-
Journal of Assisted Reproduction and... Feb 2022Several mathematical models have been developed to estimate individualized chances of assisted reproduction techniques (ART) success, although with limited clinical...
PURPOSE
Several mathematical models have been developed to estimate individualized chances of assisted reproduction techniques (ART) success, although with limited clinical application. Our study aimed to develop a decisional algorithm able to predict pregnancy and live birth rates after controlled ovarian stimulation (COS) phase, helping the physician to decide whether to perform oocytes pick-up continuing the ongoing ART path.
METHODS
A single-center retrospective analysis of real-world data was carried out including all fresh ART cycles performed in 1998-2020. Baseline characteristics, ART parameters and biochemical/clinical pregnancies and live birth rates were collected. A seven-steps systematic approach for model development, combining linear regression analyses and decision trees (DT), was applied for biochemical, clinical pregnancy, and live birth rates.
RESULTS
Of fresh ART cycles, 12,275 were included. Linear regression analyses highlighted a relationship between number of ovarian follicles > 17 mm detected at ultrasound before pick-up (OF17), embryos number and fertilization rate, and biochemical and clinical pregnancy rates (p < 0.001), but not live birth rate. DT were created for biochemical pregnancy (statistical power-SP:80.8%), clinical pregnancy (SP:85.4%), and live birth (SP:87.2%). Thresholds for OF17 entered in all DT, while sperm motility entered the biochemical pregnancy's model, and female age entered the clinical pregnancy and live birth DT. In case of OF17 < 3, the chance of conceiving was < 6% for all DT.
CONCLUSION
A systematic approach allows to identify OF17, female age, and sperm motility as pre-retrieval predictors of ART outcome, possibly reducing the socio-economic burden of ART failure, allowing the clinician to perform or not the oocytes pick-up.
Topics: Algorithms; Female; Fertility; Fertilization in Vitro; Humans; Live Birth; Male; Ovulation Induction; Pregnancy; Pregnancy Rate; Reproductive Techniques, Assisted; Retrospective Studies; Sperm Motility
PubMed: 35084638
DOI: 10.1007/s10815-021-02353-4 -
Current Nutrition Reports Jun 2020The purpose of this review was to compare physiological and metabolic changes in singleton and twin gestations and to review pregnancy outcomes with respect to current... (Review)
Review
PURPOSE OF THE REVIEW
The purpose of this review was to compare physiological and metabolic changes in singleton and twin gestations and to review pregnancy outcomes with respect to current weight gain guidelines.
RECENT FINDINGS
Reviews in singleton gestations show that weight gain below the recommended guidelines has been associated with small for gestational age infants (less than the 10th percentile) which place these infants at increased risk for neonatal morbidities. Observational studies have shown that adequate and excessive gestational weight gain in twin gestations has been associated with longer gestations and less preterm birth along with increased birth weight at delivery. Weight gain in pregnancy has been identified as a factor that affects both maternal and infant health outcomes in singleton and twin gestations. There is a larger body of research examining these effects in singleton gestations than twin gestations; however, in both groups, the data remain mostly observational and retrospective. Thus far, the research supports the Institute of Medicine recommended weight gain guidelines in singleton and twin gestations for women with normal BMI, but future research should be directed toward underweight and overweight women and the long-term outcomes in all mothers and their offspring.
Topics: Basal Metabolism; Birth Weight; Body Mass Index; Female; Gestational Weight Gain; Guidelines as Topic; Humans; Pregnancy; Pregnancy Outcome
PubMed: 32483691
DOI: 10.1007/s13668-020-00310-8 -
Discovery Medicine Oct 2023Pregnancy is often thought of as a time of happiness and anticipation, however, for some women, it can bring about significant emotional distress and feelings of... (Review)
Review
Pregnancy is often thought of as a time of happiness and anticipation, however, for some women, it can bring about significant emotional distress and feelings of vulnerability. The physiological changes that occur during pregnancy, including hormonal fluctuations and alterations to the immune and physical systems, can affect various parts of the body, including the central nervous system (CNS). As a result, existing conditions may be intensified or new ones, such as neurologic or psychiatric disorders, may arise, exposing women to increased risk of life-threatening conditions or suicide, in the worst-case scenarios. Given the impact of pregnancy on CNS diseases, it is crucial for healthcare providers and patients alike to be aware of these potential effects. By understanding how pregnancy may affect the CNS, clinicians can take appropriate steps to ensure that women receive the care and support they need to minimize any negative outcomes for both the mother and the baby. This paper aims to review the available evidence on the impact of pregnancy on CNS diseases, including mental health conditions, from both the clinical and biomolecular perspectives. By illuminating this crucial subject, this study fosters a delicate understanding within both patients and healthcare providers, thereby paving the way for enhanced outcomes for women throughout their pregnancy journey and beyond.
