Degree and rate of growth discordance in dichorionic twins conceived by in vitro fertilization.

Amira S Egic,Zagorka M Milovanovic,Aleksandar B Jurisic,Donka V Mojovic,Ljubomir P Srbinovic,Suzana P Krsmanovic,Natasa T Karadzov-Orlic

doi:10.1155/2014/543728

Amira S Egic, Zagorka M Milovanovic + Show 5 more

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https://doi.org/10.1155/2014/543728

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Abstract

Objective. Our objective was to estimate degree and rate of discordant growth and its impact on perinatal outcome in dichorionic twin pregnancies conceived by in vitro fertilization (IVF) compared to those conceived spontaneously. Study Design. Growth discordance was defined as 90th percentiles for the study population. Adverse perinatal outcome was defined as 5-minute Apgar score <7 and/or admission to neonatal intensive care unit. Results. In the total study population of dichorionic twins (176 conceived by IVF and 215 spontaneously), 30% discordant growth represented the 90th percentile. After adjusting for gestational age, discordant twins conceived by IVF or spontaneously were at higher risk for adverse perinatal outcome (hazard ratio 4.4; 95% CI 2.4–8.3, P < 0.0001; hazard ratio 2.5; 95% CI 1.5–4.4, P = 0.001, resp.). Similar rates of 5-minute Apgar score <7, admission to neonatal intensive care unit, and delivery <34 weeks were found between discordant twins conceived by IVF and those conceived spontaneously. Conclusion. Dichorionic twins conceived by IVF are at similar risk for the rate and degree of discordant growth and adverse perinatal outcome compared to dichorionic twins conceived spontaneously.

Highlights

Twin gestations are at higher risk for fetal growth restriction and stillbirth compared to singleton gestations [1]
After adjusting for gestational age, discordant twins conceived by in vitro fertilization (IVF) or spontaneously were at higher risk for adverse perinatal outcome
Dichorionic twins conceived by IVF are at similar risk for the rate and degree of discordant growth and adverse perinatal outcome compared to dichorionic twins conceived spontaneously

Summary

Introduction

Twin gestations are at higher risk for fetal growth restriction and stillbirth compared to singleton gestations [1]. Twins conceived by IVF or conceived spontaneously often do not grow at the same rate, and the reported incidence of discordant growth in both pregnancies varies from 10 to 30% [2, 3]. This difference is largely attributed to the use of different definitions of discordance in attempt to increase detection rate of discordant twins who are at higher risk for adverse perinatal outcome (15–30%). The higher risk for defective trophoblast invasion or impaired uteroplacental development has not been reported in pregnancies conceived by IVF, there are greater maternal age, nulliparity, and pregnancy-induced hypertension which may lead to greater degree of discordant growth [3]. Of gestational age at delivery, twins with significant birth weight discordance have poorer perinatal outcomes [6, 7]

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