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Worldwide prevalence of adverse pregnancy outcomes associated with in vitro fertilization/intracytoplasmic sperm injection among multiple births: a systematic review and meta-analysis based on cohort studies

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Abstract

Purpose

To perform a systematic review and meta-analysis of reported estimates of adverse pregnancy outcomes among multiple births conceived with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).

Methods

PubMed, Google Scholar, Cochrane Libraries and Chinese databases were searched through May 2016 for cohort studies assessing adverse pregnancy outcomes associated with IVF/ICSI multiple births. Random-effects meta-analyses were used to calculate pooled estimates of adverse pregnancy outcomes and, where appropriate, heterogeneity was explored in group-specific analyses.

Results

Sixty-four studies, with 60,210 IVF/ICSI multiple births and 146,737 spontaneously conceived multiple births, were selected for analysis. Among IVF/ICSI multiple births, the pooled estimates were 51.5% [95% confidence interval (CI): 48.7–54.3] for preterm birth, 12.1% (95% CI: 10.4–14.1) for very preterm birth, 49.8% (95% CI: 47.6–52.0) for low birth weight, 8.4% (95% CI: 7.1–9.9) for very low birth weight, 16.2% (95% CI: 12.9–20.1) for small for gestational age, 3.0% (95% CI: 2.5–3.7) for perinatal mortality and 4.7% (95% CI: 4.0–5.6) for congenital malformations. When the data were restricted to twins, the pooled estimates also showed a high prevalence of adverse outcomes. There was a similar prevalence of poor outcomes among multiple births conceived with IVF/ICSI and naturally (all P ≥ 0.0792). Significant differences in different continents, countries, and income groups were found.

Conclusions

The IVF/ICSI multiple pregnancies have a high prevalence of adverse pregnancy outcomes. However, population-wide prospective adverse outcomes registries covering the entire world population for IVF/ICSI pregnancies are needed to determine the exact perinatal prevalence.

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Acknowledgements

The study was carried out with the fund support of China Postdoctoral Science Foundation (2015M572248), Hunan Provincial Science and Technology Plan Project (2015RS4055), and Natural Science Foundation of Hunan Province (2016JJ4047). Authors thank editors and reviewers for their suggestions.

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Authors and Affiliations

  1. Information Management Division, Hunan Provincial Maternal and Child Health Care Hospital, 53 Xiangchun Road, Changsha, 410008, Hunan, China

    Jia-Bi Qin

  2. Division of Medical Genetics, Hunan Provincial Maternal and Child Health Care Hospital, 53 Xiangchun Road, Changsha, 410008, Hunan, China

    Xiao-Qi Sheng & Hua Wang

  3. Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China

    Guo-Chong Chen

  4. Reproductive Medicine Center, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China

    Jing Yang & Hong Yu

  5. Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, China

    Tu-Bao Yang

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  1. Jia-Bi Qin
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This study was funded by China Postdoctoral Science Foundation (2015M572248), Hunan Provincial Science and Technology Plan Project (2015RS4055), and Natural Science Foundation of Hunan Province (2016JJ4047).

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Qin, JB., Sheng, XQ., Wang, H. et al. Worldwide prevalence of adverse pregnancy outcomes associated with in vitro fertilization/intracytoplasmic sperm injection among multiple births: a systematic review and meta-analysis based on cohort studies. Arch Gynecol Obstet 295, 577–597 (2017). https://doi.org/10.1007/s00404-017-4291-2

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