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Multifetal pregnancy reduction: a possible risk factor for periventricular leukomalacia in premature newborns
E Geva1, L Lerner-Geva, Z Stavorovsky
1Tel Aviv Sourasky Medical Center, Israel.
Objective:
To investigate the possible role of multifetal pregnancy reduction as a risk factor for the development of periventricular leukomalacia, which has been associated with prematurity and twin pregnancies.
Design:
A case-control study.
Setting:
In Vitro Fertilization Unit and Intensive Care Nursery of the Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Patient(S):
A total of 1,401 consecutive preterm infants who were born between January 1, 1994, and December 31, 1995.
Intervention(S):
Cranial ultrasonographic evaluation of each infant within 3 days of birth.
Main Outcome Measure(S):
Premature infants who developed periventricular leukomalacia (cases) were compared with premature infants who did not develop this disorder (controls) when multifetal pregnancy reduction was considered.
Result(S):
Fourteen premature infants developed periventricular leukomalacia. Of these, 28.6% (4 infants) were exposed to multifetal pregnancy reduction, compared with 1.9% of the controls, giving an odds ratio (OR) of 20.9 (95% confidence interval [CI] 5.5-79.4). Adjustment of this OR for IVF treatment (OR, 18.6; 95% CI, 1.8-140.3), twinning (OR, 6.3; 95% CI, 1.3-30.3), and for both IVF treatment and twinning simultaneously (OR, 8.5; 95% CI, 1.7-42.2) did not explain all the observed associations between periventricular leukomalacia and multifetal pregnancy reduction.
Conclusion(S):
Our data suggest that multifetal pregnancy reduction may be an additional risk factor for periventricular leukomalacia among premature infants, regardless of twinning.