The Impact of Assisted Reproductive Techniques on the Risk of Multiple Pregnancies

Natalya Alexandrovna, Tyurina; Tatyana Vladimirovna, Fomicheva; Vladislav Petrovich, Laksaev; Irina Sergeevna, Naumova; Daria Valerievna, Goryachkina; Alina Sergeevna, Minashkina; Olga Ivanovna, Shukshina; Tatyana Andreevna, Kanunova

doi:10.30699/jogcr.8.4.382

Document Type : Original Research Article

Authors

National Research Mordovia university named after N.P. Ogarev, Republic of Mordovia, Saransk, Russia

https://doi.org/10.30699/jogcr.8.4.382

Abstract

Background & Objective: There is a well-established link between multiple pregnancies and assisted reproductive techniques (ARTs). Increased maternal and perinatal morbidity and mortality are directly related to multiple pregnancies. The purpose of the current study is to examine the effects of multiple pregnancies on women using various reproductive techniques.
Materials & Methods: This study used a comparative-analytical approach. We assessed a cohort of 130 pregnant women of which 120 had twins and 10 had triplets. In vitro fertilization and embryo transfer (IVF-ET) were performed on 62.0% of women, while 6.0% had ovulation induction. Using ultrasound examination, twin and triplet pregnancies were found in 92% and 8%, respectively.
Results: Our results show that 11% of women experience the physiological course of pregnancy with multiple pregnancies. Pregnancy concludes in the delivery of twins only in 50% of patients with multiple pregnancies diagnosed by ultrasound examination before 10 weeks. It was found that 46% of births in women carrying multiple pregnancies happened prematurely after studying more than 100 births. Of these, 6% occurred before 28 weeks, 20% between 29 and 34 weeks, and 20% between 35 and 37 weeks.
Conclusion: Preeclampsia and placental insufficiency are more likely to occur in multiple pregnancies than in single pregnancies. As a result, at the beginning of the second trimester, all preventative measures should be implemented. Although abdominal delivery is not the preferred option for multiple pregnancies, there is a need to increase the indications for surgical delivery for the benefit of the fetuses.

Highlights

✅ Preeclampsia and placental insufficiency are more likely to occur in multiple pregnancies than in single pregnancies. As a result, at the beginning of the second trimester, all preventative measures should be implemented. Although abdominal delivery is not the preferred option for multiple pregnancies, there is a need to increase the indications for surgical delivery for the benefit of the fetuses.

Keywords

Main Subjects

Obstetrics and Gynecology

References

1. Ebrahimi N, Adelian S, Shakerian S, Afshinpour M, Chaleshtori SR, Rostami N, et al. Crosstalk between ferroptosis and the epithelial-mesenchymal transition: Implications for inflammation and cancer therapy. Cytokine Growth Factor Rev. 2022;64:33-45. [DOI:10.1016/j.cytogfr.2022.01.006] [PMID]

2. Hiersch L, Barrett J, Fox NS, Rebarber A, Kingdom J, Melamed N. Should twin-specific growth charts be used to assess fetal growth in twin pregnancies? Am J Obstet Gynecol. 2022;227(1):10-28. [DOI:10.1016/j.ajog.2022.01.027] [PMID]

3. Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation. 2014;130(12):1003-8. [DOI:10.1161/CIRCULATIONAHA.114.009029] [PMID]

4. Wennerholm U-B, Bergh C. Perinatal outcome in children born after assisted reproductive technologies. Ups J Med Sci. 2020;125(2):158-66. [DOI:10.1080/03009734.2020.1726534] [PMID] [PMCID]

5. Berntsen S, Pinborg A. Large for gestational age and macrosomia in singletons born after frozen/thawed embryo transfer (FET) in assisted reproductive technology (ART). Birth Defects Res. 2018;110(8):630-43. [DOI:10.1002/bdr2.1219] [PMID]

6. Lei L-L, Lan Y-L, Wang S-Y, Feng W, Zhai Z-J. Perinatal complications and live-birth outcomes following assisted reproductive technology: a retrospective cohort study. Chin Med J. 2019;132(20):2408-16. [DOI:10.1097/CM9.0000000000000484] [PMID] [PMCID]

7. Wang AY, Safi N, Ali F, Lui K, Li Z, Umstad MP, et al. Neonatal outcomes among twins following assisted reproductive technology: an Australian population-based retrospective cohort study. BMC Pregnancy Childbirth. 2018;18(1):1-7. [DOI:10.1186/s12884-018-1949-0] [PMID] [PMCID]

