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Twins and neurodevelopmental outcomes: the effect of IVF, fetal growth restriction, and preterm birth
Despina D Briana1, Ariadne Malamitsi-Puchner1
1a National and Kapodistrian University of Athens, Medical School , Athens , Greece.
Insights
Neurodevelopmental outcomes in twins conceived via in vitro fertilization (IVF) are influenced by fetal growth restriction and prematurity. Evidence on IVF
Area of Science:
- Perinatology and Developmental Neuroscience
- Reproductive Medicine and Genetics
Background:
- Twins conceived via in vitro fertilization (IVF) face unique neurodevelopmental risks.
- Factors like fetal/intrauterine growth restriction (FGR/IUGR) and prematurity significantly impact outcomes.
- Existing literature on IVF twins' neurodevelopment is often heterogeneous and retrospective.
Purpose of the Study:
- To review evidence on neurodevelopmental outcomes in IVF-conceived twins.
- To examine specific outcomes such as cerebral palsy (CP), cognitive impairment, and sensory deficits.
- To assess the influence of FGR/IUGR, prematurity, and zygosity on these outcomes.
Main Methods:
- Systematic review of existing literature on neurodevelopmental outcomes in twins.
- Analysis of factors including FGR/IUGR, prematurity, and zygosity.
- Comparison of outcomes between twins and singletons, and between naturally conceived and IVF-conceived twins where data allows.
Main Results:
- FGR/IUGR, prematurity, and zygosity are associated with altered neurodevelopmental outcomes in twins.
- Cerebral palsy (CP) rates are higher in term infants with FGR/IUGR and survivors of intrauterine co-twin death.
- Cognitive abilities in twins versus singletons are largely explained by confounding factors like FGR/IUGR and prematurity; IVF's direct impact remains undocumented.
Conclusions:
- Neurodevelopmental outcomes in IVF twins are primarily linked to obstetric factors, not IVF itself.
- Further research is needed to confirm the lack of IVF impact and compare long-term outcomes with naturally conceived twins.
- Longitudinal studies and population-based registries are crucial for precise outcome descriptions.
Abstract:
This invited review aimed at presenting the evidence concerning neurodevelopmental outcomes, particularly cerebral palsy (CP), motor disability, cognitive impairment, mental retardation, any major disability, blindness and deafness in cases of twins, conceived after in vitro fertilization, presenting fetal/intrauterine growth restriction (FGR/IUGR) or being prematurely born. FGR/IUGR, prematurity and zygosity affect neurodevelopmental outcome; CP is higher in term infants, those presenting with FGR/IUGR, as well as in survivors of intrauterine co-twin death; cognitive ability of twins versus singletons mainly relates to confounding factors, as FGR/IUGR and prematurity, while evidence for differences in behavioral and psychiatric disorders between twins and singletons is limited. The impact of IVF per se has not been documented. Nevertheless, available literature, usually of heterogeneous and retrospective nature, diverges in the criteria for neurodevelopmental delay. Furthermore, differences in selection/exclusion criteria and small mixed cohorts, including the full range of complications, make comparison of the existing studies difficult. Future studies should focus in confirming the lack of IVF impact on twins' neurodevelopment and general health, in comparing long-term outcome of naturally conceived twins with those conceived following assisted reproduction techniques and in including evaluation of individual, longitudinal trajectories of growth, and development. In this respect, worldwide population-based registries will enable more precise description of neurodevelopmental outcomes among twins.
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