Abstract:Objectives To assess gestational length and prevalence of preterm birth among medically and naturally conceived twins; to establish the role of zygosity and chorionicity in assessing gestational length in twins born after subfertility treatment.
“…Mode of conception influences the risk of preterm birth (Verstraelen et al, 2005), but not weight given a gestational time (Gielen et al, 2007). Therefore we did not perform different curves for twins who were naturally conceived and twins who were born after subfertility treatment.…”
The assessment of fetal growth is an essential component of good antenatal care, especially for twins. The aims of this study are to develop twin-specific intrauterine 'growth' charts, based on cross-sectional birthweight data, for monochorionic and dichorionic twins according to sex and parity, and to detect twins at risk for neonatal death by comparing the use of twin-specific and singleton charts. The study sample consisted of 76,471 singletons and 8454 twins (4227 pairs) born in East Flanders (Belgium). Birthweights were analyzed using a nonlinear Gaussian regression. After 33 weeks of gestation, the birthweights of twins started to deviate from singletons (difference of 900 grams at 42 weeks). Birthweights of dichorionic twins continued to increase, whereas those of monochorionic twins decreased after week 40 (difference of more than 300 g at 42 weeks). After 31 weeks of gestation, neonatal mortality increased as centile decreased, and was especially high if birthweight was below the twin-specific third centile: .032 (below) versus .007 (above). Using singleton centiles, this was less obvious. In conclusion, twin-specific growth charts, taking chorionicity into account, are more accurate to detect twins at risk for neonatal death. Therefore the presented charts, based on cross-sectional birthweight data, enable an improved assessment of twin growth.
“…Mode of conception influences the risk of preterm birth (Verstraelen et al, 2005), but not weight given a gestational time (Gielen et al, 2007). Therefore we did not perform different curves for twins who were naturally conceived and twins who were born after subfertility treatment.…”
The assessment of fetal growth is an essential component of good antenatal care, especially for twins. The aims of this study are to develop twin-specific intrauterine 'growth' charts, based on cross-sectional birthweight data, for monochorionic and dichorionic twins according to sex and parity, and to detect twins at risk for neonatal death by comparing the use of twin-specific and singleton charts. The study sample consisted of 76,471 singletons and 8454 twins (4227 pairs) born in East Flanders (Belgium). Birthweights were analyzed using a nonlinear Gaussian regression. After 33 weeks of gestation, the birthweights of twins started to deviate from singletons (difference of 900 grams at 42 weeks). Birthweights of dichorionic twins continued to increase, whereas those of monochorionic twins decreased after week 40 (difference of more than 300 g at 42 weeks). After 31 weeks of gestation, neonatal mortality increased as centile decreased, and was especially high if birthweight was below the twin-specific third centile: .032 (below) versus .007 (above). Using singleton centiles, this was less obvious. In conclusion, twin-specific growth charts, taking chorionicity into account, are more accurate to detect twins at risk for neonatal death. Therefore the presented charts, based on cross-sectional birthweight data, enable an improved assessment of twin growth.
“…Another study by Morcel et al found that ART resulted in lower-risk pregnancies compared to pregnancies conceived by ovulation induction (OI) [24]. There have been studies showing that subfertility, and not ART itself, actually has a bigger influence on the adverse outcomes in patients undergoing ART [25]. The risk of significant neurodevelopmental or behavioral adverse outcomes at two-year [26] or fiveyear [27][28] follow-ups appears to be minimal.…”
This abstract was presented at the American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting, Orlando, FL, September 2014 with the abstract published (Neumann C, Thompson D, and Sidman J; Assisted reproduction is not associated with increased risk of head and neck defects; Otolaryngology-Head and Neck Surgery; Vol 151, Issue 1, supplement, 2014).
Objectives-Compare the rate of head and neck anomalies between children conceived via artificial reproductive technology (ART) versus those conceived via natural methods.-Determine the risk of congenital head and neck abnormalities associated with ART.
Study designA retrospective chart review cross-sectional study from 2004-2014 of all patients admitted to the neonatal intensive care unit (NICU) at a tertiary pediatric hospital.
ResultsA total of 14,857 charts were examined; 2,288 patients were conceived via ART, while 12,569 patients were conceived via natural methods. There were 8,022 males and 6,637 females. There were 40 patients born with defects via ART, while there were 681 patients born with defects via natural conception. The total occurrence of congenital malformations was higher for patients conceived naturally versus those conceived with artificial reproduction (5.41% vs. 1.74%). The odds ratio was 0.31 with a 95% CI of 0.23 to 0.43 and a P-value of < 0.0001; the relative risk of having any one of the head and neck defects with ART was 1.04 with a 95% CI of 1.03 to 1.05 and a P-value < 0.0001.
ConclusionThere appears to be no increased risk of congenital head and neck defects in children conceived via ART versus those conceived naturally.
“…Previous results have indicated that this could not be the case (Delbaere et al, 2007;Loos et al, 2001d;Verstraelen et al, 2005). Comparison of DC-MZ, MC-MZ, and DZ twins will allow to evaluate the degree of gene-environment interactions as the prenatal environment is concerned.…”
Section: Discussionmentioning
confidence: 99%
“…The observed risks associated with assisted reproduction are dampening down by predominantly dizygotic twinning following assisted reproduction and by differential maternal characteristics (Verstraelen et al, 2005).…”
The East Flanders Prospective Twin Survey (EFPTS) is a prospective, population-based registry of multiple births in the province of East-Flanders, Belgium. EFPTS has several unique features: it is population-based and prospective, with the possibility of long-term follow-up; the twins (and higher order multiple births) are recruited at birth; basic perinatal data recorded; chorion type and zygosity established; and since 1969 placental biopsies have been taken and frozen at −20• C for later determination of genetic markers. The EFPTS is the only large register that includes placental data and allows differentiation of three subtypes of monozygotic (MZ) twins based on the time of the initial zygotic division: the dichorionic-diamnionic pairs (early, with splitting before the fourth day after fertilization), the monochorionic-diamnionic pairs (intermediate, splitting between the fourth and the seventh day post-fertilization), and the monochorionicmonoamnionic pairs (late, splitting after the eighth day post-fertilization). Studies can be initiated taking into account primary biases, those originating 'in utero'. Such studies could throw new light on the controversy over the validity of the classic twin method, the consequences of early embryological events, and the gene-environment interactions as far as periconceptional and intrauterine environment are concerned.
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