Risikoprävention bei Geminigraviditäten und Schwangerschaften nach assistierter Reproduktion

Zusammenfassung

Hintergrund und Fragestellung: Zwillingsschwangerschaften und Graviditäten nach assistierter Reproduktion stellen aufgrund der erhöhten Rate an Komplikationen spezifische geburtshilfliche Risikokonstellationen dar. Die Auswirkungen medizinischer Maßnahmen zur Verhinderungen von Komplikationen bei diesen Konstellationen ist bis dato wenig erforscht.

Methodik: Die vorliegende Arbeit beinhaltet eine selektive Literaturübersicht über präventive Optionen für Schwangerschaftskomplikationen wie hypertensive Erkrankungen, Anämie, Gestationsdiabetes, Frühgeburtlichkeit und andere, die bei Zwillingsgraviditäten und Schwangerschaften nach assistierter Reproduktion signifikant häufiger auftreten.

Ergebnisse: In der Mehrzahl der Fälle sind Präventionsmaßnahmen für komplikationsträchtige Mehrlingsschwangerschaften und Graviditäten nach IVF/ICSI nicht speziell untersucht. Für einige Maßnahmen können sogar überwiegend negative Effekte nicht ausgeschlossen werden.

Schlussfolgerung: Die Datenlage zur speziellen Primärprävention von Komplikationen bei Zwillingsschwangerschaften und Gravidität nach IVF/ICSI ist als spärlich zu bezeichnen. Prospektive Studien sind daher dringend notwendig, um die Bedeutung präventiver Maßnahmen in diesen Risikokonstellationen zu ermitteln.

Abstract

Background: Twin pregnancies and gestations after assisted reproductive therapy (ART) are of special obstetric significance with regard to their associated risks. However, little is known about preventive approaches specifically evaluated for these constellations.

Methods: A selective literature search was conducted to examine possible preventive approaches for complications such as hypertensive disorders, anaemia, gestational diabetes, prematurity, and others, seen significantly more often in twin gestations and pregnancies after ART.

Results: For both constellations, preventive approaches are not specifically evaluated for the majority of complications. For some preventive methods a possible detrimental effect cannot even be ruled out.

Conclusions: The knowledge about specific preventive approaches against complications in twin pregnancies and gestations after ART is scarce. More prospective trials are urgently needed to assess the risks and benefits of prophylactic approaches for these risk constellations.

Schwangerschaft - Zwillinge - assistierte Reproduktion - spezifische Risiken - Prävention

