Comparing pregnancy outcomes and loss rates in elective twin pregnancy reduction with ongoing twin gestations in a large contemporary cohort

• Published in: American journal of obstetrics and gynecology 2019-09, Vol.221 (3), p.253.e1-253.e8
• Main Authors: Vieira, Luciana A., Warren, Leslie, Pan, Stephanie, Ferrara, Lauren, Stone, Joanne L.
• Format: Article
• Language: English
• Subjects: Abortion, Spontaneous - epidemiology; Abortion, Spontaneous - etiology; Adult; birthweight percentile; cesarean; elective multifetal pregnancy reduction; Female; Follow-Up Studies; Humans; Infant, Newborn; intrauterine growth restriction; Logistic Models; multifetal pregnancy reduction; multiple gestation; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal - adverse effects; Pregnancy, Twin; Premature Birth - epidemiology; Premature Birth - prevention & control; preterm birth; preterm premature rupture of membranes; Retrospective Studies; Risk Factors; twin pregnancy outcomes
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2019.04.001

As compared with singleton gestations, twin pregnancies are associated with a significantly higher risk of preterm birth and maternal complications as well as fetal and neonatal morbidity and mortality. Multifetal pregnancy reduction is a technique developed in the 1980s to reduce the fetal number in higher-order multiple pregnancies to reduce the risk of adverse pregnancy outcomes, most importantly preterm birth. The objective of the study was to compare pregnancy outcomes and loss rates in elective twin pregnancy reduction to ongoing twin gestations in a large contemporary cohort. This was a retrospective review of dichorionic diamniotic twin gestations that underwent first-trimester ultrasound at our institution from January 2008 to September 2016. Planned elective 2-to-1 multifetal pregnancy reductions at less than 15 weeks’ gestation were compared with ongoing dichorionic diamniotic twin gestations. Data were collected via chart review. Demographics between 2-to-1 reduced singletons and ongoing twins were assessed using a Student t test or a Wilcoxon rank-sum test, as appropriate, for continuous variables and χ2 or Fisher exact tests, as appropriate, for categorical variables. Univariable and multivariable logistic regressions were used to compare pregnancy outcomes between ongoing twins and reduced singletons adjusting for maternal age, body mass index, race, in vitro fertilization, use of chorionic villus sampling, prior term birth, and prior preterm birth. Of 1070 dichorionic diamniotic twin pregnancies identified, completed follow-up data were available and analyzed for 855 patients (79.9%). Among those, 250 (29.2%) were 2-to-1 singletons and 605 (70.8%) were ongoing twins. Reduced singleton patients were slightly older, more likely white, and had lower body mass index. They were also more likely to have undergone in vitro fertilization (63.6% vs 48.8%), had chorionic villus sampling (92% vs 37.5%), and had prior term births (54% vs 35.7%). Compared with 2-to-1 singletons, the adjusted odds of having preterm delivery at 37 weeks for ongoing twins were 5.62 times (95% confidence interval, 3.67–8.61; P < .001) and 2.22 times (95% confidence interval, 1.20–4.11; P < .001) at 34 weeks. While intrauterine growth restriction, placental abruption, and gestational diabetes were not significant, ongoing twins were more likely to have a cesarean delivery (odds ratio, 5.53, 95% confidence interval, 3.60–8.49; P < .001) and preeclampsia (odds ratio, 3.33, 95%