The Multiple Births of Kazakh Cinema

Continuous quality improvement and assisted reproductive technology multiple gestations: some progress, some answers, more questions

Hemoglobin concentration in multiple versus singleton pregnancies — retrospective evidence for physiology not pathology

BackgroundIt remained controversial whether women with multiple gestation are at higher risk of placenta accreta spectrum (PAS) disorders and large-scale studies are needed. This study aimed to assess whether PAS incidence is higher among women with multiple gestation than among singleton, as well as to compare the characteristics and outcomes of PAS in multiple and singleton gestation.MethodsWomen who underwent cesarean section with live births at Peking University First Hospital from January 2015 to December 2020 were included. Demographic and clinical information was collected through chart review. Logistic regression models were used to analyze the associations between multiple gestation and PAS. The clinical characteristics and perioperative outcomes of PAS in multiple and singleton gestation were further compared.ResultsAmong the 14583 women included, 2.4% (352/14583) were diagnosed with PAS. PAS was slightly more prevalent among multiple gestations than among singletons (2.5% vs 2.4%, P=0.857). After adjusting for known risk factors and pregnancy complications, multiple gestation was associated with a higher risk of PAS (aOR=1.63, 95% CI 1.01-2.62). Among PAS patients, women who had multiple births had a significantly lower rate of previous cesarean deliveries (27.6% vs. 56.3%, P=0.003), placenta previa (17.2% vs. 56.3%, P<0.001) and invasive PAS (24.1% vs. 53.9, P=0.002) than singletons. There were no significant differences in perioperative outcomes between these two groups.ConclusionMultiple gestation could be independently associated with an elevated risk of PAS. The clinical characteristics of PAS in the multiple and singleton gestation groups differed significantly in cesarean delivery history and placenta previa. The results of this study may inform guidelines on the screening, early detection and timely intervention of PAS patients among women with multiple births.

Women's mental health can be compromised during reproductive life, but to date there has been relatively little specific investigation of the links between multiple births and perinatal psychiatric illness. There has been more comprehensive examination of some of the psychological sequelae of multiple gestations and births, but many of the studies have small samples and are descriptive in nature. Most of the literature is drawn from investigations of the psychological aspects of multiple births following assisted conception. Current conceptualizations of the determinants of maternal perinatal mental health, with particular reference to multiple gestations and births are discussed and implications for clinical practice suggested. Overall there is evidence that women with multiple gestation and multiple births may be at elevated risk for pregnancy anxiety, postpartum depression and complicated grief reactions. Much less is currently known about the associations between multiple birth and either maternity blues or postpartum psychosis. The relationships between personal or family psychiatric history, past experience of childhood abuse, intimate partner intimidation and psychological adjustment to multiple births are not known. The interactions between multiple births, operative delivery, prematurity, neonatal illness and separation of mother and infant as contributing factors to maternal postpartum mental health are not known. There is very limited evidence about the psychological functioning of fathers of multiple infants. Routine antenatal, intrapartum and postnatal health care for women with multiple infants needs to take into account the additional psychological demands they face.

To describe the trend of multiple pregnancies and to compare the results with single pregnancy in Beijing from 1996 to 2010. Prevalence rates of pregnancy complications were compared between multiple and single pregnancies. In 1996, 1997, 1998, 1999, 2000, 2005, 2010, live births in two hospitals in Beijing were included to describe the trend of multiple and single pregnancy. Case-retrospective analyses were used. Information was collected, including maternal age, fetus number, delivery mode, with/without pregnancy induced diseases as hypertension, diabetes or anemia, gender of the baby, birth-weight and gestation etc. Linear regression analyses were applied to assess the trend of birth-weight and the rates of prevalence. 63 661 babies and 62 895 puerperal were involved in this study. From 1996 to 2010, prevalence of multiple pregnancies increased by 0.02%, prevalence of cesarean delivery among multiple pregnancy women increased by 2.25% and the proportion of women older than 30 years increased by 3.52% and 2.89% among multiple or single pregnancy women, annually. However, the birth-weight did not show obvious change in both multiple and single birth babies. No obvious change was observed in the prevalence of low birth weight. Prevalence rates of premature birth increased by 1.62% and 0.16% among multiple and single pregnancy women, annually. From 1996 to 2010, the mean values of birth-weight among single birth babies were larger than 3 250 grams and under 2 500 gram among multiple birth babies. Rates of prevalence on pregnancy induced hypertension and anemia were higher in multiple pregnancy women than in single pregnancy women. Differences of rates on prevalence rates of pregnancy diabetes between multiple and single pregnancy women were not statistically significant. Prevalence of multiple pregnancies increased from 1995 to 2010 in Beijing. Mothers of multiples were more likely to get pregnancy complication than the single pregnancy women.

