Perinatal outcomes in vanishing twin pregnancies following assisted reproductive technology (ART) – a systematic review and meta-analysis

Fan Zhou 1 , Yaqian Li 1 , He Wang 1 , Shanling Liu 1 ,  and Xiaodong Wanghttp://orcid.org/https://orcid.org/0000-0002-0164-1251 1
  • 1 Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, P.R. China
Fan Zhou
  • Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, P.R. China
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, Yaqian Li
  • Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, P.R. China
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, He Wang
  • Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, P.R. China
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, Shanling Liu
  • Corresponding author
  • Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, P.R. China
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and Xiaodong WangORCID iD: https://orcid.org/0000-0002-0164-1251
  • Corresponding author
  • Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, P.R. China
  • orcid.org/0000-0002-0164-1251
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Abstract

Objectives

To compare the fetal and maternal outcomes in surviving singletons of vanishing twin, with singletons or twins, in pregnancies following assisted reproductive technology (ART).

Content

We searched the PubMed, Embase, Web of Science and Cochrane databases from the time of conception of the database until Dec 2019 to identify relevant published studies. Perinatal outcomes were synthesized with random effects meta-analysis using RevMan 5.3.

Summary and Outlook

Fifteen studies were included. Dichorionic twin pregnancies conceived by ART wherein the vanishing twin phenomenon occurred had a risk of fetal malformation similar to that of ART singleton pregnancies (OR=1.25; 95% CI 0.87–1.79) and a higher risk of fetal malformation compared with ART twin pregnancies (OR=1.82; 95% CI 1.23–2.70). Moreover, the remaining fetus in ART vanishing twin pregnancy was at a significantly higher risk of preterm birth (<37 weeks) compared to fetuses in ART singleton pregnancies (OR=2.41; 95% CI 1.46–3.99) and a markedly lower risk of preterm birth (<37 weeks) compared to the fetuses in ART twin pregnancies (OR=0.19; 95% CI 0.16–0.22). Meanwhile, the risk of delivery of infants who were small for gestational age (SGA) was significantly higher in ART vanishing twin pregnancies compared to that in ART singleton pregnancies (OR=2.70; 95% CI 1.39–5.24) and similar to that in ART twin pregnancies (OR=0.67; 95% CI 0.27–1.65).

The risks of preterm birth and of the infant being SGA is higher for the remaining fetus in an ART vanishing twin pregnancy compared to those for the fetuses in ART singleton pregnancies; the risk of fetal malformation is also higher in such cases compared with ART twin pregnancies.

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