Hostname: page-component-77f85d65b8-hzqq2 Total loading time: 0 Render date: 2026-04-12T17:37:28.580Z Has data issue: false hasContentIssue false
  • English
  • Français

Spontaneous loss of a co-twin and the risk of birth defects after assisted conception

Published online by Cambridge University Press:  04 July 2016

M. J. Davies ,
A. R. Rumbold ,
M. J. Whitrow ,
K. J. Willson ,
W. K. Scheil ,
B. W. Mol  and
V. M. Moore
M. J. Davies*
Affiliation:
Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, North Terrace, Adelaide, South Australia 5005, Australia
A. R. Rumbold
Affiliation:
Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, North Terrace, Adelaide, South Australia 5005, Australia
M. J. Whitrow
Affiliation:
Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, North Terrace, Adelaide, South Australia 5005, Australia
K. J. Willson
Affiliation:
Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, North Terrace, Adelaide, South Australia 5005, Australia Discipline of Public Health, University of Adelaide, Adelaide, South Australia 5005, South Australia, Australia
W. K. Scheil
Affiliation:
Epidemiology Branch, South Australian Department of Health, South Australia, Australia
B. W. Mol
Affiliation:
Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, North Terrace, Adelaide, South Australia 5005, Australia
V. M. Moore
Affiliation:
Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, North Terrace, Adelaide, South Australia 5005, Australia Discipline of Public Health, University of Adelaide, Adelaide, South Australia 5005, South Australia, Australia
*
*Address for correspondence: Professor M. Davies, Lifecourse and Intergenerational Health Research Group, Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Level 8 Hughes Building, North Terrace, Adelaide, South Australia 5005, Australia. (Email michael.davies@adelaide.edu.au)
Get access Rights & Permissions [Opens in a new window]

Abstract

The study of very early pregnancy loss is impractical in the general population, but possible amongst infertility patients receiving carefully monitored treatments. We examined the association between fetal loss and the risk of birth defects in the surviving co-twin in a retrospective cohort study of infertility patients within an infertility clinic in South Australia from January 1986 to December 2002, linked to population registries for births, terminations and birth defects. The study population consisted of a total of 5683 births. Births from singleton pregnancies without loss were compared with survivors from (1) pregnancies with an empty fetal sac at 6–8 weeks after embryo transfer, (2) fetal loss subsequent to 8-week ultrasound and (3) multiple pregnancy continuing to birth. Odds ratios (OR) for birth defects were calculated with adjustment for confounders. Amongst infertility patients, the prevalence of birth defects was 7.9% for all twin pregnancies without fetal loss compared with 14.6% in pregnancies in which there had been an empty sac at ultrasound, and 11.6% for pregnancies with fetal loss after 6–8 weeks. Compared with singleton pregnancies without loss, the presence of an empty sac was associated with an increased risk of any defect (OR=1.90, 95% confidence intervals (CI)=1.09–3.30) and with multiple defects (OR=2.87, 95% CI=1.31–6.28). Twin pregnancies continuing to birth without loss were not associated with an overall increased prevalence of defects. We conclude that the observed loss of a co-twin by 6–8 weeks of pregnancy is related to the risk of major birth defects in the survivor.

Keywords

Assisted reproductive technologies (ART)congenital abnormalitiesfetal lossinfertilityvanishing twin

