-
European Journal of Obstetrics,... Jun 2021Twin pregnancy has risks of adverse outcomes for mother and baby. Data synthesis is required to gain evidence to aid recommendations but may be hampered by variations in... (Review)
Review
OBJECTIVES
Twin pregnancy has risks of adverse outcomes for mother and baby. Data synthesis is required to gain evidence to aid recommendations but may be hampered by variations in outcome reporting.
STUDY DESIGN
Systematically review outcomes reported in twin pregnancy trials (PROSPERO - CRD42019133805). Searches were performed in MEDLINE, EMBASE, CINHAL, Cochrane library (inception-January 2019) for randomised control trials or their follow-up studies reporting prediction, prognosis, intervention or management outcomes in twin pregnancy. The study characteristics, outcomes definitions and measurements were extracted and descriptively analysed.
RESULTS
49 RCTs and 8 follow-up studies evaluated 21 interventions, 1257 outcomes, categorised into 170 unique outcomes. 65 % of trials included all twin pregnancies, 12 % DCDA and 11 % MCDA only or MCMA and MCDA. Five (9 %) papers were prediction/ prognosis RCT's and 52 (91 %) related to an intervention. Of interventions, 40 (77 %) were medical, 34 (85 %) for preterm birth; 12 (23 %) surgical, 6 (50 %) related to TTTS interventions (83 % for monochrorionic studies). Commonest domains were: 'Neonatal' 77 %, 'Delivery' 70 % and 'Survival' 67 %. Least reported were longer term outcomes for 'Infant' or 'Parental'.
CONCLUSIONS
Twin pregnancy outcomes are diverse and complex. This is related to the need to address maternal, single and double fetal outcomes and different types of chorionicity. The lack of outcome standardisation in selection, definition and reporting hinders evidence synthesis and the selection of outcomes important to women and health care professionals thus limiting the effectiveness of research.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy, Twin; Premature Birth; Prenatal Care; Twins
PubMed: 33964726
DOI: 10.1016/j.ejogrb.2021.04.025 -
Nutrients Jan 2021Maternal diet and nutritional status are of key importance with regard to the short- and long-term health outcomes of both the mother and the fetus. Multiple pregnancies...
Maternal diet and nutritional status are of key importance with regard to the short- and long-term health outcomes of both the mother and the fetus. Multiple pregnancies are a special phenomenon in the context of nutrition. The presence of more than one fetus may lead to increased metabolic requirements and a faster depletion of maternal macro- and micro- nutrient reserves than in a singleton pregnancy. The aim of this systematic review was to gather available knowledge on the supply and needs of mothers with multiple pregnancies in terms of micronutrients and the epidemiology of deficiencies in that population. It was constructed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). The authors conducted a systematic literature search with the use of three databases: PubMed/MEDLINE, Scopus and Embase. The last search was run on the 18 October 2020 and identified 1379 articles. Finally, 12 articles and 1 series of publications met the inclusion criteria. Based on the retrieved studies, it may be concluded that women with multiple pregnancies might be at risk of vitamin D and iron deficiencies. With regard to other microelements, the evidence is either inconsistent, scarce or absent. Further in-depth prospective and population studies are necessary to determine if nutritional recommendations addressed to pregnant women require adjustments in cases of multiple gestations.
Topics: Anemia, Iron-Deficiency; Calcium; Female; Humans; Meta-Analysis as Topic; Micronutrients; Nutritional Status; Phosphorus; Pregnancy; Pregnancy, Multiple; Prospective Studies; Vitamin D Deficiency
PubMed: 33513722
DOI: 10.3390/nu13020386 -
The Cochrane Database of Systematic... Nov 2015Multiple pregnancies are associated with higher rates of perinatal mortality and morbidity than singleton pregnancies, mainly due to an increased risk of preterm birth.... (Review)
Review
BACKGROUND
Multiple pregnancies are associated with higher rates of perinatal mortality and morbidity than singleton pregnancies, mainly due to an increased risk of preterm birth. Because fetal outcome is best at a particular range of maternal weight gain, it has been suggested that women with multiple pregnancies should take special diets (particularly high-calorie diets) designed to boost weight gain. However, 'optimal weight gain' in the mother in retrospective studies may merely reflect good growth of her babies and delivery at or near term (both associated with a good outcome) and artificially boosting weight gain by nutritional input may confer no advantage. Indeed, a high-calorie diet may be unpleasant to consume, and could lead to long-term problems of being overweight. It is therefore important to establish if specialised diets are actually of benefit to women with multiple pregnancies and their babies.
OBJECTIVES
To assess the effects of specialised diets or nutritional advice for women with multiple pregnancies (two or more fetuses).
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 June 2015).
SELECTION CRITERIA
Randomised controlled trials, 'quasi-random' studies, and cluster-randomised trials of women with multiple pregnancies (two or more fetuses) either nulliparous or multiparous and their babies. Cross-over trials and studies reported only as abstracts were not eligible for inclusion.
