Neonatal outcomes among twins following assisted reproductive technology: An Australian population-based retrospective cohort study

© 2018 The Author(s). Background: While their incidence is on the rise, twin pregnancies are associated with risks to the mothers and their babies. This study aims to investigate the likelihood of adverse neonatal outcomes of twins following assisted reproductive technology (ART) compared to non-ART twins. Methods: A retrospective population study using the Australian National Perinatal Data Collections (NPDC) which included 19,662 twins of ≥20weeks gestational age or≥400g birthweight in Australia. Maternal outcomes and neonatal outcomes (preterm birth, low birth weight, resuscitation and neonatal death) were compared. Generalized Estimating Equations were used to assess the likelihood of any neonatal outcomes, with adjusted odds ratio (AOR) and 95% confidence intervals (CI) presented. Weinberg's differential rule was used to estimate monozygotic twin rate. Results: ART mothers were 3.3years older than non-ART mothers. The rates of pregnancy-induced hypertension and gestational diabetes were significantly higher for ART mothers than non-ART mothers (12.2% vs. 8.4%, p< 0.01) and (9.7% vs. 7.5%, p< 0.01) respectively. The incidence of monozygotic twins was 2.0% for ART twins and 1.1% for non-ART twins. Compared with non-ART twins, ART twins had higher rates of preterm birth (AOR 1.13, 95% CI: 1.05-1.22), low birth weight (AOR 1.13, 95% CI: 1.05-1.22), and resuscitation (AOR 1.26, 95% CI: 1.17-1.36). Liveborn ART twins had 28% (AOR 1.28, 95% CI 1.09-1.50) increased odds of having any adverse neonatal outcome compared to liveborn non-ART twins, especially for opposite-sex ART twins (AOR 1.42, 95% CI 1.11-1.82). Conclusion: As ART twins had higher rates of adverse outcome, special prenatal care is recommended. Couples accessing ART should be fully informed of the risk of adverse outcome of twin pregnancies

Pregnancy risk factors associated with birthweight of infants born to Australian Aboriginal women in an urban setting - a retrospective cohort study

BACKGROUND: A key focus of the Closing the Gap campaign is to reduce low birthweight in Aboriginal babies. Limited research exists on factors affecting Aboriginal birthweight in urban areas. METHODS: Retrospective cohort analysis of 38,382 births (38,167 non-Aboriginal, 215 Aboriginal) at the Royal Women's Hospital in Melbourne from January 2010 to December 2015. Aboriginal status was defined by mothers who identified themselves and their baby as Aboriginal or Torres Strait Islander. The aim was to examine the association of maternal health risk behaviours and obstetric complications with birthweight of infants born to Australian Aboriginal women birthing in an urban setting. RESULTS: Aboriginal babies had a lower mean birthweight than non-Aboriginal babies (mean difference -290 g; 95% confidence interval [CI] -413, - 166 g), but when accounting for gestational age and sex there was little difference (mean difference 5 g; 95% CI -53, 6 g). Aboriginal babies were significantly more likely to be delivered preterm < 37 weeks (23.3% vs 7.9%, odds ratio [OR] 3.58; 95% CI 2.58, 4.95) and be of low birthweight < 2500 g (22.3% vs 6.7%, OR 4.03; 95% CI 2.90, 5.60) or very low birthweight < 1500 g (9.8% vs 1.8%, OR 5.81; 95% CI 3.67, 9.16). Aboriginal mothers were significantly more likely to be teenage mothers (9.8% vs 1.6%, OR 5.72; 95% CI 3.54, 9.24), smoke cigarettes throughout the pregnancy (53.8% vs 5.6%, OR 17.2; 95% CI 12.8, 23.0), and use drugs (26.5% vs 2.4%, OR 14.3; 95% CI 10.4, 19.6) during pregnancy, all of which were associated with lower birthweight. Aboriginal mothers were also more likely to have a mental health diagnosis (49.5% vs 18.8%, OR 3.77; 95% CI 2.86, 4.97), be overweight (59.9% vs 42.6%, OR 1.88; 95% CI 1.39, 2.56) and have diabetes (15.3% vs 7.3%, OR 2.31; 95% CI 1.59, 3.35) which were all associated with higher birthweight. CONCLUSIONS: Aboriginal babies born in metropolitan Melbourne are more likely to be of low birthweight compared with non-Aboriginal babies, which in turn was related to higher rates of prematurity and not to being small for gestational age

Editorial-Special Issue.

Monochorionic twin pregnancies are subject to unique complications that can threaten the life and well-being of both fetuses, resulting in a disproportionate increase in perinatal morbidity and mortality

Multiple deliveries: The reduced impact of in vitro fertilisation in Australia

Background The number of twins born in Australia steadily increased from 2420 sets in 1983 to 4458 sets in 2010. At one stage, almost 25% of all twin deliveries in Australia were a consequence of assisted reproductive technologies. Aims To determine the influence of a policy of single embryo transfer (SET) on the rate of multiple deliveries in Australia. Methods We used population data to compare the prevalence of twin and higher order multiple births in women giving birth in Australia before and after the implementation of the RTAC COP 2001 and 2005 revisions for ART units. Results There was a steady fall in the twin delivery rate for assisted reproductive technologies from 210.4 per 1000 deliveries in 2001 to 84.3 per 1000 deliveries in 2009. In 2009, assisted reproductive technologies accounted for approximately 16% of all twin births from 3% of all conceptions, substantially less than the 24.5% in 2002. Conclusions The decline in multiple births is multifactorial. However, the fall in the proportion of ART multiple births has paralleled adoption of a voluntary policy of SET within a setting of largely public funding of ART. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists