VP, Hansen M, Bower C, Sullivan EA. Hospital utilization, costs and mortality rates during the first 5 years of life: a population study of ART and non-ART singletons. Hum Reprod 2013; 29:601-10. [DOI: 10.1093/humrep/det397] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chambers GM, Wang YA, Chapman MG, Hoang VP, Sullivan EA, Abdalla HI, Ledger W. What can we learn from a decade of promoting safe embryo transfer practices? A comparative analysis of policies and outcomes in the UK and Australia, 2001-2010. Hum Reprod 2013; 28:1679-86. [DOI: 10.1093/humrep/det080] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Twin pregnancies: evaluation of major depression, stress, and social support. Twin Res Hum Genet 2013; 16:629-33. [PMID: 23398666 DOI: 10.1017/thg.2012.153] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Twin pregnancies are at increased physiological and psychosocial risks. OBJECTIVE To investigate the prevalence of major depression in twin pregnancies and correlate with stress and social support. METHOD The study included 51 pregnant women under specialized prenatal care who were evaluated by a Portuguese version of the semi-structured questionnaire Primary Care Evaluation of Mental Disorders (PRIME-MD) for Major Depression, and the Prenatal Psychosocial Profile (PPP) for evaluation of stress and social support. RESULTS Major depression was found in 33.3% of pregnant women, and prevailing symptoms were fatigue or loss of energy (100%), insomnia or hypersomnia (82.4%), changes in appetite (82.4%), decreased interest in daily activities (82.4%), and psychomotor agitation or retardation (82.4%). Among pregnant women who were diagnosed depressive, 76.5% also had a high level of stress and 47.1% complained about lack of social support. Statistical significance was found when correlating depression with perception of negative aspects of having twins and belief in significant body changes during pregnancy (p = .005 and .03, respectively). Marital status, occupation, and pregnancy planning were not significantly associated with the diagnosis of depression. CONCLUSION Major depression occurs in one-third of pregnant women expecting twins and is associated with higher levels of stress and lack of social support. A multidisciplinary approach in these cases is fundamental to minimize further risks and complications.
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Abstract
The last three decades have witnessed a dramatic increase in the use of assisted reproductive technology (ART) so that now, in developed countries, 1.7% to 4.0% of all children are born after ART. Although absolute risks appear small, data from prospective and retrospective studies indicate increased risks of adverse maternal and perinatal outcomes after ART as compared with spontaneous conception. Recent studies suggest that underlying maternal factors and subfertility play an important role in some of these outcomes rather than the ART procedure itself. A significant risk of assisted conception is multiple pregnancies, but even singleton pregnancies achieved by ART are at a higher risk of hypertensive disease, diabetes, prematurity, low birth weight, and perinatal mortality even after adjusting for confounders. Couples undergoing ART procedures should be counseled in advance regarding increased risks of pregnancy complications and higher rates of obstetric interventions. Although conflicting data exist, studies of children born from ART suggest increased rates of congenital malformations, imprinting disorders (Beckwith-Wiedemann syndrome and Angelman syndrome), and marginally increased risk of cancer. However, the current evidence is inadequate, and prospective long-term studies are needed to eliminate the effect of confounders and draw definite conclusions about the long-term outcomes after ART. The absolute risk of imprinting disorders remains small, and routine screening is not recommended at present. The long-term outcomes after ART are difficult to evaluate because of the variability in ART methods and data reporting, and there is a need for standardized methodology for follow-up after ART.
