The prevalence of unplanned pregnancy ending in birth, associated factors, and health outcomes.

STUDY QUESTION: What are associated factors of unplanned pregnancies ending in birth? SUMMARY ANSWER: Pregnancies that were less planned were associated with women of lower socio-economic status (SES), an unhealthier lifestyle before and during the pregnancy, more stress, and less social support. WHAT IS KNOWN ALREADY: In Europe, the prevalence of unplanned pregnancy leading to birth varies. Unplanned pregnancy is more common among socially disadvantaged women, and associated with adverse pregnancy outcomes. STUDY DESIGN, SIZE, DURATION: In a cross-sectional study, 517 women were recruited from May through September 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women were recruited from six hospitals in Flanders, Belgium. Data from self-report and medical records were collected during the first 5 days postpartum. The validated London Measure of Unplanned Pregnancy was used to collect data regarding pregnancy planning. Data were analysed with Mann-Whitney U tests, Kruskal-Wallis tests, and multiple linear regression analysis. MAIN RESULTS AND THE ROLE OF CHANCE: The majority of the pregnancies (83%) ending in birth were planned, 15% were ambivalent, and 2% unplanned. Women who are multigravida (95% CI -0.30 to -0.02), less well educated (95% CI 0.07-0.85), single or having a non-cohabiting relationship (95% CI 0.01-2.53), having history of drug abuse (95% CI -2.07 to -0.35), and experiencing intimate partner violence (95% CI -3.82 to -1.59) tended to have a significantly higher risk of a less planned pregnancy. Less planned pregnancies were significantly associated with initially unwanted pregnancies (P < 0.001), no folic acid or vitamin use before pregnancy (P < 0.001), lower number of prenatal visits (P = 0.03), smoking during pregnancy (P < 0.001), more stress (P = 0.002), lower relationship satisfaction (P = 0.001), and less social support (P < 0.001). Less planned pregnancies were also significantly associated with hyperemesis (P < 0.001) and shorter duration of delivery (P = 0.03). No differences were found in neonatal outcomes. LIMITATIONS, REASONS FOR CAUTION: The prevalence of unplanned pregnancies is probably underestimated due to overrepresentation of women with higher SES in this study. Women's emotions may have influenced the answer to certain questions. Owing to the cross-sectional design, no causal relationships could be established. WIDER IMPLICATIONS OF THE FINDINGS: This study emphasizes the importance of targeting socially disadvantaged women in the prevention of unplanned pregnancies. STUDY FUNDING/COMPETING INTERESTS: This study was funded by the Research Foundation - Flanders (FWO). The authors have no conflict of interests. TRIAL REGISTRATION NUMBER: Not applicable.

[Single embryo transfer]. / In Process Citation.

Thanks to assisted reproduction technology (ART) most couples with infertility can be helped today. Since the beginning of ART, however, two major problems have existed. In the first years of IVF more than one embryo was transferred in order to reach acceptable pregnancy rates, but this entails a risk of multiple pregnancy with all its morbidity and mortality due to premature birth. Also, studies comparing the outcome of children following ART with the outcome of children who were spontaneously conceived, showed that ART increased the risk of prematurity and low birth weight, even in singleton pregnancies. The transfer of just one embryo (single embryo transfer or SET) in IVF/ICSI treatment cycles appeared to be the only answer to the epidemic of multiple pregnancies. The studies which analyze the outcome of SET singletons are promising, since they suggest that a broader application of SET could have a positive influence on the outcome of pregnancies after ART as well.

Human chorionic gonadotropin levels in early IVF/ICSI pregnancies are higher in singletons after single embryo transfer compared with singletons after double embryo transfer.