DATA COLLECTION AND ANALYSIS
We identified no trials for inclusion in this review.
MAIN RESULTS
A comprehensive search of the Cochrane Pregnancy and Childbirth Group's Trials Register found no potentially eligible trial reports.
AUTHORS' CONCLUSIONS
There is no robust evidence from randomised trials to indicate whether specialised diets or nutritional advice for women with multiple pregnancies do more good than harm. There is a clear need to undertake a randomised controlled trial.
Topics: Female; Humans; Pregnancy; Pregnancy, Multiple; Prenatal Nutritional Physiological Phenomena; Weight Gain
PubMed: 26599328
DOI: 10.1002/14651858.CD008867.pub3 -
The Cochrane Database of Systematic... Nov 2015When couples are faced with the dilemma of a higher-order multiple pregnancy there are three options. Termination of the entire pregnancy has generally not been... (Review)
Review
BACKGROUND
When couples are faced with the dilemma of a higher-order multiple pregnancy there are three options. Termination of the entire pregnancy has generally not been acceptable to women, especially for those with a past history of infertility. Attempting to continue with all the fetuses is associated with inherent problems of preterm birth, survival and long-term morbidity. The other alternative relates to reduction in the number of fetuses by selective termination. The acceptability of these options for the couple will depend on their social background and underlying beliefs. This review focused on reduction in the number of fetuses.
OBJECTIVES
To assess a policy of multifetal reduction with a policy of expectant management of women with a multiple pregnancy.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2015).
SELECTION CRITERIA
Randomised controlled trials with reported data that compared outcomes in mothers and babies who were managed expectantly with outcomes in women who underwent selective fetal reduction of a multiple pregnancy.
DATA COLLECTION AND ANALYSIS
We planned that two review authors would independently assess trials for inclusion and risk of bias, extract data and check them for accuracy. However, no randomised trials were identified.
MAIN RESULTS
There were no randomised controlled trials identified.
AUTHORS' CONCLUSIONS
We found no available data from randomised trials to inform the risks and benefits of pregnancy reduction procedures for women with a multiple pregnancy. While randomised controlled trials will provide the most reliable evidence about the risks and benefits of fetal reduction procedures, reduction in the number of fetuses by selective termination may not be acceptable to women, particularly couples with a past history of infertility. The acceptability of this option, and willingness to undergo randomisation will depend on the couple's social background and beliefs, and consequently, recruitment to such a trial may prove exceptionally difficult.
Topics: Female; Humans; Pregnancy; Pregnancy Reduction, Multifetal; Pregnancy, Multiple
PubMed: 26544079
DOI: 10.1002/14651858.CD003932.pub3 -
The Cochrane Database of Systematic... Nov 2015Regular antenatal care for women with a multiple pregnancy is accepted practice, and while most women have an increase in the number of antenatal visits, there is no... (Review)
Review
BACKGROUND
Regular antenatal care for women with a multiple pregnancy is accepted practice, and while most women have an increase in the number of antenatal visits, there is no consensus as to what constitutes optimal care. 'Specialised' antenatal clinics have been advocated as a way of improving outcomes for women and their infants.
OBJECTIVES
To assess, using the best available evidence, the benefits and harms of 'specialised' antenatal clinics compared with 'standard' antenatal care for women with a multiple pregnancy.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies.
SELECTION CRITERIA
All published, unpublished, and ongoing randomised controlled trials with reported data that compared outcomes in mothers and babies with a multiple pregnancy who received antenatal care specifically designed for women with a multiple pregnancy (as defined by the trial authors) with outcomes in controls who received 'standard' antenatal care (as defined by the trial authors).
DATA COLLECTION AND ANALYSIS
Two of the review authors independently assessed trials for inclusion and trial quality. Both review authors extracted data. Data were checked for accuracy. We graded the quality of the evidence using GRADEpro software.
MAIN RESULTS
Findings were based on the results of a single study with some design limitations.Data were available from one study involving 162 women with a multiple pregnancy. For the only reported primary outcome, perinatal mortality, we are uncertain whether specialised antenatal clinics makes any difference compared to standard care (risk ratio (RR) 1.02; 95% confidence interval (CI) 0.26 to 4.03; 324 infants, very low quality evidence). Women receiving specialised antenatal care were significantly more likely to birth by caesarean section (RR 1.38; 95% CI 1.06 to 1.81; 162 women, moderate quality evidence). Data were not reported in the study on the following primary outcomes: small-for-gestational age, very preterm birth or maternal death. There were no differences identified between specialised antenatal care and standard care for other secondary outcomes examined: postnatal depression (RR 0.48; 95% CI 0.19 to 1.20; 133 women, very low quality evidence), breastfeeding (RR 0.63; 95% CI 0.24 to 1.68; 123 women, very low quality evidence), stillbirth (RR 0.68; 0.12 to 4.04) or neonatal death (RR 2.05; 95% CI 0.19 to 22.39) (324 infants).
