In-vitro fertilization, twin pregnancy and HELLP syndrome: A population-based study

Area of Science:

• Reproductive Medicine
• Maternal-Fetal Medicine
• Obstetrics

Background:

• HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets) is a severe pregnancy complication.
• In vitro fertilization (IVF) is increasingly common, necessitating understanding its impact on pregnancy complications.

Purpose of the Study:

• To compare the incidence of HELLP syndrome in singleton and twin pregnancies conceived via IVF versus spontaneous conception.
• To identify if IVF influences HELLP syndrome risk differently based on the number of fetuses.

Main Methods:

• Retrospective cohort study using British Columbia Perinatal Database Registry (2008/09-2020/21).
• Inclusion of all singleton or twin live births and stillbirths.
• Logistic regression analysis adjusted for confounders to compare HELLP rates between IVF and non-IVF groups, stratified by plurality.

Main Results:

• The incidence of HELLP syndrome was higher in twin pregnancies compared to singleton pregnancies for both IVF and spontaneous conception groups.
• IVF was associated with an increased risk of HELLP syndrome in singleton pregnancies (AOR 1.64; 95% CI 1.32-2.04).
• No significant association between IVF and HELLP syndrome was found in twin pregnancies (AOR 0.75; 95% CI 0.55-1.02).

Conclusions:

• The mode of conception is linked to HELLP syndrome risk in singleton pregnancies, but not in twins.
• Twin pregnancies have a substantially higher risk of HELLP syndrome irrespective of conception method.
• Findings support tailored preconception counseling and prenatal care for women undergoing IVF, especially those with multiple gestations.