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Deonandan R, Loncar M, Rahman P, Omar S. Measuring reproductive tourism through an analysis of Indian ART clinic Websites. Int J Gen Med 2012; 5:763-73. [PMID: 23049270 PMCID: PMC3459663 DOI: 10.2147/ijgm.s36426] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Indexed: 11/23/2022] Open
Abstract
Objectives: India is fast becoming the most prominent player in the global industry of reproductive tourism, in which infertile people cross international borders to seek assisted reproduction technologies. This study was conducted to better understand the extent and manner in which Indian clinics seek foreign clients. Methods: A systematic search of official Indian assisted reproduction technologies clinic Websites was undertaken, and instances noted where foreign clients were overtly targeted, and where maternal surrogacy was overtly offered. Results: A total of 159 clinics with Web addresses were identified, though only 78 had functioning Websites. All were published in English, with the majority clustered in the states of Maharashtra (14) and Gujarat (9). Of the 78 functioning Websites, 53 (68%) featured some mention of maternal surrogacy services, and 42 (54%) made overt overtures to foreign clients. Qualitative appeals to foreigners included instructions for international adoption, visa application, and the legal parental disposition of the surrogate. All Maharashtran clinic Websites that mentioned surrogacy also overtly featured reproductive tourism. Preimplantation diagnosis services were not offered disproportionately by clinics mentioning reproductive tourism. Conclusions: Based upon clinic online profiles, reproductive tourism comprises a substantial fraction of India’s assisted reproduction technologies clinics’ business focus, clustering around its most tourist-friendly locales, and surrogacy may be a strong motivator for international clientele.
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Affiliation(s)
- Raywat Deonandan
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
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A reduction in public funding for fertility treatment--an econometric analysis of access to treatment and savings to government. BMC Health Serv Res 2012; 12:142. [PMID: 22682009 PMCID: PMC3464128 DOI: 10.1186/1472-6963-12-142] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 06/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Almost all assisted reproductive technology (ART) and intrauterine insemination (IUI) treatments performed in Australia are subsidized through the Australian Government's universal insurance scheme, Medicare. In 2010 restrictions on the amount Medicare paid in benefits for these treatments were introduced, increasing patient out-of-pocket payments for fresh and frozen embryo ART cycles and IUI. The aim of this study was to evaluate the impact of the policy on access to treatment, savings in Medicare benefits and the number of ART conceived children not born. METHODS Pooled quarterly cross-sectional Medicare data from 2007 and 2011 where used to construct a series of Ordinary Least Squares (OLS) regression models to evaluate the impact of the policy on access to treatment by women of different ages. Government savings in the 12 months after the policy was calculated as the difference between the predicted and observed Medicare benefits paid. RESULTS After controlling for underlying time trends and unobserved factors the policy change reduced the number of fresh embryo cycles by almost 8600 cycles over 12 months (a 16% reduction in cycles, p < 0.001). The policy effect was greatest on women aged 40 years and older (38% reduction in cycles, p < 0.001). Younger women engaged in relatively more anticipatory behaviour by bringing forward their fresh cycles to 2009. Frozen embryo cycles, which are approximately one quarter of the cost of a fresh cycle, were only marginally impacted by the policy. Utilisation of IUI cycles were not impacted by the policy. After adjusting for anticipatory behaviour, $76 million in Medicare benefits was saved in the 12 months after the policy change (0.47% of annual Medicare benefits). Between 1200 and 1500 ART conceived children were not born in 2010 as a consequence of the policy. CONCLUSIONS The introduction of the policy resulted in a significant reduction in fresh ART cycles in the first 15 months after its introduction. Further evaluation on the long-term impact of the policy with regard access to treatment and on clinical practice, particularly the number of embryos transferred, is crucial to ensuring equitable access to fertility treatment and the health and welfare of ART children.
