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547: Multifetal pregnancy reduction to singleton reduces the risk of small for gestational age neonates in comparison to twins
SMFM Abstracts
www.AJOG.org 547
MULTIFETAL PREGNANCY REDUCTION TO SINGLETON REDUCES THE RISK OF SMALL FOR GESTATIONAL AGE NEONATES IN COMPARISON TO TWINS LAUREN FERRARA1, MANISHA GANDHI1, CHRISTIAN LITTON1, VICTORIA BELOGOLOVKIN2, JACQUELINE KAMRATH1, E. CLAIR MCCLURG1, ERIN MOSHIER3, KEITH EDDLEMAN1, JOANNE STONE1, 1 Mount Sinai School of Medicine, New York, New York, 2Mount Sinai School of Medicine, , New York, 3Mount Sinai School of Medicine, Department of Community and Preventive Medicine, New York, New York OBJECTIVE: Multiple gestations have been shown to have an increased risk of intrauterine growth restriction (IUGR). There has also been data to suggest that multifetal pregnancy reduction(MPR) is associated with IUGR. We sought out to determine if MPR reduces the risk of small for gestational age (SGA), defined as actual birthweight less that 10th percentile, in comparison to twin gestations who have undergone MPR as well as those who have had not had a reduction. STUDY DESIGN: We retrospectively identified all patients who had undergone MPR to either a singleton or twin gestation from an established MPR database and compared them to twin gestations extracted from our ultrasound database. Demographics including age, race, ART and cvs were collected. Birthweights were collected and categorized as less than 10th percentile based on gestational age and gender as described by Alexander et al. RESULTS: Complete data was available on 260 MPR singletons, 413 MPR twins, and 257 non-reduced twins. Reducing to a singleton gestation was associated with a statistically significant decrease small for gestational age neonates. CONCLUSION: Small for gestational age infants have a variety of clinical problems beginning at birth even if born at term. Reduction to a singleton gestation significantly decreases the likelihood of a small for gestational age infant when comparing not only to MPR twins but also to those who have not undergone this type of procedure. This should be an essential part of counseling patients who are considering this procedure. Risk for small for gestational age neonates
MPR singleton vs. MPR twins MPR singleon vs. non-MPR twins
Adjusted OR
p-value
95% CI for OR
0.21 0.24
⬍0.001 ⬍0.001
[0.134, 0.330] [0.1440, 0.409]
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.571
548
Gestational age at delivery GA delivery (wks)
No CVS
CVS
p-value
Singletons Twins
38 35.2
37.9 35.1
0.71 0.76
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.572
549
MULTIFETAL PREGNANCY REDUCTION TO SINGLETON REDUCES THE RISK OF MATERNAL MORBIDITES IN COMPARISON TO TWINS LAUREN FERRARA1, CHRISTIAN LITTON1, MANISHA GANDHI1, VICTORIA BELOGOLOVKIN1, JACQUELINE KAMRATH1, E. CLAIR MCCLURG1, ANDREI REBARBER1, ERIN MOSHIER2, KEITH EDDLEMAN1, JOANNE STONE1, 1Mount Sinai School of Medicine, Obstetrics, Gynecology and Reproductive Science, New York, New York, 2Mount Sinai School of Medicine, Department of Community and Preventive Medicine, New York, New York OBJECTIVE: To determine if multifetal pregnancy reduction (MPR) to a singleton gestation reduces the risk of maternal morbities associated with pregnancy when compared to twin gestations, who have and have not undergone MPR. STUDY DESIGN: We retrospectively identified all patients who had undergone MPR to either a singleton or twin gestation from an established MPR database and compared them to twin gestations extracted from our ultrasound database. Demographics including age, race, ART and cvs were collected. Outcomes including preterm labor, preterm premature rupture of mebranes(PPROM), preeclampsia and gestational diabetes(GDM) were analyzed. RESULTS: Complete data was available on 260 MPR singletons, 413 MPR twins, and 257 non-reduced twins. Reducing to a singleton gestation was associated with a statistically significant decreased risk of preeclampsia, PPROM, GDM and preterm labor, when compared to nonreduced twins (Table 1). In comparison to reduced twins there is a significant reduction in the incidence of preterm labor and PPROM. The incidence of preeclampsia and GDM is also reduced in comparison to non-MPR twins but this did not reach statistical significance. (Table 2) CONCLUSION: Multifetal pregnancy reduction to a singleton gestation leads to a decreasedincidenceofsignificantmaternalmorbiditeswhencomparingtomultiplegestaions. Outcome comparison: MPR singleton to MPR twins
CVS DOES NOT INCREASE THE RISK OF ADVERSE OUTCOME IN PATIENTS UNDERGOING MULTIFETAL PREGNANCY REDUCTION LAUREN FERRARA1, MANISHA GANDHI2, CHRISTIAN LITTON2, E. CLAIR MCCLUNG2, KATHERINE JANDL3, ERIN MOSHIER4, KEITH EDDLEMAN2, JOANNE STONE2, 1Society for Maternal-Fetal Medicine, New York, New York, 2Mount Sinai School of Medicine, New York, New York, 3 Mount Sinai School, New York, New York, 4Mount Sinai School of Medicine, Department of Community and Preventive Medicine, New York, New York OBJECTIVE: To determine if patients undergoing CVS prior to multifetal pregnancy reduction (MPR) are at an increased risk for adverse outcome when compared to those patients who have not undergone this additional procedure. STUDY DESIGN: We retrospectively identified all patients who had undergone MPR from an established MPR database. Demographics including age, race, marital status, parity, presence of monochorionicity, starting and ending number of fetuses and method of CVS was collected. Outcomes including complete pregnancy loss, gestational age at delivery and birthweight were analyzed. RESULTS: Complete data was available on 758 MPR patients. 437 patients had undergone CVS compared to 321 patients who had not. There was no significant difference in pregnancy loss overall between the two groups (3.9% vs. 6.5%, p⫽0.098). When stratified by finishing number, there was a significantly lower loss rate in the singleton CVS group (2.1% vs. 8.6%, p⫽0.015)and no significant difference in those patients who reduced to twins. There was also no significant difference in average gestational age of delivery or birthweight between the two groups. CONCLUSION: Having an additional invasive procedure such as CVS does not increase the risk of adverse pregnancy outcome in patients undergoing mulitfetal pregnancy reduction. In fact, our data suggests that CVS in those reducing to a singleton may lead to a decreased risk of adverse outcome.
