A comparison of perinatal outcomes in singletons and multiples born after in vitro fertilization or intracytoplasmic sperm injection stratified for neonatal risk criteria. (March 2014)

• Record Type: Journal Article
• Authors: van, Mirjam M.J.; Evers, Johannes L.H.; Dumoulin, John C.M.; van der, Mark A.H.B.M.; van, Catharina E.M.; Bonsel, Gouke J.; Dykgraaf, Ramon H.M.; van, Johannes B.; Koopman‐Esseboom, Corine; Nelen, Willianne L.D.M.; Steiner, Katerina; Tamminga, Pieter; Tonch, Nino; van, Piet; Dirksen, Carmen D.
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 93:Number 3(2014)
• Page Start: 277
• Page End: 286
• Publication Date: 2014-03
• Subjects: Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.12328
• Languages: English
• ISSNs: 0001-6349

Abstract

<abstract abstract-type="main" id="aogs12328-abs-0001"> <title>Abstract</title> <sec id="aogs12328-sec-0001" sec-type="section"> <title>Objective</title> <p>To compare perinatal singleton and multiple outcomes in a large Dutch in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) population and within risk subgroups. Newborns were assigned to a risk category based on gestational age, birthweight, Apgar score and congenital malformation.</p> </sec> <sec id="aogs12328-sec-0002" sec-type="section"> <title>Design</title> <p>Register‐based retrospective cohort study.</p> </sec> <sec id="aogs12328-sec-0003" sec-type="section"> <title>Setting</title> <p>Netherlands Perinatal Registry data.</p> </sec> <sec id="aogs12328-sec-0004" sec-type="section"> <title>Sample</title> <p>A total of 3041 singletons and 1788 multiple children born from IVF/ICSI in 2003–2005.</p> </sec> <sec id="aogs12328-sec-0005" sec-type="section"> <title>Methods</title> <p>Student's <italic>t</italic>‐test or Mann–Whitney <italic>U</italic>‐test was used to analyze continuous data, chi‐squared analyses were used for categorical data. Multivariate logistic and linear regression analysis was performed to analyze whether the risk stratification criteria were associated with neonatal hospital admission and length of stay.</p> </sec> <sec id="aogs12328-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Start of labor, mode of delivery, gestational age, birthweight, 5‐min Apgar score, congenital malformation, neonatal hospital admission, neonatal intensive care unit admission and mortality.</p> </sec> <sec id="aogs12328-sec-0007" sec-type="section"> <title>Results</title> <p>IVF/ICSI‐conceived multiples had considerably poorer outcomes than singletons in terms of cesarean section rate, preterm birth, birthweight, being small‐for‐gestational‐age, Apgar score, neonatal hospital admission, neonatal intensive care unit admission and neonatal mortality. As opposed to the results found in the total study population and the low‐risk and moderate‐risk populations, high‐risk multiples showed better outcomes than high‐risk singletons regarding cesarean section rate, birthweight and Apgar score. All risk stratification variables were associated with being hospitalized after birth. Length of stay was associated with all risk stratification criteria except Apgar score.</p> </sec> <sec id="aogs12328-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Perinatal outcomes in IVF/ICSI‐conceived multiples are considerably poorer than in singletons. This finding mainly pertains to low‐risk children. High‐risk multiples had significantly better perinatal outcomes than high‐risk singletons.</p> </sec> </abstract>