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Outcome of two sequential singleton pregnancies and twin pregnancies among primiparous women at advanced age undergoing IVF

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To compare the obstetrical and detailed neonatal outcomes of primipara of advanced maternal age conceiving two sequential singleton pregnancies by IVF with those of primipara conceiving twins by IVF.

Methods

A retrospective study of all primiparous women aged ≤ 38 years and conceived by IVF who delivered sequential singletons or delivered twins at a single tertiary university affiliated medical center between 2011 and 2019. We performed two main comparisons: 1. First vs. second singleton pregnancies. 2. Two singleton pregnancies vs. twin pregnancies.

Results

Overall, there were 63 women with consecutive singleton IVF pregnancies. The median age was 40.0 at first pregnancy and 42.0 in the second pregnancy. Pregnancy and delivery complications rates did not differ significantly between the first and the second singleton pregnancies, including gestational hypertensive disorders (7 (11.1%) vs. 4 (6.3%), p = 0.530), gestational diabetes mellitus (13 (20.6%) vs 18 (28.5%), p = 0.410), intrauterine growth restriction (6 (9.5%) vs. 4 (6.3%), p = 0.744), or cesarean delivery (25 (39.7%) vs. 29 (46%), p = 0.589). Rates of delivery before 32 weeks gestation were similar for both first and second singleton pregnancies (1.6%, p > 0.999). The proportion of neonatal adverse outcome in both first and second singleton pregnancies groups was low and did not differ between the groups. Compared with women who delivered sequential singletons, women with twin pregnancies had significantly higher cesarean delivery rates (113 (83.7%) vs. 29 (46%), p < 0.001) and lower gestational ages at delivery (36.2 vs. 38.4, p < 0.001) than women with two singleton deliveries. Adverse neonatal outcomes were significantly higher for twin pregnancies, including birthweight < 1500 g (17 (12.6%) vs. 2 (3.2%), p = 0.036), neonatal intensive care unit admission (57 (42.2%) vs. 4 (6.3%), p < 0.001), neonatal hypoglycemia (23 (17%) vs. 3 (4.8%), p = 0.017), and respiratory distress syndrome (14 (10.4%) vs. 1 (1.6%), p = 0.040). Length of neonatal hospitalization was significantly longer for twins (9 vs. 5 days, p < 0.001). The rate of gestational hypertensive disorders (preeclampsia and gestational hypertension) was similar between the groups, but the rates of severe preeclampsia trended higher among women who carried twins (8 (5.9%) vs. 0, p = 0.057).

Conclusions

Sequential singleton pregnancies at primipara women of advanced maternal age have an overall very good outcome, with no clinically significant difference between the pregnancies. In addition, their outcome is much better compared with twins.

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Acknowledgements

This work was performed in partial fulfilment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University.

Funding

Research for this study did not receive any specific grants from any funding agency in the public, commercial, or non-for-profit sectors.

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Author notes

  1. Nizan Mor and Ronit Machtinger have contributed equally to this work.

Authors and Affiliations

  1. The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel

    Nizan Mor, Ronit Machtinger, Yoav Yinon, Shlomo Toussia-Cohen, Daphna Amitai Komem, Michael Levin, Eyal Sivan & Raanan Meyer

  2. The Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, P.O.B 39040, Tel Aviv, 69978, Israel

    Nizan Mor, Ronit Machtinger, Yoav Yinon, Shlomo Toussia-Cohen, Daphna Amitai Komem, Michael Levin, Eyal Sivan & Raanan Meyer

Authors
  1. Nizan Mor
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  2. Ronit Machtinger
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  3. Yoav Yinon
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  4. Shlomo Toussia-Cohen
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  5. Daphna Amitai Komem
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Contributions

NM: Data collection, Data analysis, Manuscript writing. RM: Project development, Data analysis, Manuscript writing. YY: Revision of the manuscript. ST-C: Data collection, Data analysis. DAK: Data collection, Data analysis. ML: Data collection, Data analysis. ES: Revision of the manuscript. RM: Project development, Data collection, Data analysis, Manuscript writing.

Corresponding author

Correspondence to Nizan Mor.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was performed per the principles of the Declaration of Helsinki. Approval was granted by the institutional review board (#1411-14-SMC, August 2014).

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Mor, N., Machtinger, R., Yinon, Y. et al. Outcome of two sequential singleton pregnancies and twin pregnancies among primiparous women at advanced age undergoing IVF. Arch Gynecol Obstet 302, 1113–1119 (2020). https://doi.org/10.1007/s00404-020-05700-5

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  • DOI: https://doi.org/10.1007/s00404-020-05700-5

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