Outcome of two sequential singleton pregnancies and twin pregnancies among primiparous women at advanced age undergoing
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MATERNAL-FETAL MEDICINE
Outcome of two sequential singleton pregnancies and twin pregnancies among primiparous women at advanced age undergoing IVF Nizan Mor1,2 · Ronit Machtinger1,2 · Yoav Yinon1,2 · Shlomo Toussia‑Cohen1,2 · Daphna Amitai Komem1,2 · Michael Levin1,2 · Eyal Sivan1,2 · Raanan Meyer1,2 Received: 28 March 2020 / Accepted: 11 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 preg‑ nancy 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 0.999 > 0.999 0.589 > 0.999 0.941
Data are presented in n (%) or median (interquartile range) BMI body mass index, DM diabetes mellitus, LMWH low molecular weight heparin, LDA low dose aspirin, IUGRintrauterine fetal growth restriction (≤ 10th birth weight percentile) *Hypercoagulation disorders included: factor II heterozygous or homozygous, antithrombin III deficiency, factor V Leiden heterozygous, antiphospholipid syndrome, protein C deficiency, protein S deficiency **Arrhythmias, autoimmune diseases, multiple sclerosis, asthma, thyroid disorders ***Steroids, asthma medications, thyroid hormone replacement therapy, IV immunoglobulins (IVIG), hypertension medications
34 weeks gestation (19.2% vs. 3.2%, p = 0.002) and had significantly higher rates of CD (83.7% vs. 46%, p
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