Topics: Pregnancy; Infant; Humans; Female; Central Nervous System; Immunity; Central Nervous System Diseases
PubMed: 37811609
DOI: 10.24976/Discov.Med.202335178.66 -
Journal of Applied Physiology... Apr 2021In conjunction with significant cardiovascular adaptation, changes in cardioautonomic balance, specifically greater sympathetic activation and vagal withdrawal, are...
In conjunction with significant cardiovascular adaptation, changes in cardioautonomic balance, specifically greater sympathetic activation and vagal withdrawal, are considered normal adaptations to healthy singleton pregnancy. Cardiovascular adaptation to twin pregnancy is more profound than that of singleton pregnancies; however, the changes in cardioautonomic control during multifetal gestation are unknown. To address this gap, beat-by-beat blood pressure (photoplethysmography) and heart rate (lead II electrocardiogram) were measured continuously in 25 twin pregnancies and 25 singleton pregnancies (matched for age, prepregnancy body mass index, and gestational age) during 10 min of rest. Data extracted from a 3- to 5-min period were used to analyze heart rate variability (HRV), blood pressure variability (BPV), cardiovagal baroreflex gain, and cardiac intervals as indicators of cardioautonomic control. Independent tests were used to determine statistical differences between groups (α = 0.05), and the false rate discovery was determined to adjust for multiple comparisons. Resting heart rate was greater in twin compared with singleton pregnancies (91 ± 10 vs. 81 ± 10 beats/min; = 0.001), but blood pressure was not different. Individuals with twin pregnancies had lower HRV, evidenced by lower standard deviation of R-R intervals (32 ± 11 vs. 47 ± 18 ms; = 0.001), total power (1,035 ± 810 vs. 1,945 ± 1,570 ms; = 0.004), and high frequency power (224 ± 262 vs. 810 ± 806 ms; < 0.001) compared with singleton pregnancies. There were no differences in cardiac intervals, BPV, and cardiovagal baroreflex gain between groups. Our findings suggest that individuals with twin pregnancies have greater sympathetic and lower parasympathetic contributions to heart rate and that cardiac, but not vascular, autonomic control is impacted during twin compared with singleton pregnancy. Individuals with healthy twin pregnancies had lower overall heart rate variability compared with those with singleton pregnancies at similar gestational ages. These results suggest a greater sympathetic and reduced parasympathetic contribution to cardiac control in twin pregnancies. Baseline heart rate was elevated, while arterial pressure and spontaneous cardiovagal baroreflex gain were not different between groups. This was result of the upward resetting of the cardiovagal baroreflex during healthy twin pregnancy, thus maintaining arterial pressure.
Topics: Autonomic Nervous System; Baroreflex; Blood Pressure; Female; Heart Rate; Humans; Pregnancy; Pregnancy, Twin
PubMed: 33356983
DOI: 10.1152/japplphysiol.00707.2020 -
Social Science & Medicine (1982) May 2020Today, across all aspects of societal living, risk assessment is an ever-present exercise. Pervasiveness of technology in the everyday life has caused the world of...
Today, across all aspects of societal living, risk assessment is an ever-present exercise. Pervasiveness of technology in the everyday life has caused the world of 'risk' to change tremendously, and this is particularly true for childbearing females. The social construction of pregnancy and childbirth as, arguably, medical events that necessitate medical intervention - ever more so for multifetal pregnancies - makes it almost impossible to avoid the notions of risk that surround the events. Drawing on semi-structured interviews with 41 mothers of twins or triplets, we investigate how understandings of risk, combined with the ideology of good motherhood and information provided by physicians impact perceptions of fetal reduction or termination. We have discussed and theorized empirical findings within the framework of risk, discourses of the responsibilization of females, and the potential 'sacred child' in a context where selective reduction becomes a potentiality.
Topics: Child; Choice Behavior; Female; Gestational Age; Humans; Negotiating; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal; Pregnancy, Multiple; Risk
PubMed: 32197141
DOI: 10.1016/j.socscimed.2020.112926 -
BJOG : An International Journal of... Dec 2018To estimate the intergenerational association in teenage pregnancy, and whether there is a coupling tendency between a mother and daughter in how their teen pregnancies...
OBJECTIVE
To estimate the intergenerational association in teenage pregnancy, and whether there is a coupling tendency between a mother and daughter in how their teen pregnancies end, such as a termination of pregnancy (TOP) versus a live birth.