pregnancy - twins - assisted reproduction - specific risks - prevention

Literatur

• 1 Ward Platt MP, Glinianaia SV, Rankin J. et al . The North of England Multiple Pregnancy Register: Five-year results of data collection.  Twin Res Hum Genet. 2006;  9 913-918
• 2 Baldwin VJ. Pathology of multiple pregnancy. 1. Auflage 1994, Springer Verlag Berlin Heidelberg, New York
• 3 Bohlmann MK, Fritzsching B, Luedders DW. et al .Einfluss der assistierten Reproduktion auf Geburtshilfe und Neonatologie. Z Geburtsh Neonatol 2009 213: 221-227
• 4 Fauser BC, Devroey P, Macklon NS. Multiple birth resulting from ovarian stimulation for subfertility treatment.  Lancet. 2005;  365 1807-1816
• 5 Jahrbuch 2007 des Deutschen IVF-Registers   http://www.deutsches-ivf-register.de
• 6 Wenstrom KD, Syrop CH, Hammitt DG. et al . Increased risk of monochorionic twinning associated with assisted reproduction.  Fertil Steril. 1993;  60 510-514
• 7 Knopman J, Krey LC, Lee J. et al . Monozygotic twinning: An eight-year experience at a large IVF center.  Fertil Steril. 2009 Apr 29;  [Epub ahead of print] 
• 8 Oleszczuk JJ, Cervantes A, Kiely JL. et al . Maternal race/ethnicity and twinning rates in the United States, 1989–1991.  J Reprod Med. 2001;  46 550-557
• 9 Pharoah PO, Glinianaia SV, Rankin J. Congenital anomalies in multiple births after early loss of a conceptus.  Hum Reprod. 2009;  24 726-731
• 10 Lumley J, Watson L, Watson M. et al . Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects.  Cochrane Database Syst Rev. 2001;  3 CD001056
• 11 Maheshwari A, Scotland G, Bell J. et al . The direct health services costs of providing assisted reproduction services in overweight or obese women: A retrospective cross-sectional analysis.  Hum Reprod. 2009;  24 633-639
• 12 Yogev Y, Visser GH. Obesity, gestational diabetes and pregnancy outcome.  Semin Fetal Neonatal Med. 2009;  14 77-84
• 13 Rackham O, Paize F, Weindling AM. Cause of death in infants of women with pregestational diabetes mellitus and the relationship with glycemic control.  Postgrad Med. 2009;  121 26-32
• 14 Allen VM, Armson BA, Wilson RD. et al . Teratogenicity associated with pre-existing and gestational diabetes.  J Obstet Gynaecol Can. 2007;  29 927-944
• 15 Sibai BM, Hauth J, Caritis S. et al . Hypertensive disorders in twin versus singleton gestations.  Am J Obstet Gynecol. 2000;  182 938-942
• 16 Krotz S, Fajardo J, Ghandi S. et al . Hypertensive disease in twin pregnancies: A review.  Twin Res. 2002;  5 8-14
• 17 Maxwell CV, Lieberman E, Norton M. et al . Relationship of twin zygosity and risk of preeclampsia.  Am J Obstet Gynecol. 2001;  185 819-821
• 18 Savvidou MD, Karanastasi E, Skentou C. et al . Twin chorionicity and pre-eclampsia.  Ultrasound Obstet Gynecol. 2001;  18 228-231
• 19 Schauf B, Bohlmann MK, Wallwiener D. et al . Prophylactic treatment of preeclampsia.  Gynakol Geburtshilfliche Rundsch. 2007;  47 205-208
• 20 Miyakis S, Lockshin MD, Atsumi T. et al . International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS).  J Thromb Haemost. 2006;  4 295-306
• 21 Robertson L, Wu O, Langhorne P. et al . The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study. Thrombophilia in pregnancy: A systematic review.  Br J Haematol. 2006;  132 171-196
• 22 Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) . Diagnostik und Therapie hypertensiver Schwangerschaftserkrankungen. 2008;  http://dggg.de/_download/unprotected/g_03_03_05_diagnostik_therapie_hypertensiver.pdf
• 23 Rey E, Garneau P, David M. et al . Dalteparin for the prevention of recurrence of placental-mediated complications of pregnancy in women without thrombophilia: A pilot randomized controlled trial.  J Thromb Haemost. 2009;  7 58-64
• 24 Bohlmann MK, Luedders DW, Baumann K. et al . Indikationen zur Antikoagulation in der Schwangerschaft.  Geburtsh Frauenheilk. 2009;  69 730-732