Preeclampsia PPROM Preterm labor GDM
Adjusted OR
p-value
95% CI for OR
0.59 0.46 0.124 0.47
0.29 0.11 ⬍0.001 0.37
[0.219, [0.173, [0.079, [0.091,
1.582] 1.206] 0.194] 2.441]
Outcome comparison: MPR singleton to non-MPR twins
Preeclampsia PPROM Preterm labor GDM
Adjusted OR
p-value
CI for OR
0.21 0.19 0.09 0.08
0.003 0.002 ⬍0.001 0.002
[0.076, [0.066, [0.053, [0.016,
0.586] 0.529] 0.149] 0.381]
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.573
Pregnancy loss
Overall Ending number ⫽ 1 Ending number ⫽ 2
No CVS
CVS
p-value
6.5% 8.6% 6%
3.9% 2.1% 5.3%
0.10 0.02 0.75
Average birthweight Average birthweight (g)
No CVS
CVS
p-value
Singletons Twin A Twin B
3086 2555 2214
2999 2264 2202
0.43 0.88 0.84
Supplement to DECEMBER 2007 American Journal of Obstetrics & Gynecology
S159
www.AJOG.org 547
MULTIFETAL PREGNANCY REDUCTION TO SINGLETON REDUCES THE RISK OF SMALL FOR GESTATIONAL AGE NEONATES IN COMPARISON TO TWINS LAUREN FERRARA1, MANISHA GANDHI1, CHRISTIAN LITTON1, VICTORIA BELOGOLOVKIN2, JACQUELINE KAMRATH1, E. CLAIR MCCLURG1, ERIN MOSHIER3, KEITH EDDLEMAN1, JOANNE STONE1, 1 Mount Sinai School of Medicine, New York, New York, 2Mount Sinai School of Medicine, , New York, 3Mount Sinai School of Medicine, Department of Community and Preventive Medicine, New York, New York OBJECTIVE: Multiple gestations have been shown to have an increased risk of intrauterine growth restriction (IUGR). There has also been data to suggest that multifetal pregnancy reduction(MPR) is associated with IUGR. We sought out to determine if MPR reduces the risk of small for gestational age (SGA), defined as actual birthweight less that 10th percentile, in comparison to twin gestations who have undergone MPR as well as those who have had not had a reduction. STUDY DESIGN: We retrospectively identified all patients who had undergone MPR to either a singleton or twin gestation from an established MPR database and compared them to twin gestations extracted from our ultrasound database. Demographics including age, race, ART and cvs were collected. Birthweights were collected and categorized as less than 10th percentile based on gestational age and gender as described by Alexander et al. RESULTS: Complete data was available on 260 MPR singletons, 413 MPR twins, and 257 non-reduced twins. Reducing to a singleton gestation was associated with a statistically significant decrease small for gestational age neonates. CONCLUSION: Small for gestational age infants have a variety of clinical problems beginning at birth even if born at term. Reduction to a singleton gestation significantly decreases the likelihood of a small for gestational age infant when comparing not only to MPR twins but also to those who have not undergone this type of procedure. This should be an essential part of counseling patients who are considering this procedure. Risk for small for gestational age neonates
MPR singleton vs. MPR twins MPR singleon vs. non-MPR twins
Adjusted OR
p-value
95% CI for OR
0.21 0.24
⬍0.001 ⬍0.001
[0.134, 0.330] [0.1440, 0.409]
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.571
548
Gestational age at delivery GA delivery (wks)
No CVS
CVS
p-value
Singletons Twins
38 35.2
37.9 35.1
0.71 0.76
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.572
549
MULTIFETAL PREGNANCY REDUCTION TO SINGLETON REDUCES THE RISK OF MATERNAL MORBIDITES IN COMPARISON TO TWINS LAUREN FERRARA1, CHRISTIAN LITTON1, MANISHA GANDHI1, VICTORIA BELOGOLOVKIN1, JACQUELINE KAMRATH1, E. CLAIR MCCLURG1, ANDREI REBARBER1, ERIN MOSHIER2, KEITH EDDLEMAN1, JOANNE STONE1, 1Mount Sinai School of Medicine, Obstetrics, Gynecology and Reproductive Science, New York, New York, 2Mount Sinai School of Medicine, Department of Community and Preventive Medicine, New York, New York OBJECTIVE: To determine if multifetal pregnancy reduction (MPR) to a singleton gestation reduces the risk of maternal morbities associated with pregnancy when compared to twin gestations, who