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Potentially preventable excess mortality among higher-order multiples.

Hamisu M Salihu1, Muktar H Aliyu, Dwight J Rouse

  • 1Department of Maternal and Child Health, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA. hsalihu@uab.edu

Obstetrics and Gynecology
|October 11, 2003
PubMed
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Preventing higher-order multiple pregnancies from assisted reproductive technologies can significantly reduce excess infant mortality. Avoiding quadruplets over twins could prevent 70% of excess early deaths, highlighting the need for embryo transfer regulations.

Area of Science:

  • Reproductive Medicine
  • Perinatal Epidemiology
  • Public Health

Background:

  • Assisted reproductive technologies (ART) increase the risk of multiple gestations.
  • Higher-order multiple pregnancies (triplets, quadruplets, quintuplets) are associated with significantly increased perinatal and infant mortality.
  • Quantifying preventable mortality is crucial for informing ART guidelines.

Purpose of the Study:

  • To estimate the potential reduction in excess mortality by avoiding higher-order multiple gestations.
  • To assess the impact of ART on preventable infant deaths.

Main Methods:

  • Retrospective cohort study of US multiple pregnancies (1995-1997).
  • Analyzed data on twins, triplets, quadruplets, and quintuplets.
  • Used generalized estimating equations to calculate adjusted relative risks for early mortality and preventable excess mortality.

Related Experiment Videos

Main Results:

  • Early mortality increased with each additional fetus in a dose-dependent manner.
  • Relative risks for early mortality were 2.4 for triplets, 3.3 for quadruplets, and 10.3 for quintuplets compared to singletons (implied).
  • Avoiding quadruplet pregnancies instead of twin pregnancies could prevent 70% of excess mortality; avoiding quintuplets instead of triplets could prevent 75%.

Conclusions:

  • Findings support regulating the number of embryos transferred in ART.
  • Reducing higher-order multiple gestations can substantially decrease preventable infant mortality.
  • ART guidelines should consider the mortality risks associated with multiple pregnancies.