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Chambers GM, Illingworth PJ, Sullivan EA. Assisted reproductive technology: public funding and the voluntary shift to single embryo transfer in Australia. Med J Aust 2011; 195:594-8. [DOI: 10.5694/mja10.11448] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Georgina M Chambers
- Perinatal and Reproductive Epidemiology Research Unit, School of Women's and Children's Health, University of New South Wales, Sydney, NSW
| | - Peter J Illingworth
- Westmead Clinical School, University of Sydney, Sydney, NSW
- IVFAustralia, Sydney, NSW
| | - Elizabeth A Sullivan
- Perinatal and Reproductive Epidemiology Research Unit, School of Women's and Children's Health, University of New South Wales, Sydney, NSW
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D'Angelo DV, Whitehead N, Helms K, Barfield W, Ahluwalia IB. Birth outcomes of intended pregnancies among women who used assisted reproductive technology, ovulation stimulation, or no treatment. Fertil Steril 2011; 96:314-320.e2. [PMID: 21718990 DOI: 10.1016/j.fertnstert.2011.05.073] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/20/2011] [Accepted: 05/22/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study birth outcomes among live born infants conceived by women who used infertility treatment. DESIGN Population-based surveillance of women who recently delivered a live infant. SETTING The birth outcomes among infants whose mothers used assisted reproductive technology (ART) or ovulation stimulation medications alone were compared with the outcomes of infants conceived without treatment. PATIENT(S) Stratified random sample of women who were attempting conception and gave birth to a live infant in six US states (n = 16,748). INTERVENTION(S) Assisted reproductive technology and ovulation stimulation. MAIN OUTCOME MEASURE(S) Adjusted odds ratios for perinatal outcomes. RESULT(S) The prevalence of infertility treatment use overall among women attempting conception was 10.9% (5.4% ART procedures, 5.5% ovulation stimulation medications). Singletons of mothers who received ART procedures were more likely to be born with low birthweight, preterm, and small for gestational age (SGA) than singleton infants conceived without treatment. Singleton infants of mothers who used ovulation stimulation medications alone were more likely to be SGA than singleton infants conceived without treatment. No differences were found between ART and no treatment twin infants. CONCLUSION(S) Among singleton infants, ART is associated with decreased fetal growth, decreased gestational length, and SGA; ovulation stimulation alone is associated with SGA.
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Affiliation(s)
- Denise V D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, NE Mailstop K-22, Atlanta, Georgia 30341, USA.
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Lou HY, Huang XY. Modified natural cycle for in vitro fertilization and embryo transfer in normal ovarian responders. J Int Med Res 2011; 38:2070-6. [PMID: 21227012 DOI: 10.1177/147323001003800622] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Controlled ovarian hyperstimulation (COH) using a gonadotrophin-releasing hormone (GnRH) analogue plus gonadotrophins is used widely in in vitro fertilization (IVF), but there can be significant complications. Sixty women with a normal ovarian response participated in a comparison of COH (triptorelin [GnRH agonist] 0.1 mg/day SC from day 21 of the menstrual cycle [before the IVF cycle] and recombinant follicle-stimulating hormone (FSH) 150 - 300 IU/day from day 2 of the IVF cycle, when triptorelin was reduced to 0.05 mg/day) with a modified natural cycle (MNC) treatment (human menopausal gonado trophin [HMG] 150 IU/day IM if serum oestradiol was ≤ 50 pg/ml on day 2 or 3 of the menstrual cycle). The groups did not differ significantly in implantation rate (21.1% and 22.6%, respectively) and clinical pregnancy rate (30.0% and 30.0%, respectively). When comparing successful pregnancies, MNC patients had significantly lower values than COH patients for total amount of gonadotrophin (HMG and recombinant FSH) used, number of oocytes retrieved and medication cost. It is concluded that MNC seems to be a feasible treatment option, with low medication cost, relatively low risk of complications and, possibly, greater patient acceptability.
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Affiliation(s)
- H Y Lou
- Department of Obstetrics and Gynaecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, China
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Khan AA, Rodriguez A, Kaakinen M, Pouta A, Hartikainen AL, Jarvelin MR. Does in utero exposure to synthetic glucocorticoids influence birthweight, head circumference and birth length? A systematic review of current evidence in humans. Paediatr Perinat Epidemiol 2011; 25:20-36. [PMID: 21133966 DOI: 10.1111/j.1365-3016.2010.01147.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Synthetic glucocorticoids are the mainstay treatment for stimulating lung maturation in threatened preterm delivery. Animal studies suggest that in utero exposure to glucocorticoids leads to a reduction in birth size. Smaller birthweight has been associated with higher risk of many chronic diseases. Therefore, the authors undertook a systematic review of human studies examining the association between synthetic glucocorticoid treatment and birth size. Medline, EMBASE, PubMed, Cochrane, Google scholar and Institute of Life Science databases were searched for studies published between 1978 and 2009 investigating the association between synthetic glucocorticoids and birthweight, head circumference, birth length and ponderal index. All studies controlling for gestational age were examined. Seventeen studies were included in the analysis. Nine out of 17 studies reported a reduction in birthweight (range 12-332 g), five of nine a reduction of head circumference (range 0.31-1.02 cm) and two of four a reduction of 0.8 cm in birth length. Despite methodological inconsistencies and limitations that impede clear conclusions, the evidence suggests an association between in utero exposure to synthetic glucocorticoids and reduced birth size.
