Evolution of gender options in multiple pregnancy management

Area of Science:

• Maternal-Fetal Medicine
• Reproductive Health
• Clinical Genetics

Background:

• Fetal reduction (FR) in multiple gestations significantly improves pregnancy outcomes.
• Historically, FR decisions prioritized fetal health, excluding gender considerations.
• Evolving societal views prompted a re-evaluation of incorporating gender preference into FR decisions.

Purpose of the Study:

• To analyze the impact of gender preference on fetal reduction decisions.
• To assess changes in patient preferences regarding fetal sex during reduction procedures.
• To evaluate the role of chorionic villus sampling in enhancing patient autonomy during FR.

Main Methods:

• Retrospective analysis of 396 patients undergoing FR (triplets or twins).
• Patients categorized by reduction type (3➔2, 3➔1, 2➔1), anomaly status (Major/minor), and same gender (SG) or gender preference (GP) possibility.
• Exclusion of higher-order multiples and non-chorionic villus sampling cases; prioritization of medical indications over GP.

Main Results:

• Of 319 analyzed cases, 214 (67%) involved medical indications or same-gender fetuses.
• In 3➔2 reductions with GP, 71/79 patients chose male/female or had no preference; 7 chose female/female.
• For 2➔1 reductions, 20/44 male/female twins were chosen, with 24 preferring female.

Conclusions:

• A cultural shift indicates a preference for one male and one female fetus or no preference.
• When reducing to a single fetus, over 50% of patients now express a preference for a girl.
• Integrating chorionic villus sampling before FR enhances patient autonomy by allowing for informed gender selection.