8. Nishio S, Takeno T, Fukuda T, Shikama A, Nakai H, Nakamura H, et al. Outcomes of Pregnancies and Deliveries of Patients Who Underwent Fertility-Preserving Surgery for Early-Stage Epithelial Ovarian Cancer. J Clin Med. 2022;11(18):5346. [DOI:10.3390/jcm11185346] [PMID] [PMCID]

9. De Geyter C. Assisted reproductive technology: Impact on society and need for surveillance. Best Pract Res Clin Endocrinol Metab. 2019;33(1):3-8. [DOI:10.1016/j.beem.2019.01.004] [PMID]

10. Kouhkan A, Khamseh ME, Pirjani R, Moini A, Arabipoor A, Maroufizadeh S, et al. Obstetric and perinatal outcomes of singleton pregnancies conceived via assisted reproductive technology complicated by gestational diabetes mellitus: a prospective cohort study. BMC Pregnancy Childbirth. 2018;18(1):1-11. [DOI:10.1186/s12884-018-2115-4] [PMID] [PMCID]

11. da Silva SG, da Silveira MF, Bertoldi AD, Domingues MR, dos Santos IdS. Maternal and child-health outcomes in pregnancies following Assisted Reproductive Technology (ART): a prospective cohort study. BMC Pregnancy Childbirth. 2020;20(1):106. [DOI:10.1186/s12884-020-2755-z] [PMID] [PMCID]

12. Nagata C, Yang L, Yamamoto-Hanada K, Mezawa H, Ayabe T, Ishizuka K, et al. Complications and adverse outcomes in pregnancy and childbirth among women who conceived by assisted reproductive technologies: a nationwide birth cohort study of Japan environment and children's study. BMC Pregnancy Childbirth. 2019;19(1):77. [DOI:10.1186/s12884-019-2213-y] [PMID] [PMCID]

13. Ko HS, Wie JH, Choi SK, Park IY, Park Y-G, Shin JC. Multiple birth rates of Korea and fetal/neonatal/infant mortality in multiple gestation. PloS One. 2018;13(8):e0202318. [DOI:10.1371/journal.pone.0202318] [PMID] [PMCID]

14. Esteves-Pereira A, da Cunha AJLA, Nakamura-Pereira M, Moreira M, Domingues R, Soares m, et al. Twin pregnancy and perinatal outcomes: Data from 'Birth in Brazil Study. PLOS One. 2021;16(1):e0245152. [DOI:10.1371/journal.pone.0245152] [PMID] [PMCID]

15. Leonard LG, Denton J. Preparation for parenting multiple birth children. Early Hum Dev. 2006;82(6):371-8. [DOI:10.1016/j.earlhumdev.2006.03.009] [PMID]

16. Kennedy H, Haynes SL, Shelton CL. Maternal body weight and estimated circulating blood volume: a review and practical nonlinear approach. Br J Anaesth. 2022;129(5):716-25. [DOI:10.1016/j.bja.2022.08.011] [PMID]

17. Norwitz ER, Edusa V, Park JS. Maternal Physiology and Complications of Multiple Pregnancy. Semin Perinatol. 2005;29(5):338-48. [DOI:10.1053/j.semperi.2005.08.002] [PMID]

18. Gavrilov SG. Vulvar varicosities: diagnosis, treatment, and prevention. Int J Women's Health. 2017;9:463-75. [DOI:10.2147/IJWH.S126165] [PMID] [PMCID]

19. Bonney E, Rathod M, Cohen K, Ferriman E. Twin pregnancy. Obstet Gynaecol Reprod Med. 2013;23(6):165-70. [DOI:10.1016/j.ogrm.2013.03.008]

20. Lewi L, Deprest J, Hecher K. The vascular anastomoses in monochorionic twin pregnancies and their clinical consequences. Am J Obstet Gynecol. 2013;208(1):19-30. [DOI:10.1016/j.ajog.2012.09.025] [PMID]

21. Ma A, Go A, O A AA, Ma A, Go A, et al. Triplet with Dicephalus Twins: A Case Report. Sci J Gene Ther. 2017;3 (1):001-3. [DOI:10.17352/sjggt.000012]

22. Sago H, Ishii K, Sugibayashi R, Ozawa K, Sumie M, Wada S. Fetoscopic laser photocoagulation for twin-twin transfusion syndrome. J Obstet Gynaecol Res. 2018;44(5):831-9. [DOI:10.1111/jog.13600] [PMID] [PMCID]

23. Tanaka K, Suesada N, Homma T, Mori H, Okazaki M. Reliability of temporal vascular anastomosis and techniques for better outcomes. J Reconstr Microsurg. 2021;38(01):041-6. [DOI:10.1055/s-0041-1729883] [PMID]