• 25 Bohlmann MK, Hornemann A, Ortmann J. et al . Antikoagulation und assistierte Reproduktion – verbesserte Schwangerschafts- und Austragungsraten durch Aspirin und Heparin?.  Gynäkol Endokrinol. 2009;  7 74-79
• 26 Hernández-Díaz S, Werler MM, Louik C. et al . Risk of gestational hypertension in relation to folic acid supplementation during pregnancy.  Am J Epidemiol. 2002;  156 806-812
• 27 Muggli EE, Halliday JL. Folic acid and risk of twinning: A systematic review of the recent literature, July 1994 to July 2006.  Med J Aust. 2007;  186 243-248
• 28 Hirtenlehner K, Huber A, Strohmer H. et al . Reduction of preeclampsia in multiple pregnancies by a dedicated monitoring protocol.  J Soc Gynecol Investig. 2003;  10 418-422
• 29 Ben Miled S, Bibi D, Khalfi N. et al . Iron stocks and risk of anemia in twins.  Arch Inst Pasteur Tunis. 1989;  66 221-241
• 30 Pena-Rosas JP, Viteri FE. Effects of routine oral iron supplementation with or without folic acid for women during pregnancy.  Cochrane Database Syst Rev. 2006;  3 CD004736
• 31 Chiossi G, Quigley MR, Esaka EJ. et al . Nutritional supplementation in monochorionic diamniotic twin pregnancies: impact on twin-twin transfusion syndrome.  Am J Perinatol. 2008;  25 667-672
• 32 Senoo M, Okamura K, Murotsuki J. et al . Growth pattern of twins of different chorionicity evaluated by sonographic biometry.  Obstet Gynecol. 2000;  95 656-661
• 33 Blickstein I. The definition, diagnosis, and management of growth-discordant twins: an international census survey.  Acta Genet Med Gemellol (Roma). 1991;  40 345-351
• 34 Rydhström H. Discordant birthweight and late fetal death in like-sexed and unlike-sexed twin pairs: A population-based study.  Br J Obstet Gynaecol. 1994;  101 765-769
• 35 Blickstein I. Controversial issues in the management of multiple pregnancies.  Twin Res. 2001;  4 165-167
• 36 Jackson RA, Gibson KA, Wu YW. et al . Perinatal outcomes in singletons following in vitro fertilization: A meta-analysis.  Obstet Gynecol. 2004;  103 551-563
• 37 Sivan E, Maman E, Homko CJ. et al . Impact of fetal reduction on the incidence of gestational diabetes.  Obstet Gynecol. 2002;  99 91-94
• 38 Gérardin P, Boumahni B, Choker G. et al . Twin pregnancies in southern Reunion Island: A three-year cross-sectional study of risk factors and complications.  J Gynecol Obstet Biol Reprod (Paris). 2006;  35 804-812
• 39 Rauh-Hain JA, Rana S, Tamez H. et al . Risk for developing gestational diabetes in women with twin pregnancies.  J Matern Fetal Neonatal Med. 2009;  22 293-299
• 40 Buhling KJ, Henrich W, Starr E. et al . Risk for gestational diabetes and hypertension for women with twin pregnancy compared to singleton pregnancy.  Arch Gynecol Obstet. 2003;  269 33-36
• 41 Glueck CJ, Pranikoff J, Aregawi D. et al . Prevention of gestational diabetes by metformin plus diet in patients with polycystic ovary syndrome.  Fertil Steril. 2008;  89 625-634
• 42 Thatcher SS, Jackson EM. Pregnancy outcome in infertile patients with polycystic ovary syndrome who were treated with metformin.  Fertil Steril. 2006;  85 1002-1009
• 43 Glueck CJ, Wang P, Kobayashi S. et al . Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome.  Fertil Steril. 2002;  77 520-525
• 44 Sherer DM, Divon MY. Fetal growth in multifetal gestation.  Clin Obstet Gynecol. 1997;  40 764-770
• 45 Chang YL, Chang SD, Chao AS. et al . Clinical outcome and placental territory ratio of monochorionic twin pregnancies and selective intrauterine growth restriction with different types of umbilical artery Doppler.  Prenat Diagn. 2009;  29 253-256
• 46 Lawn JE, Yakoob MY, Haws RA. et al . 3.2 million stillbirths: epidemiology and overview of the evidence review.  BMC Pregnancy and Childbirth. 2009;  9 S2