While various policies to support couples experiencing infertility have been introduced due to the fertility rate rapidly dropping in developed countries, few large-scale nationwide cohort studies have evaluated the outcomes of assisted reproductive technology (ART) health insurance coverage policies. To evaluate ART health insurance coverage for multiple pregnancies and births in Korea. This population-based cohort study used delivery cohort data from the Korean National Health Insurance Service database between July 1, 2015, and December 31, 2019. A total of 1 474 484 women were included after exclusion of those who gave birth at nonmedical institutions and those with missing data. Two 27-month periods were examined before and after the Korean National Health Insurance Service had begun covering ART treatment (preintervention period, July 1, 2015, to September 30, 2017; postintervention period, October 1, 2017, to December 31, 2019). Multiple pregnancies and multiple births were identified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes. Total births were defined as the total number of babies born to each pregnant woman during the follow-up period. An interrupted time series with segmented regression was conducted to analyze the time trend and its change in outcomes. Data analysis was conducted between December 2, 2022, and February 15, 2023. Of the 1 474 484 women eligible for the analysis (mean [SD] age, 33.2 [4.6] years), approximately 1.60% had multiple pregnancies and 1.10% had multiple births. After covering ART treatment, the likelihood of multiple pregnancies and multiple births was estimated to increase by 0.7% (estimate, 1.007; 95% CI, 1.004-1.011; P < .001) and 1.2% (estimate, 1.012; 95% CI, 1.007-1.016; P < .001) compared with before coverage. The probability of an increase in the number of total births per pregnant woman after the intervention was estimated to be 0.5% (estimate, 1.005; 95% CI, 1.005-1.005; P < .001). The relatively high-income class above the median income showed a decreasing trend in multiple births and total births before the intervention, but after the intervention, a significant increase was observed. This population-based cohort study found that the possibility of multiple pregnancies and births in Korea significantly increased after the implementation of an ART health insurance coverage policy. These findings suggest that the development and coverage of policies to support couples experiencing infertility may help address low fertility rates.

In recent years there has been an increase in the frequency of multiple pregnancies and the associated perinatal losses. It is a result of multiple pregnancy in ART refers to a high-risk gestation, at which premature births occur in 2 times more often than in singleton pregnancies. The objective: to determine the role of pro-inflammatory cytokines in the pathogenesis of premature labor in multiple pregnancy, as a result of assisted reproductive technology. Patients and methods. to determine the pro-inflammatory cytokines that all pregnant with bagtopliddyam held immunosorbent assay, defined concentrations of interleukin (IL) in serum and cervical mucus. Results. The analysis of the levels of pro-inflammatory cytokines (IL-1, IL-8) in the test environment, found high concentrations in the surveyed women with multiple pregnancy, due to the use of ART, compared with spontaneous multiple and singleton pregnancy. Increased concentration of proinflammatory cytokines in patients with multiple pregnancy by ART is associated with their synthesis at the system level, it stimulated foci of inflammation in the female genitals and extragenital localization. This correlates with the clinical data and statistical analysis, patients with multiple pregnancy as a result of ART had weighed infectious-inflammatory history. Conclusion. The study showed that elevated levels of proinflammatory cytokines in the systemic and local level in patients with multiple pregnancy due to ART, typical for women with miscarriage, because of the physiological course of pregnancy characterized by the predominance of anti-inflammatory cytokines that prevent rejection of the fetus as a foreign factor. Based on the data obtained proved the role of systemic inflammatory factors in the genesis of preterm labor in women with a multiple pregnancy, as a result of assisted reproductive technology. Key words: multiple pregnancy, assisted reproductive technology, premature birth, interleukine-1, interleukine-8.

Monozygotic triplet pregnancy following egg donation and transfer of single frozen-thawed embryo

Ovarian stimulation and intrauterine insemination at the quarter centennial: implications for the multiple births epidemic

Aim. To study complications and perinatal outcomes of multiple pregnancy in women of the Altai Region.Materials and Methods. We recruited 678 consecutive pregnant women, including 378 with multiple pregnancy, with the subsequent analysis of clinical and ultrasound examination data as well as perinatal outcomes.Results. Women with multiple pregnancy were characterised by a significantly higher rate of gynecological and somatic diseases including pregnancy-related anemia (20.2% versus 4.3% in women with multiple and singleton pregnancy, respectively, OR = 6.0, 95% CI = 3.2-11.3). Further, multiple pregnancy was a significant risk factor for preterm birth (62.26% and 21.82%, respectively, OR = 5.9, 95% CI = 4.2-8.4, p ≤ 0.001). Application of cervical pessary was able to prolong the multiple pregnancy for 4 weeks.Conclusion. Prevention of threatening preterm birth in women with a multiple pregnancy using a cervical pessary improves perinatal outcomes.