Information

Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 7 , Issue 6: Themed Issue: Developmental Origins of Adult Mental Health and Illness , December 2016 , pp. 678 - 684
Check for updates
Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1. Almog, B, Levin, I, Wagman, I, et al. Adverse obstetric outcome for the vanishing twin syndrome. Reprod Biomed Online. 2010; 20, 256–260.Google Scholar
2. Pinborg, A, Lidegaard, O, Freiesleben, NC, Andersen, AN. Vanishing twins: a predictor of small-for-gestational age in IVF singletons. Hum Reprod. 2007; 22, 2707–2714.CrossRefGoogle ScholarPubMed
3. Pinborg, A, Lidegaard, O, Andersen, AN. The vanishing twin: a major determinant of infant outcome in IVF singleton births. Br J Hosp Med (Lond). 2006; 67, 417–420.CrossRefGoogle Scholar
4. Pinborg, A, Lidegaard, O, la Cour Freiesleben, N, Andersen, AN. Consequences of vanishing twins in IVF/ICSI pregnancies. Hum Reprod. 2005; 20, 2821–2829.Google Scholar
5. van Oppenraaij, RH, Jauniaux, E, Christiansen, OB, et al. Predicting adverse obstetric outcome after early pregnancy events and complications: a review. Hum Reprod. 2009; 15, 409–421.Google Scholar
6. Pharoah, PO, Glinianaia, SV, Rankin, J. Congenital anomalies in multiple births after early loss of a conceptus. Hum Reprod. 2009; 24, 726–731.Google Scholar
7. Hvidtjorn, D, Grove, J, Schendel, D, et al. ‘Vanishing embryo syndrome’ in IVF/ICSI. Hum Reprod. 2005; 20, 2550–2551.Google Scholar
8. Mansour, R, Serour, G, Aboulghar, M, Kamal, O, Al-Inany, H. The impact of vanishing fetuses on the outcome of ICSI pregnancies. Fertil Steril. 2010; 94, 2430–2432.CrossRefGoogle ScholarPubMed
9. Shebl, O, Ebner, T, Sommergruber, M, Sir, A, Tews, G. Birth weight is lower for survivors of the vanishing twin syndrome: a case-control study. Fertil Steril. 2008; 90, 310–314.CrossRefGoogle ScholarPubMed
10. Dickey, RP, Taylor, SN, Lu, PY, et al. Spontaneous reduction of multiple pregnancy: incidence and effect on outcome. Am J Obstet Gynecol. 2002; 186, 77–83.Google Scholar
11. Landy, HJ, Keith, LG. The vanishing twin: a review. Hum Reprod. 1998; 4, 177–183.Google Scholar
12. Davies, MJ, Moore, VM, Willson, KJ, et al. Reproductive technologies and the risk of birth defects. N Engl J Med. 2012; 366, 1803–1813.Google Scholar
13. Li, SJ, Ford, N, Meister, K, Bodurtha, J. Increased risk of birth defects among children from multiple births. Birth Defects Res A Clin Mol Teratol. 2003; 67, 879–885.Google Scholar
14. SABD. South Australian Birth Defects Register, 2012. Retrieved 10 January 2016 from http://www.wch.sa.gov.au/services/az/other/phru/birthdefect.html.Google Scholar
15. Weinberg, W. Beiträge zur Physiologie und Pathologie der Mehrlingsgebuhrten beim Menschen. Archiv gesamte Physiol. Menschen Tiere. 1902; 88, 346–430.Google Scholar
16. Hansen, M, Kurinczuk, JJ, Bower, C, Webb, S. The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization. N Engl J Med. 2002; 346, 725–730.CrossRefGoogle ScholarPubMed
17. Santos, MA, Kuijk, EW, Macklon, NS. The impact of ovarian stimulation for IVF on the developing embryo. Reproduction. 2010; 139, 23–34.Google Scholar
18. Verberg, MFG, Macklon, NS, Nargund, G, et al. Mild ovarian stimulation for IVF. Hum Reprod. 2009; 15, 13–29.Google Scholar
19. Vega, M, Breborowicz, A, Moshier, EL, McGovern, PG, Keltz, MD. Blastulation rates decline in a linear fashion from euploid to aneuploid embryos with single versus multiple chromosomal errors. Fertil Steril. 2014; 102, 394–398.Google Scholar
20. Teklenburg, G, Salker, M, Molokhia, M, et al. Natural selection of human embryos: decidualizing endometrial stromal cells serve as sensors of embryo quality upon implantation. PloS one. 2010; 5, e10258.Google Scholar
21. Hall, JG. Twinning. The Lancet. 2003; 362, 735–743.Google Scholar
22. Hardin, J, Selvin, S, Carmichael, SL, Shaw, GM. The estimated probability of dizygotic twins: a comparison of two methods. Twin Res Hum Genet. 2009; 12, 79–85.Google Scholar
Supplementary material: File

Davies supplementary material

Davies supplementary material 1

Download Davies supplementary material(File)
File 14.6 KB