have and have not undergone MPR. STUDY DESIGN: We retrospectively identified all patients who had undergone MPR to either a singleton or twin gestation from an established MPR database and compared them to twin gestations extracted from our ultrasound database. Demographics including age, race, ART and cvs were collected. Outcomes including preterm labor, preterm premature rupture of mebranes(PPROM), preeclampsia and gestational diabetes(GDM) were analyzed. RESULTS: Complete data was available on 260 MPR singletons, 413 MPR twins, and 257 non-reduced twins. Reducing to a singleton gestation was associated with a statistically significant decreased risk of preeclampsia, PPROM, GDM and preterm labor, when compared to nonreduced twins (Table 1). In comparison to reduced twins there is a significant reduction in the incidence of preterm labor and PPROM. The incidence of preeclampsia and GDM is also reduced in comparison to non-MPR twins but this did not reach statistical significance. (Table 2) CONCLUSION: Multifetal pregnancy reduction to a singleton gestation leads to a decreasedincidenceofsignificantmaternalmorbiditeswhencomparingtomultiplegestaions. Outcome comparison: MPR singleton to MPR twins
CVS DOES NOT INCREASE THE RISK OF ADVERSE OUTCOME IN PATIENTS UNDERGOING MULTIFETAL PREGNANCY REDUCTION LAUREN FERRARA1, MANISHA GANDHI2, CHRISTIAN LITTON2, E. CLAIR MCCLUNG2, KATHERINE JANDL3, ERIN MOSHIER4, KEITH EDDLEMAN2, JOANNE STONE2, 1Society for Maternal-Fetal Medicine, New York, New York, 2Mount Sinai School of Medicine, New York, New York, 3 Mount Sinai School, New York, New York, 4Mount Sinai School of Medicine, Department of Community and Preventive Medicine, New York, New York OBJECTIVE: To determine if patients undergoing CVS prior to multifetal pregnancy reduction (MPR) are at an increased risk for adverse outcome when compared to those patients who have not undergone this additional procedure. STUDY DESIGN: We retrospectively identified all patients who had undergone MPR from an established MPR database. Demographics including age, race, marital status, parity, presence of monochorionicity, starting and ending number of fetuses and method of CVS was collected. Outcomes including complete pregnancy loss, gestational age at delivery and birthweight were analyzed. RESULTS: Complete data was available on 758 MPR patients. 437 patients had undergone CVS compared to 321 patients who had not. There was no significant difference in pregnancy loss overall between the two groups (3.9% vs. 6.5%, p⫽0.098). When stratified by finishing number, there was a significantly lower loss rate in the singleton CVS group (2.1% vs. 8.6%, p⫽0.015)and no significant difference in those patients who reduced to twins. There was also no significant difference in average gestational age of delivery or birthweight between the two groups. CONCLUSION: Having an additional invasive procedure such as CVS does not increase the risk of adverse pregnancy outcome in patients undergoing mulitfetal pregnancy reduction. In fact, our data suggests that CVS in those reducing to a singleton may lead to a decreased risk of adverse outcome.
Preeclampsia PPROM Preterm labor GDM
Adjusted OR
p-value
95% CI for OR
0.59 0.46 0.124 0.47
0.29 0.11 ⬍0.001 0.37
[0.219, [0.173, [0.079, [0.091,
1.582] 1.206] 0.194] 2.441]
Outcome comparison: MPR singleton to non-MPR twins
Preeclampsia PPROM Preterm labor GDM
Adjusted OR
p-value
CI for OR
0.21 0.19 0.09 0.08
0.003 0.002 ⬍0.001 0.002
[0.076, [0.066, [0.053, [0.016,
0.586] 0.529] 0.149] 0.381]
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.573
Pregnancy loss
Overall Ending number ⫽ 1 Ending number ⫽ 2
No CVS
CVS
p-value
6.5% 8.6% 6%
3.9% 2.1% 5.3%
0.10 0.02 0.75
Average birthweight Average birthweight (g)
No CVS
CVS
p-value
Singletons Twin A Twin B
3086 2555 2214
2999 2264 2202
0.43 0.88 0.84
Supplement to DECEMBER 2007 American Journal of Obstetrics & Gynecology
S159