DESIGN
Population-based cohort study.
SETTING
Ontario, Canada.
POPULATION
A total of 15 097 mothers and their 16 177 daughters.
METHODS
Generalised estimating equations generated adjusted odds ratios (aOR) of a daughter experiencing a teen pregnancy in relation to the number of teen pregnancies her mother had. Multinomial logistic regression estimated the odds that a teen pregnancy ended with TOP among both mother and daughter. All models were adjusted for maternal age and world region of origin, the daughter's socio-demographic characteristics and comorbidities, mother-daughter cohabitation, and neighbourhood-level teen pregnancy rate.
MAIN OUTCOME MEASURES
Teen pregnancy in the daughter, between ages 15 and 19 years, and also the nature of the daughter's teen pregnancy, categorised as (1) no teen pregnancy, (2) at least one teen pregnancy, all exclusively ending with a live birth, and (3) at least one teen pregnancy, with at least one teen pregnancy ending with a TOP.
RESULTS
The proportion of daughters having a teen pregnancy among those whose mother had zero, one, two, or at least three teen pregnancies was 16.3, 24.9, 33.5 and 36.3%, respectively. The aOR of a daughter having a teen pregnancy was 1.42 (95% CI 1.25-1.61) if her mother had one, 1.97 (95% CI 1.71-2.26) if she had two, and 2.17 (95% CI 1.84-2.56) if her mother had three or more teen pregnancies, relative to none. If a mother had at least one teen pregnancy ending with TOP, then her daughter had an aOR of 2.12 (95% CI 1.76-2.56) for having a teen pregnancy also ending with TOP; whereas, if a mother had at least one teen pregnancy, all ending with a live birth, then her daughter had an aOR of 1.73 (95% CI 1.46-2.05) for that same outcome.
CONCLUSION
There is a strong intergenerational occurrence of teenage pregnancy between a mother and daughter, including a coupling tendency in how the pregnancy ends.
TWEETABLE ABSTRACT
Strong intergenerational association for teenage pregnancy between mother and daughter.
Topics: Abortion, Induced; Adolescent; Female; Gravidity; Humans; Live Birth; Mothers; Nuclear Family; Odds Ratio; Parity; Pregnancy; Pregnancy in Adolescence; Young Adult
PubMed: 29786971
DOI: 10.1111/1471-0528.15297 -
Acta Diabetologica Jun 2022To compare fetomaternal outcomes between GDM pregnant women with twin versus singleton pregnancies and then between women with GDM versus non-GDM twin pregnancies.
AIM
To compare fetomaternal outcomes between GDM pregnant women with twin versus singleton pregnancies and then between women with GDM versus non-GDM twin pregnancies.
METHODS
We performed a retrospective study including GDM pregnant women with both twin and singleton pregnancies followed in our tertiary center between 2011 and 2018. The fetomaternal characteristics of each group were compared. We then compared women with GDM twin pregnancy followed at our institution between 2011 and 2018 to non-GDM twin pregnant women giving childbirth in 2018.
RESULTS
A total of 1127 GDM pregnant women were evaluated: 42 with twin pregnancy and 1085 with singleton pregnancy. Preeclampsia (14.3% vs. 3.3%, p < 0.001) and cesarean delivery (76.2% vs. 36.9%, p < 0.001) were more frequent among women with twin pregnancy. Neonatal morbidity was also more common among neonates delivered from twin pregnant women, including preterm labor (73.8% vs. 7.8%, p < 0.001), hypoglycemia (6% vs. 4.8%, p = 0.043), hyperbilirubinemia (33.3% vs. 9.0%, p < 0.001), RDS (28.6% vs. 2.7%, p < 0.001), admission in NICU (32.1% vs. 4.5%, p < 0.001) and SGA (19.0% vs. 11.0%, p = 0.001). Overall there were no significant differences in fetomaternal morbidity parameters between GDM (n = 42) versus non-GDM (n = 83) twin pregnancies, although SGA infants were more frequent in the latter group (33.9% vs. 19.0%, p = 0.014).
CONCLUSIONS
In GDM pregnant women, twin pregnancy seems to be associated with an increased prevalence of neonatal morbidity when compared to singleton pregnancy. On the other hand, in twin pregnancy, diagnosis of GDM does not seem to be associated with poorer fetomaternal outcomes. GDM seems to be protective for the occurrence of SGA neonates in twin pregnancies.
Topics: Diabetes, Gestational; Female; Humans; Infant, Newborn; Male; Pregnancy; Pregnancy Outcome; Pregnancy, Twin; Retrospective Studies; Twins
PubMed: 35297494
DOI: 10.1007/s00592-022-01874-3 -
Current Opinion in Obstetrics &... Jun 2017To critically appraise the existing literature on perinatal outcomes following oocyte donation (OD) pregnancies and compare it with autologous in-vitro fertilization... (Review)
Review
PURPOSE OF REVIEW
To critically appraise the existing literature on perinatal outcomes following oocyte donation (OD) pregnancies and compare it with autologous in-vitro fertilization (IVF) pregnancies.
RECENT FINDINGS
OD pregnancies are at higher risk of developing hypertensive disorders compared with autologous IVF. The risk of preterm birth and low birth weight is higher with singleton and multiple OD compared with autologous IVF pregnancies. There is no increased risk of congenital malformations following OD compared with autologous IVF births.
SUMMARY
OD pregnancies are at higher risk of developing hypertensive disorders and adverse perinatal outcomes compared with autologous IVF.
Topics: Congenital Abnormalities; Female; Fertilization in Vitro; Humans; Hypertension, Pregnancy-Induced; Infant, Low Birth Weight; Infant, Newborn; Oocyte Donation; Pregnancy; Pregnancy, Multiple; Premature Birth
PubMed: 28234769
DOI: 10.1097/GCO.0000000000000356 -
Acta Obstetricia Et Gynecologica... Nov 2021Our objective was to evaluate the perinatal outcome of selective termination of dichorionic twin pregnancies with discordant anomalies, according to gestational age at...
INTRODUCTION
Our objective was to evaluate the perinatal outcome of selective termination of dichorionic twin pregnancies with discordant anomalies, according to gestational age at time of procedure.
MATERIAL AND METHODS
Retrospective review of 147 dichorionic twin pregnancies referred to our Fetal Medicine Unit between 2003 and 2018 for selective termination. Gestational age at delivery, fetal loss, and overall and 28-day post-delivery survival rates, were evaluated according to gestational age at time of procedure. Selective termination procedure was defined as early, intermediate, and late when performed before 18 weeks, between 18 and 23 weeks, and after 23 weeks, respectively. Kruskal-Wallis and chi-squared test were used to compare groups.
RESULTS
Overall survival at 28 days post-delivery, pregnancy loss, and preterm delivery before 32 weeks of gestation rates were 93.4%, 6.9%, and 15.5%, respectively. When stratified by gestational age at procedure, intermediate selective termination was associated with a lower survival rate than early and late procedures (86% vs. 96.9% and 100%, respectively; p = 0.035), and a nonsignificant trend for higher pregnancy loss (12% vs. 3.1%). Preterm delivery before 32 weeks of gestation occurred in 27% of late procedures, which was significantly higher than in early (9.5%) and intermediate (18.2%) procedures.
CONCLUSIONS
Selective termination in dichorionic twin pregnancies with discordant fetal anomaly is associated with low pregnancy loss and preterm delivery rate, primarily when performed before 18 weeks. When legally possible, late procedures can be a good alternative, particularly in those cases diagnosed beyond the 18th week of gestation.
Topics: Abortion, Spontaneous; Adult; Congenital Abnormalities; Female; Gestational Age; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal; Pregnancy, Twin; Premature Birth; Retrospective Studies; Twins, Dizygotic
PubMed: 34472083
DOI: 10.1111/aogs.14249 -
Journal of Obstetrics and Gynaecology... Jul 2022To review evidence-based recommendations for the management of dichorionic twin pregnancies.
OBJECTIVE
To review evidence-based recommendations for the management of dichorionic twin pregnancies.
TARGET POPULATION
Pregnant women with a dichorionic twin pregnancy.
BENEFITS, HARMS, AND COSTS
Implementation of the recommendations in this guideline may improve the management of twin pregnancies and reduce neonatal and maternal morbidity and mortality.
EVIDENCE
Published literature was retrieved through searches of PubMed and the Cochrane Library using appropriate controlled vocabulary (e.g., twin, preterm birth). Results were restricted to systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies. There were no date limits, but results were limited to English- or French-language materials.
VALIDATION METHODS
The content and recommendations were drafted and agreed upon by the principal authors. The Board of the SOGC approved the final draft for publication. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).
INTENDED AUDIENCE
Obstetricians, family physicians, nurses, midwives, maternal-fetal medicine specialists, radiologists, and other health care providers who care for women with twin pregnancies.
SUMMARY STATEMENTS
RECOMMENDATIONS.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Pregnancy, Twin; Premature Birth; Twins
PubMed: 35798461
DOI: 10.1016/j.jogc.2022.05.002