The effect of early fetal losses on twin assisted-conception pregnancy outcomes
Barbara Luke1, Morton B Brown, David A Grainger
1Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan 48824, USA. lukeb@msu.edu
Objective:
To evaluate the effect of first trimester fetal losses on twin births from assisted reproductive technology (ART).
Design:
Historical cohort study.
Setting:
Clinic-based data.
Patient(S):
The study population included 9,036 twin pregnancies of >or=22 weeks' gestation in the 2005 Society for Assisted Reproductive Technology Clinic Outcomes Reporting System database, categorized by the presence of three versus two fetal heartbeats on early ultrasound.
Intervention(S):
None.
Main Outcome Measure(S):
Length of gestation and birthweight. Adjusted odds ratios (AORs) were calculated with the group with two fetal heartbeats on early ultrasound as the reference.
Result(S):
Increased odds with three fetal heartbeats included <32 weeks, 32-36 weeks, and <37 weeks (AORs 1.47, 1.28, and 1.35, respectively) and very low birthweight (<1,500 g), moderately low birthweight (1,500-2,499 g), and low birthweight (<2,500 g) (AORs 1.69, 1.38, and 1.47, respectively). Significantly decreased odds included term birth (>or=37 weeks) and nonlow birthweight (>or=2,500 g) (AORs 0.74 and 0.68).
Conclusion(S):
Early fetal loss in assisted-conception pregnancies that result in a twin live birth is associated with significantly increased risks for lowered birthweight and shortened gestation. Because first-trimester multiple fetal heartbeats are more common in ART pregnancies, this factor may help explain the greater risk for reduced birthweight and shorter gestations observed in this population.
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