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Affiliation(s)
- Anokhi Ali Khan
- Department of Epidemiology and Biostatistics, Imperial College London, Faculty of Medicine, London, UK
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Are US results for assisted reproduction better than the rest? Is it a question of competence or policies? Reprod Biomed Online 2010; 21:624-30. [DOI: 10.1016/j.rbmo.2010.04.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 04/15/2010] [Accepted: 04/20/2010] [Indexed: 11/21/2022]
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Martin JR, Bromer JG, Sakkas D, Patrizio P. Live babies born per oocyte retrieved in a subpopulation of oocyte donors with repetitive reproductive success. Fertil Steril 2010; 94:2064-8. [DOI: 10.1016/j.fertnstert.2010.02.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 01/27/2010] [Accepted: 02/01/2010] [Indexed: 11/27/2022]
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Simerly CR, Castro CA, Jacoby E, Grund K, Turpin J, McFarland D, Champagne J, Jimenez JB, Frost P, Bauer C, Hewitson L, Schatten G. Assisted Reproductive Technologies (ART) with baboons generate live offspring: a nonhuman primate model for ART and reproductive sciences. Reprod Sci 2010; 17:917-30. [PMID: 20631291 DOI: 10.1177/1933719110374114] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Human reproduction has benefited significantly by investigating nonhuman primate (NHP) models, especially rhesus macaques. To expand the Old World monkey species available for human reproductive studies, we present protocols in baboons, our closest Old World primate relatives, for assisted reproductive technologies (ART) leading to live born offspring. Baboons complement rhesus by confirming or modifying observations generated in humans often obtained by the study of clinically discarded specimens donated by anonymous infertility patient couples. Here, baboon ART protocols, including oocyte collection, in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), preimplantation development to blastocyst stage, and embryo transfer techniques are described. With baboon ART methodologies in place, motility during baboon fertilization was investigated by time-lapse video microscopy (TLVM). The first ART baboons produced by ICSI, a pair of male twins, were delivered naturally at 165 days postgestation. Genetic testing of these twins confirmed their ART parental origins and demonstrated that they are unrelated fraternal twins not identicals. These results have implications for ART outcomes, embryonic stem cell (ESC) derivation, and reproductive sciences.
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Affiliation(s)
- Calvin R Simerly
- Division of Developmental and Regenerative Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Pittsburgh Development Center; Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Connolly MP, Hoorens S, Chambers GM. The costs and consequences of assisted reproductive technology: an economic perspective. Hum Reprod Update 2010; 16:603-13. [PMID: 20530804 DOI: 10.1093/humupd/dmq013] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite the growing use of assisted reproductive technologies (ART) worldwide, there is only a limited understanding of the economics of ART to inform policy about effective, safe and equitable financing of ART treatment. METHODS A review was undertaken of key studies regarding the costs and consequences of ART treatment, specifically examining the direct and indirect costs of treatment, economic drivers of utilization and clinical practice and broader economic consequences of ART-conceived children. RESULTS The direct costs of ART treatment vary substantially between countries, with the USA standing out as the most expensive. The direct costs generally reflect the costliness of the underlying healthcare system. If unsubsidized, direct costs represent a significant economic burden to patients. The level of affordability of ART treatment is an important driver of utilization, treatment choices, embryo transfer practices and ultimately multiple birth rates. The costs associated with caring for multiple-birth ART infants and their mothers are substantial, reflecting the underlying morbidity associated with such pregnancies. Investment analysis of ART treatment and ART-conceived children indicates that appropriate funding of ART services appears to represent sound fiscal policy. CONCLUSIONS The complex interaction between the cost of ART treatment and how treatments are subsidized in different healthcare settings and for different patient groups has far-reaching consequences for ART utilization, clinical practice and infant outcomes. A greater understanding of the economics of ART is needed to inform policy decisions and to ensure the best possible outcomes from ART treatment.
