Triple trouble: uncovering the risks and benefits of early fetal reduction in trichorionic triplets in a large national Danish cohort study
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Triple trouble : uncovering the risks and benefits of early fetal reduction in trichorionic triplets in a large national Danish cohort study. / Kristensen, Steffen Ernesto; Ekelund, Charlotte Kvist; Sandager, Puk; Jørgensen, Finn Stener; Hoseth, Eva; Sperling, Lene; Zingenberg, Helle Jeanette; Duelund Hjortshøj, Tina; Gadsbøll, Kasper; Wright, Alan; Wright, David; McLennan, Andrew; Sundberg, Karin; Petersen, Olav Bjørn.
In: American Journal of Obstetrics and Gynecology, Vol. 229, No. 5, 2023, p. 555.e1-555.e14.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Triple trouble
T2 - uncovering the risks and benefits of early fetal reduction in trichorionic triplets in a large national Danish cohort study
AU - Kristensen, Steffen Ernesto
AU - Ekelund, Charlotte Kvist
AU - Sandager, Puk
AU - Jørgensen, Finn Stener
AU - Hoseth, Eva
AU - Sperling, Lene
AU - Zingenberg, Helle Jeanette
AU - Duelund Hjortshøj, Tina
AU - Gadsbøll, Kasper
AU - Wright, Alan
AU - Wright, David
AU - McLennan, Andrew
AU - Sundberg, Karin
AU - Petersen, Olav Bjørn
N1 - Funding Information: O.B.P. was financially supported by a grant from the Novo Nordisk Foundation , Denmark (grant number: NNFSA170030576 ). The Novo Nordisk Foundation did not participate in any part of the study design, collection, analysis, interpretation, writing of the manuscript, or decision to submit the article for publication. Publisher Copyright: © 2023 The Author(s)
PY - 2023
Y1 - 2023
N2 - Background: Triplet pregnancies are high risk for both the mother and the infants. The risks for infants include premature birth, low birthweight, and neonatal complications. Therefore, the management of triplet pregnancies involves close monitoring and may include interventions, such as fetal reduction, to prolong the pregnancy and improve outcomes. However, the evidence of benefits and risks associated with fetal reduction is inconsistent. Objective: This study aimed to compare the outcomes of trichorionic triplet pregnancies with and without fetal reduction and with nonreduced dichorionic twin pregnancies and primary singleton pregnancies. Study Design: All trichorionic triplet pregnancies in Denmark, including those with fetal reduction, were identified between 2008 and 2018. In Denmark, all couples expecting triplets are informed about and offered fetal reduction. Pregnancies with viable fetuses at the first-trimester ultrasound scan and pregnancies not terminated were included. Adverse pregnancy outcome was defined as a composite of miscarriage before 24 weeks of gestation, stillbirth at 24 weeks of gestation, or intrauterine fetal death of 1 or 2 fetuses. Results: The study cohort was composed of 317 trichorionic triplet pregnancies, of which 70.0% of pregnancies underwent fetal reduction to a twin pregnancy, 2.2% of pregnancies were reduced to singleton pregnancies, and 27.8% of pregnancies were not reduced. Nonreduced triplet pregnancies had high risks of adverse pregnancy outcomes (28.4%), which was significantly lower in triplets reduced to twins (9.0%; difference, 19.4%, 95% confidence interval, 8.5%–30.3%). Severe preterm deliveries were significantly higher in nonreduced triplet pregnancies (27.9%) than triplet pregnancies reduced to twin pregnancies (13.1%; difference, 14.9%, 95% confidence interval, 7.9%–21.9%). However, triplet pregnancies reduced to twin pregnancies had an insignificantly higher risk of miscarriage (6.8%) than nonreduced twin pregnancies (1.1%; difference, 5.6%; 95% confidence interval, 0.9%–10.4%). Conclusion: Triplet pregnancies reduced to twin pregnancies had significantly lower risks of adverse pregnancy outcomes, severe preterm deliveries, and low birthweight than nonreduced triplet pregnancies. However, triplet pregnancies reduced to twin pregnancies were potentially associated with a 5.6% increased risk of miscarriage.
AB - Background: Triplet pregnancies are high risk for both the mother and the infants. The risks for infants include premature birth, low birthweight, and neonatal complications. Therefore, the management of triplet pregnancies involves close monitoring and may include interventions, such as fetal reduction, to prolong the pregnancy and improve outcomes. However, the evidence of benefits and risks associated with fetal reduction is inconsistent. Objective: This study aimed to compare the outcomes of trichorionic triplet pregnancies with and without fetal reduction and with nonreduced dichorionic twin pregnancies and primary singleton pregnancies. Study Design: All trichorionic triplet pregnancies in Denmark, including those with fetal reduction, were identified between 2008 and 2018. In Denmark, all couples expecting triplets are informed about and offered fetal reduction. Pregnancies with viable fetuses at the first-trimester ultrasound scan and pregnancies not terminated were included. Adverse pregnancy outcome was defined as a composite of miscarriage before 24 weeks of gestation, stillbirth at 24 weeks of gestation, or intrauterine fetal death of 1 or 2 fetuses. Results: The study cohort was composed of 317 trichorionic triplet pregnancies, of which 70.0% of pregnancies underwent fetal reduction to a twin pregnancy, 2.2% of pregnancies were reduced to singleton pregnancies, and 27.8% of pregnancies were not reduced. Nonreduced triplet pregnancies had high risks of adverse pregnancy outcomes (28.4%), which was significantly lower in triplets reduced to twins (9.0%; difference, 19.4%, 95% confidence interval, 8.5%–30.3%). Severe preterm deliveries were significantly higher in nonreduced triplet pregnancies (27.9%) than triplet pregnancies reduced to twin pregnancies (13.1%; difference, 14.9%, 95% confidence interval, 7.9%–21.9%). However, triplet pregnancies reduced to twin pregnancies had an insignificantly higher risk of miscarriage (6.8%) than nonreduced twin pregnancies (1.1%; difference, 5.6%; 95% confidence interval, 0.9%–10.4%). Conclusion: Triplet pregnancies reduced to twin pregnancies had significantly lower risks of adverse pregnancy outcomes, severe preterm deliveries, and low birthweight than nonreduced triplet pregnancies. However, triplet pregnancies reduced to twin pregnancies were potentially associated with a 5.6% increased risk of miscarriage.
KW - adverse pregnancy outcome
KW - chance of live born
KW - Danish national cohort
KW - embryo reduction
KW - multifetal pregnancy
KW - multifetal pregnancy reduction
KW - multiples
KW - pregnancy complications
KW - preterm birth
KW - preterm delivery
KW - reproductive autonomy
KW - selective termination
U2 - 10.1016/j.ajog.2023.05.029
DO - 10.1016/j.ajog.2023.05.029
M3 - Journal article
C2 - 37263399
AN - SCOPUS:85166190147
VL - 229
SP - 555.e1-555.e14
JO - American Journal of Obstetrics & Gynecology
JF - American Journal of Obstetrics & Gynecology
SN - 0002-9378
IS - 5
ER -
ID: 370802334