AUTHORS' CONCLUSIONS
There is currently limited information available from randomised controlled trials to assess the role of 'specialised' antenatal clinics for women with a multiple pregnancy compared with 'standard' antenatal care in improving maternal and infant health outcomes. The value of 'specialised' multiple pregnancy clinics in improving health outcomes for women and their infants requires evaluation in appropriately powered and designed randomised controlled trials.
Topics: Cesarean Section; Female; Humans; Infant Welfare; Infant, Newborn; Maternal Welfare; Perinatal Mortality; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Pregnancy, Twin; Prenatal Care; Randomized Controlled Trials as Topic
PubMed: 26545291
DOI: 10.1002/14651858.CD005300.pub4 -
BMJ (Clinical Research Ed.) Aug 1988
Topics: Ethics, Medical; Female; Fetus; Humans; Potassium Chloride; Pregnancy; Pregnancy, Multiple; Pregnant Women; Risk Assessment; Value of Life
PubMed: 3139132
DOI: 10.1136/bmj.297.6646.433 -
Croatian Medical Journal Oct 2005The main perinatal complications of assisted reproduction include congenital malformation, chromosomal aberrations, multiple pregnancy, and prematurity. Earlier studies... (Review)
Review
The main perinatal complications of assisted reproduction include congenital malformation, chromosomal aberrations, multiple pregnancy, and prematurity. Earlier studies and in vitro fertilization (IVF) registries showed that there was no increased incidence of congenital malformations in children conceived by IVF/intracytoplasmic sperm injection (ICSI). However, a large Australian study has found that by one year of age, the incidence of congenital malformations in IVF/ICSI children is increased in comparison with those naturally conceived. Several investigators found a slight but increased risk of chromosomal aberrations in ICSI children. Multiple pregnancy is a major cause of increased perinatal mortality due to increased incidence of both prematurity and congenital malformations. Even in singleton pregnancies conceived by assisted reproductive technologies, the risk of prematurity and newborns small for gestational age is increased. In this article, recently published work on perinatal complications associated with assisted reproductive technologies is reviewed.
Topics: Chromosome Aberrations; Congenital Abnormalities; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Premature Birth; Reproductive Techniques, Assisted; Risk Factors
PubMed: 16158467
DOI: No ID Found -
Fertility and Sterility Mar 2022This Committee Opinion provides practitioners with suggestions to reduce the likelihood of iatrogenic multiple gestation resulting from infertility treatment. This... (Review)
Review
This Committee Opinion provides practitioners with suggestions to reduce the likelihood of iatrogenic multiple gestation resulting from infertility treatment. This document replaces the document of the same name previously published in 2012 (Fertil Steril 2012;97:825-34 by the American Society for Reproductive Medicine).
Topics: Embryo Culture Techniques; Female; Humans; Infertility, Female; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Reproductive Medicine; Reproductive Techniques, Assisted; Societies, Medical
PubMed: 35115166
DOI: 10.1016/j.fertnstert.2021.12.016 -
Fertility and Sterility Jan 2004
Topics: Female; Humans; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Pregnancy, Multiple; Regression Analysis; Triplets
PubMed: 14711574
DOI: 10.1016/j.fertnstert.2003.09.015 -
Pregnancy characteristics and maternal breast cancer risk: a review of the epidemiologic literature.Cancer Causes & Control : CCC Jul 2010The short- and long-term effects of pregnancy on breast cancer risk are well documented. Insight into potential biological mechanisms for these associations may be... (Review)
Review
The short- and long-term effects of pregnancy on breast cancer risk are well documented. Insight into potential biological mechanisms for these associations may be gained by studying breast cancer risk and pregnancy characteristics (e.g., preeclampsia, twining), which may reflect hormone levels during pregnancy. To date, no review has synthesized the published literature for pregnancy characteristics and maternal breast cancer using systematic search methods. We conducted a systematic search to identify all published studies. Using PUBMED (to 31 July 2009), 42 relevant articles were identified. Several studies suggest that multiple births may be associated with a lowered breast cancer risk of about 10-30%, but results were inconsistent across 18 studies. The majority of 13 studies suggest about a 20-30% reduction in risk with preeclampsia and/or gestational hypertension. Six of seven studies reported no association for infant sex and breast cancer risk. Data are sparse and conflicting for other pregnancy characteristics such as gestational age, fetal growth, pregnancy weight gain, gestational diabetes, and placental abnormalities. The most consistent findings in a generally sparse literature are that multiple births and preeclampsia may modestly reduce breast cancer risk. Additional research is needed to elucidate associations between pregnancy characteristics, related hormonal profiles, and breast cancer risk.
Topics: Breast Neoplasms; Female; Humans; Pregnancy; Pregnancy, Multiple; Risk Assessment; Risk Factors; Weight Gain
PubMed: 20224871
DOI: 10.1007/s10552-010-9524-7