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Affiliation(s)
- Mark P Connolly
- Department of Pharmacy, Unit of Pharmacoepidemiology and Pharmacoeconomics (PE2), University of Groningen, Groningen, The Netherlands
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CHAMBERS GM, SULLIVAN EA, SHANAHAN M, HO MT, PRIESTER K, CHAPMAN MG. Is in vitro fertilisation more effective than stimulated intrauterine insemination as a first-line therapy for subfertility? A cohort analysis. Aust N Z J Obstet Gynaecol 2010; 50:280-8. [DOI: 10.1111/j.1479-828x.2010.01155.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Luke B, Brown MB, Grainger DA, Cedars M, Klein N, Stern JE. Practice patterns and outcomes with the use of single embryo transfer in the United States. Fertil Steril 2010; 93:490-8. [DOI: 10.1016/j.fertnstert.2009.02.077] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 02/13/2009] [Accepted: 02/25/2009] [Indexed: 11/26/2022]
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Pistorius END, Adang EMM, Stalmeier PFM, Braat DDM, Kremer JAM. Prospective patient and physician preferences for stimulation or no stimulation in IVF. HUM FERTIL 2009; 9:209-16. [PMID: 17190666 DOI: 10.1080/14647270600560287] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim is to explore the preferences of female patients and physicians for IVF in three natural cycles compared to one stimulated cycle and to investigate which factors predict these preferences. STUDY DESIGN A questionnaire about IVF preference was administered initially to 105 patients between 36 and 42 years, who were on the waiting list for their first or second IVF attempt. In addition a questionnaire was sent to 56 physicians of Dutch IVF centres. The participants were asked for their preferences at different success rates based on treatment trade-off scenarios. Finally, information on demographic, psychological and other predictors for treatment choice were collected. RESULTS Complete data were obtained in 69 female patients (67%) and 27 physicians (49%). At a success rate for a life birth of 17% for both treatments, IVF in three natural cycles is preferred by 78% of the patients and physicians. Half of the patients and physicians still preferred natural cycle treatment at a success rate of 13%. Anxiety for hormone injections was the only significant predictor for patients' preferences. CONCLUSION There seems to be a latent demand for IVF in the natural cycle related to anxiety for hormone injections.
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Affiliation(s)
- Eefke N D Pistorius
- Department of Medical Technology Assessment, University Medical Centre, St Radboud Nijmegen, The Netherlands
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Ombelet W, Cooke I, Dyer S, Serour G, Devroey P. Infertility and the provision of infertility medical services in developing countries. Hum Reprod Update 2008; 14:605-21. [PMID: 18820005 PMCID: PMC2569858 DOI: 10.1093/humupd/dmn042] [Citation(s) in RCA: 342] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Worldwide more than 70 million couples suffer from infertility, the majority being residents of developing countries. Negative consequences of childlessness are experienced to a greater degree in developing countries when compared with Western societies. Bilateral tubal occlusion due to sexually transmitted diseases and pregnancy-related infections is the most common cause of infertility in developing countries, a condition that is potentially treatable with assisted reproductive technologies (ART). New reproductive technologies are either unavailable or very costly in developing countries. This review provides a comprehensive survey of all important papers on the issue of infertility in developing countries. METHODS Medline, PubMed, Excerpta Medica and EMBASE searches identified relevant papers published between 1978 and 2007 and the keywords used were the combinations of 'affordable, assisted reproduction, ART, developing countries, health services, infertility, IVF, simplified methods, traditional health care'. RESULTS The exact prevalence of infertility in developing countries is unknown due to a lack of registration and well-performed studies. On the other hand, the implementation of appropriate infertility treatment is currently not a main goal for most international non-profit organizations. Keystones in the successful implementation of infertility care in low-resource settings include simplification of diagnostic and ART procedures, minimizing the complication rate of interventions, providing training-courses for health-care workers and incorporating infertility treatment into sexual and reproductive health-care programmes. CONCLUSIONS Although recognizing the importance of education and prevention, we believe that for the reasons of social justice, infertility treatment in developing countries requires greater attention at National and International levels.