24. Soppi ET. Iron deficiency without anemia - a clinical challenge. Clin Case Rep. 2018;6(6):1082-6. [DOI:10.1002/ccr3.1529] [PMID] [PMCID]

25. Daru J, Allotey J, Peña-Rosas JP, Khan KS. Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review. Transfus Med. 2017;27(3):167-74. [DOI:10.1111/tme.12408] [PMID] [PMCID]

26. Anand T, Rahi M, Sharma P, Ingle GK. Issues in prevention of iron deficiency anemia in India. Nutrition. 2014;30(7):764-70. [DOI:10.1016/j.nut.2013.11.022] [PMID]

27. Kamel RA, Negm SM, Youssef A, Bianchini L, Brunelli E, Pilu G, et al. Predicting cesarean delivery for failure to progress as an outcome of labor induction in term singleton pregnancy. Am J Obstet Gynecol. 2021;224(6):609.e1-.e11. [DOI:10.1016/j.ajog.2020.12.1212] [PMID]

28. Taghibeikzadehbadr P, Shirian S, Sabouri M. Effect of different muscle contraction mode on the expression of Myostatin, IGF-1, and PGC-1 alpha family members in human Vastus Lateralis muscle. Mol Biol Rep. 2020;47(12):9251-8. [DOI:10.1007/s11033-020-06017-x] [PMID]

29. Grobman WA, Bailit JL, Rice MM, Wapner RJ, Reddy UM, Varner MW, et al. Frequency of and factors associated with severe maternal morbidity. Obstet Gynecol. 2014;123(4):804-10. [DOI:10.1097/AOG.0000000000000173] [PMID] [PMCID]

30. Attah RA, Mohammed Z, Gobir M. A review of twin deliveries in Aminu Kano teaching hospital, North-West Nigeria. Niger j basic clin sci. 2014;11(1):3. [DOI:10.4103/0331-8540.130148]

31. Herskind AM, Larsen LA, Pedersen DA, Christensen K. Comparison of Late Mortality Among Twins Versus Singletons With Congenital Heart Defects. Am J Cardiol. 2017;119(10):1680-6. [DOI:10.1016/j.amjcard.2017.02.006] [PMID]

32. Daemi A, Ravaghi H, Jafari M. Risk factors of neonatal mortality in Iran: a systematic review. Med J Islam Repub Iran. 2019;33:87. [DOI:10.47176/mjiri.33.87] [PMID] [PMCID]

33. Partridge JC, Robertson KR, Rogers EE, Landman GO, Allen AJ, Caughey AB. Resuscitation of neonates at 23 weeks' gestational age: a cost-effectiveness analysis. J Matern -Fetal Neonatal Med. 2015;28(2):121-30. [DOI:10.3109/14767058.2014.909803] [PMID]

34. James-Todd TM, Karumanchi SA, Hibert EL, Mason SM, Vadnais MA, Hu FB, et al. Gestational age, infant birth weight, and subsequent risk of type 2 diabetes in mothers: Nurses' Health Study II. Prev Chronic Dis. 2013;10:E156. [DOI:10.5888/pcd10.120336] [PMID] [PMCID]

35. Shirazi M, Zarkesh M, Fakehi M, Ghaemi M. Elective Cesarean Section Beyond 39 Weeks of Gestation Decreases Prenatal Morbidities and Improve Psychomotor Development One Year After Birth. J Obstet Gynaecol Res. 2022;7(4):329-34. [DOI:10.30699/jogcr.7.4.329]

36. Beru Brahmana I, Inayati I. Vaginal Discharge in Pregnancy: The Relationship of Uterine Contractions in the Case of Preterm Birth. J Obstet Gynecol Cancer Res. 2022;7(5):422-8. [DOI:10.30699/jogcr.7.5.422]

37. Borna S, Radi V, Saleh M, Ataee M, Feizmahdavi H, Salari Z, et al. Evaluation of The Relationship Between Fetal Lung to Head Ratio and Amniotic Fluid Index in The Third Trimester of Pregnancy. J Obstet Gynecol Cancer Res. 2022;7(3):144-50. [DOI:10.30699/jogcr.7.3.144]

Journal of Obstetrics, Gynecology and Cancer Research

The Impact of Assisted Reproductive Techniques on the Risk of Multiple Pregnancies

References

References

Volume 8, Issue 4 - Serial Number 33
July and August 2023
Pages 382-388

The Impact of Assisted Reproductive Techniques on the Risk of Multiple Pregnancies

References

References

Volume 8, Issue 4 - Serial Number 33July and August 2023Pages 382-388

Volume 8, Issue 4 - Serial Number 33
July and August 2023
Pages 382-388