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Perinatal and Peripartum Outcomes in Vanishing Twin Pregnancies Achieved by In Vitro Fertilization

Romanski, Phillip, A., MD; Carusi, Daniela, A., MD, MSc; Farland, Leslie, V., ScD; Missmer, Stacey, A., ScD; Kaser, Daniel, J., MD; Walsh, Brian, W., MD; Racowsky, Catherine, PhD; Brady, Paula, C., MD

doi: 10.1097/AOG.0000000000002595
Obstetrics: Original Research: PDF Only

OBJECTIVE: To compare perinatal and peripartum outcomes of vanishing twin gestations with singleton and dichorionic twin gestations in pregnancies conceived by in vitro fertilization.

METHODS: We conducted a retrospective cohort study of vanishing twin pregnancies after fresh and cryopreserved autologous in vitro fertilization cycles performed at our institution from 2007 to 2015. Singleton, dichorionic twin, and dichorionic twin pregnancies with spontaneous reduction to one by 14 weeks of gestation (vanishing twins) were included. Analysis was restricted to patients with a live birth delivery at our institution at or beyond 24 weeks of gestation. The primary outcomes were gestational age and birth weight at delivery; secondary outcomes included peripartum morbidities. A subanalysis further differentiated the vanishing twin pregnancies between those in which demise of the twin occurred before compared with after identification of fetal cardiac activity. Logistic regression models were used to estimate the adjusted odds ratio (OR) with a 95% CI of outcomes.

RESULTS: There were 1,189 pregnancies that met inclusion criteria (798 singleton, 291 twin, and 100 vanishing twin). The mean gestational age at birth and birth weights were 38.6±2.3 weeks of gestation and 3,207±644 g in singleton pregnancies, 35.5±2.7 weeks of gestation and 2,539±610 g in twin pregnancies, and 38.5±1.8 weeks of gestation and 3,175±599 g in vanishing twin pregnancies. When compared with twins, those with a vanishing twin had lower odds of preterm delivery (OR 0.13, 95% CI 0.07–0.23; adjusted OR 0.12, 95% CI 0.07–0.22) and small-for-gestational-age birth weight (OR 0.24, 95% CI 0.13–0.45; adjusted OR 0.14, 95% CI 0.07–0.28).

CONCLUSION: In pregnancies conceived by in vitro fertilization that progress to at least 24 weeks of gestation, vanishing twin and singleton pregnancies had similar perinatal and peripartum outcomes. Both were significantly better than twin pregnancies.

In pregnancies conceived by in vitro fertilization, live births after a vanishing twin have similar perinatal and peripartum outcomes as singleton pregnancies but significantly better outcomes than twin pregnancies.

Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; the Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan; and Reproductive Medicine Associates of New Jersey, Basking Ridge, New Jersey.

Corresponding author: Phillip A. Romanski, MD, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115; email: promanski@partners.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Cassandra Thomas for her assistance in data acquisition for this study.

Each author has indicated that he or she has met the journal’s requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.