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Affiliation(s)
- Willem Ombelet
- Department of Obstetrics and Gynaecology, Genk Institute for Fertility Technology, Schiepse Bos 6, 3600 Genk, Belgium.
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Hammoud I, Vialard F, Casasnovas P, Lefebvre G, Vauthier-Brouzes D, Poirot C. How viable are zygotes in which the PN are still intact at 25 hours? Impact on the choice of embryo for transfer. Fertil Steril 2008; 90:551-6. [PMID: 17412335 DOI: 10.1016/j.fertnstert.2007.01.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Revised: 01/18/2007] [Accepted: 01/18/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the pertinence of kinetic observations of embryonic development 25 hours after IVF, with a view to optimizing the choice of embryos for transfer. DESIGN Retrospective study of 471 cycles with embryo transfer. SETTING University Hospital. INTERVENTION(S) Observations of changes in zygotes, in the 25th hour after insemination (25 h PI). MAIN OUTCOME MEASURE(S) Identification of three stages of development: two cells (2C), loss of the pronuclei (in syngamy; 0PN) and persistence of the two pronuclei (2PN). Embryonic morphology at 48 hours, according to the stages identified at 25 hours, was correlated with the rates of implantation and clinical pregnancy. RESULT(S) Two thousand four hundred seventy-eight day-2 embryos were observed. The number of blastomeres on day 2 differed significantly according to stage of development at 25 hours (2C: 69.8% vs. 0PN: 55% and 2PN: 24.6%). Implantation rates were significantly lower for cycles in which only 2PN embryos were produced (7%, n = 160) than for cycles with at least one 2C embryo and/or, preferably, a 0PN embryo (14.4%). The implantation rate was significantly lower for the transfer of only 2PN embryos (7.6%) than for the transfer of only embryos that had advanced further by 25 h PI (15.2%). If only one type of embryo was transferred (2PN vs. 2C or 0PN), for embryos with a similar morphology at 48 hours, four-blastomere embryos derived from 2PN embryos implanted less efficiently than those derived from 2C and/or 0PN embryos. CONCLUSION(S) Observation at 25 h PI is a simple, rapid, and cheap method for identifying the best embryos to transfer. A lack of zygote development at 25 hours is associated with a poor prognosis, unless the zygote concerned has two to three cells on day 2. The development of zygotes with 2PN at 25 h PI should be taken into account as a function of their development at 48 hours.
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Affiliation(s)
- Ibrahim Hammoud
- Groupe Hospitalier Pitié Salpêtrière, Unité Fonctionnelle de Biologie de Reproduction, Paris cedex 13, Université Pierre et Marie Curie, Paris VI, France.
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Abstract
An exploration of distributive justice in Canadian infertility treatment requires the integration of ethical, clinical, and economic principles. In 1971, American philosopher John Rawls proposed a theoretical model for fair decision-making in which "rational" and "self-interested" citizens are behind a "veil of ignorance" with respect to both their own position and the position of other decision-makers. Rawls proposed that these self-interested decision-makers, fearing that they are among the least advantaged persons who could be affected by the decision, will agree only upon rules that encode equality of opportunity and that bestow the greatest benefit on the least advantaged citizens. Regarding health policy decision-making, Rawls' model is best illustrated by Canadian philosopher Warren Bourgeois in his panel of "volunteers." These rational and self-interested volunteers receive an amnestic drug that renders them unaware of their health, social, and financial position, but they know that they are representative of diverse spheres of citizens whose well-being will be affected by their decision. After describing fair decision-making, Bourgeois considers the lack of a distributive justice imperative in Canada's Assisted Human Reproduction Act, in contrast to legislation in European nations and Australia, summarizes the economic and clinical considerations that must be provided to the decision-makers behind the "veil of ignorance" for fair decisions to occur, and considers altruism in relation to equality of access. He concludes by noting that among countries with legislation governing assisted reproduction Canada is alone in having legislation that is void of distributive justice in providing access to clinically appropriate infertility care.
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Isaacs JC. Infertility coverage is good business. Fertil Steril 2008; 89:1049-1052. [DOI: 10.1016/j.fertnstert.2008.01.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 01/25/2008] [Accepted: 01/25/2008] [Indexed: 11/28/2022]
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