BACKGROUND: The aim of this study is to assess differences in human chorionic gonadotropin (hCG) values between singleton IVF/ICSI pregnancies after elective single (eSET) versus double embryo transfer (DET). METHODS: This is a unicentre, retrospective, non-randomized study of women with eSET or DET in years 2000-2006, giving birth to a singleton child with a birthweight of at least 500 g (N = 790). These women had between 1 and 6 hCG assessments in our centre. Log hCG values from Days 15 to 35 after oocyte pick-up were compared between eSET and DET patients in a multivariate analysis. RESULTS: We compared log hCG values in 456 eSET patients with log hCG values in 334 DET patients. Log hCG values were significantly higher after eSET than after DET from Day 15 until Day 35 after oocyte pick-up (P < 0.001). CONCLUSION: The lower hCG values in early pregnancy are possibly due to a delay in implantation when two embryos are transferred and one of them does not implant, but the exact mechanism is unknown.

Implantation of the human embryo: clinical and epidemiological aspects.

The aim of this thesis is to define determinants of impaired implantation and adverse pregnancy outcome in a retrospective manner. Our results demonstrate that pregnancy outcome in singletons of older mothers (> or = 35 years) is less favourable when compared with younger mothers (25-29 years). Remarkably, the same can not be said of twin pregnancies in older mothers. Twins fare better when their mother is older than 34 years. In another study, we found higher incidences of velamentous cord insertion in twins after assisted reproduction, compared with naturally conceived twins. The incidence increased along with invasiveness of the applied technique. Since the aetiology of velamentous cord insertion occurs very early in the implantation--phase, we hypothesize that increased embryo manipulation has an effect on the implantation of the human embryo. Other results show that more advantageous pregnancy outcome may be expected when there is maximal implantation potential in assisted reproduction. We first hypothesized that the more advantageous pregnancy outcome in singletons after single embryo transfer (SET) was attributable to a vanishing--twin effect in singletons after double embryo transfer (DET). However, our results indicated higher mean hCG--values in singletons after SET when compared with singletons after DET. As a consequence, we concluded that less good outcomes in singletons after DET are not attributable to an early decease of the embryo. Probably only one embryo implants, but this implantation may be hampered by the other not--implanting embryo.

Birth weight for gestational age among Flemish twin population.

OBJECTIVE: The aim of this study was to develop birth weight references for twins. Mean birth weights of individual twins are lower than those of singletons, hence singleton birth weight curves may not be suitable to assess twin birth weights. STUDY DESIGN: Twin birth weight curves were developed according to gestational age, gender, parity and mode of -conception. The curves are based on population-based data of 40,494 twins born in Flanders, Belgium between 1987 and 2007. RESULTS: A different growth potential was found comparing the birth weights of twins and singletons. Twins deviate from the singleton curve from 30 weeks gestational age on. CONCLUSION: Our study underlines that singleton birth weight curves differ from twin birth weight curves. We developed specific twin birth weight curves can be used in clinical practice in order to follow growth patterns of twins in utero.

Umbilical cord anomalies are more frequent in twins after assisted reproduction.

BACKGROUND: The objective of this study is to analyse differences in cord characteristics between naturally conceived twins and twins born after assisted reproduction. METHODS: Between 1985 and 2004, the East Flanders Prospective Twin Survey (EFPTS) registered 4159 twin pairs. We compared cord characteristics between 2119 naturally conceived dizygotic (DZ) twin members and 2243 DZ twin members originating from assisted reproductive technologies (ART). Data were adjusted for intra-twin correlation, year of birth, maternal age, gestational age, parity, sex of the child and number of placentas. RESULTS: Marginal cord insertion, velamentous cord insertion and single umbilical artery (SUA) occur more frequently in twins following infertility treatment (P < 0.001). The incidence of velamentous cord insertion increases proportionate with 'invasiveness' of reproductive techniques: 3.6% in naturally conceived twins versus 5% in twins after artificial induction of ovulation (AIO) [odds ratio (OR) 1.45; 95% confidence interval (CI) 0.99-2.11], 7.4% in twins after IVF (OR 1.49; 95% CI 1.26-1.77) and 10.4% in twins after ICSI (OR 1.31; 95% CI 1.14-1.51). SUA has the highest incidence in twins after AIO: 1.9% compared with 0.6% in naturally conceived twins (OR 3.19; 95% CI 1.66-6.11). CONCLUSIONS: Umbilical cords of twins born after ART have more pathologic characteristics when compared with cords of naturally conceived twins.