A personalized medicine approach to ovulation induction/ovarian stimulation: development of a predictive model and online calculator from level-I evidence

Embryo transfer practices and multiple births resulting from assisted reproductive technology: an opportunity for prevention

During the past 20 years, the prevalence of Down syndrome (DS) has increased with the increase in mean maternal age. The prevalence of multiple births has also increased because of older maternal age and use of assisted reproductive technologies. This study was designed to determine the maternal age–specific prevalence of DS in monozygotic and dizygotic pregnancies, assess risk relative to singleton pregnancies, as well as compare prenatal diagnosis and pregnancy outcomes for DS fetuses in multiple and singleton pregnancies. The database of the European Surveillance of Congenital Anomalies includes live-born congenital anomaly cases, stillborn cases and fetal deaths after 20 weeks’ gestation, as well as prenatally diagnosed cases resulting in termination of pregnancy for fetal anomaly. The study population consisted of 14,827,105 pregnancies between 1990 and 2009, of which 2.89% were multiple gestations. Individual fetuses/babies with DS from multiple and singleton pregnancies were considered “cases.” Twin pairs with both twins having DS were “concordant” pairs. Relative risk (RR) with the 95% confidence interval (CI) was used to estimate the prevalence of cases with DS among multiple births relative to that among singleton births. From 1990 to 1999, the total corrected prevalence of DS cases from multiple pregnancies as opposed to singleton pregnancies per 10,000 births was 0.40 (95% CI, 0.36–0.45), rising to 0.47 (95% CI, 0.42–0.53) in 2000 to 2009 (P > 0.05). Overall (1990–2009), the prevalence of DS cases per 10,000 multiple births was 15.1 (95% CI, 14.6–15.9); and per 10,000 singleton births, 20.1 (95% CI, 19.9–20.3). The prevalence of DS cases per 10,000 multiple births rose with age of 44 years or younger, after which it was considerably lower. The adjusted RR of DS for babies from multiple births relative to singleton births was 0.58 (95% CI, 0.53–0.62). Of 19,397 babies born to mothers older than 44 years, 2043 (10.5%) were from multiple births. Only 1 fetus from a multiple pregnancy was a DS case, a prevalence of 4.48 (95% CI, 0.67–35.1) per 10,000 multiple births, compared with 562 singleton DS cases, a prevalence of 327 (95% CI, 301–356) per 10,000 singleton births (RR, 0.015; 95% CI, 0.002–0.107). In 8.7% (n = 54) of affected pairs, the twins were concordant for DS, 51 same-sex twin pairs and 3 unlike-sex twin pairs. The maternal age–adjusted RR of a monozygotic pregnancy being affected was 0.34 (95% CI, 0.25–0.44) compared with singleton pregnancies. No affected monozygotic twin pregnancies occurred in the group older than 44 years. For dizygotic pregnancies, the maternal age–adjusted RR of at least 1 twin being affected was 1.34 (95% CI, 1.23–1.46) compared with singleton pregnancies. For age older than 44 years, the RR was 0.04 (95% CI, 0.01–0.27). The proportion of DS cases prenatally diagnosed was lower for multiple than for singleton pregnancies at all maternal ages, for an overall maternal age–adjusted odds ratio (OR) of 0.62 (95% CI, 0.50–0.78). The overall proportion of termination of pregnancy for fetal anomaly cases from multiple pregnancies was lower than singletons at every maternal age, giving an overall maternal age–adjusted OR of 0.52 (95% CI, 0.41–0.65). Down syndrome cases from multiple births were not more likely to be stillbirths/fetal deaths than from singleton births; the maternal age–adjusted OR was 1.03 (95% CI, 0.59–1.78). Individual fetuses from twin pregnancies are at lower risk for DS than those from singleton pregnancies. The estimates of the lower maternal age–specific DS risk in twin pregnancies, combined with the clinician’s knowledge of zygosity/chorionicity and maternal age at ovulation for women having assisted reproductive technologies, should allow more accurate risk estimates for genetic counseling and prenatal screening.

Data from two case-control studies conducted in New York State during 1982-1986 were used to examine the relation between multiple births and the maternal risk of breast cancer. The cases were 2,561 women between 20 and 79 years of age with a diagnosis of primary breast cancer. Controls (n = 2,616) were selected from driver's license files and matched to cases by year of birth and county of residence. The odds ratio for any multiple birth was 0.94 (95% confidence interval (CI) 0.56-1.56) in women less than 55 years of age and 0.95 (95% CI 0.62-1.46) in women aged 55-79 years. A previous study had shown a multiple last birth to be protective against breast cancer in women less than 55 years of age (odds ratio (OR) = 0.60, 95% CI 0.43-0.85). A decreased risk of breast cancer was also observed for this age group in the present study, but the magnitude of the effect was not as strong and the confidence interval included unity (OR = 0.85, 95% CI 0.43-1.68). A logistic model that controlled for age at first pregnancy, number of live births, age, and county of residence increased the odds ratio to 0.97 for a multiple last birth. The current study does not support an association between multiple births and maternal risk of breast cancer.

Neonatal outcomes of antenatal corticosteroids in preterm multiple pregnancies compared to singletons.