• 47 Haws RA, Yakoob MY, Soomro T. et al . Reducing stillbirths: screening and monitoring during pregnancy and labour.  BMC Pregnancy Childbirth. 2009;  9 ((Suppl)) 1: S5
• 48 Aliyu MH, Salihu HM, Wilson RE. et al . Prenatal smoking and risk of intrapartum stillbirth.  Arch Environ Occup Health. 2007;  62 87-92
• 49 Lumley J, Chamberlain C, Dowswell T. et al . Interventions for promoting smoking cessation during pregnancy.  Cochrane Database Syst Rev. 2009;  3 CD001055
• 50 Crowther CA. Hospitalisation and bed rest for multiple pregnancy.  Cochrane Database Syst Rev. 2001;  1 CD000110
• 51 Yamasmit W, Chaithongwongwatthana S, Tolosa JE. et al . Prophylactic oral betamimetics for reducing preterm birth in women with a twin pregnancy.  Cochrane Database Syst Rev. 2005;  3 CD004733
• 52 Drakeley AJ, Roberts D, Alfirevic Z. Cervical stitch (cerclage) for preventing pregnancy loss in women.  Cochrane Database Syst Rev. 2003;  1 CD003253
• 53 Berghella V, Odibo AO, To MS. et al . Cerclage for short cervix on ultrasonography: Meta-analysis of trials using individual patient-level data.  Obstet Gynecol. 2005;  106 181-189
• 54 Eskandar M, Shafiq H, Almushait MA. et al . Cervical cerclage for prevention of preterm birth in women with twin pregnancy.  Int J Gynaecol Obstet. 2007;  99 110-112
• 55 Bohlmann MK, Lüdders DW, Baumann K. et al . Use of progestogen during pregnancy.  Gynäkol Endokrinol. 2008;  6 171-176
• 56 Norman JE, Mackenzie F, Owen P. et al . Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): A randomised, double-blind, placebo-controlled study and meta-analysis.  Lancet. 2009;  373 2034-2040
• 57 Rouse DJ, Caritis SN, Peaceman AM. et al . A trial of 17 alpha-hydroxyprogesterone caproate to prevent prematurity in twins.  N Engl J Med. 2007;  357 454-461
• 58 Thinkhamrop J, Hofmeyr GJ, Adetoro O. et al . Prophylactic antibiotic administration in pregnancy to prevent infectious morbidity and mortality.  Cochrane Database Syst Rev. 2002;  4 CD002250
• 59 McDonald HM, Brocklehurst P, Gordon A. Antibiotics for treating bacterial vaginosis in pregnancy.  Cochrane Database Syst Rev. 2007;  1 CD000262
• 60 Lamont RF. Can antibiotics prevent preterm birth – the pro and con debate.  BJOG. 2005;  112 (S1) 67-73
• 61 Hornemann A, Bohlmann MK, Altgassen C. et al . Primäre Sectiones subventionieren Spontangeburten. Spielen finanzielle Interessen bei der steigenden Sectiorate eine Rolle?.  Geburtsh Frauenheilk. 2008;  68 1082-1088
• 62 Valsecchi L, Serafini A, Maniscalsco L. et al . Actual controversies in twin delivery: From the analysis of the case histories to a reasoned protocol.  Minerva Ginecol. 2009;  61 23-33
• 63 Pasquini L, Wimalasundera RC, Fichera A. et al . High perinatal survival in monoamniotic twins managed by prophylactic sulindac, intensive ultrasound surveillance, and Cesarean delivery at 32 weeks’ gestation.  Ultrasound Obstet Gynecol. 2006;  28 681-687
• 64 Shveiky D, Ezra Y, Schenker JG. et al . Monoamniotic twins: an update on antenatal diagnosis and treatment.  J Matern Fetal Neonatal Med. 2004;  16 180-186
• 65 Peek MJ, McCarthy A, Kyle P. et al . Medical amnioreduction with sulindac to reduce cord complications in monoamniotic twins.  Am J Obstet Gynecol. 1997;  176 334-346
• 66 Koren G, Florescu A, Costei AM. et al . Nonsteroidal antiinflammatory drugs during third trimester and the risk of premature closure of the ductus arteriosus: A meta-analysis.  Ann Pharmacother. 2006;  40 824-829
• 67 Hack KE, Derks JB, Elias SG. et al . Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: Clinical implications of a large Dutch cohort study.  BJOG. 2008;  115 58-67
• 68 Salihu HM, Bekan B, Aliyu MH. et al . Perinatal mortality associated with abruptio placenta in singletons and multiples.  Am J Obstet Gynecol. 2005;  193 198-203
• 69 Raziel A, Schachter M, Friedler S. et al . Outcome of IVF pregnancies following severe OHSS.  Reprod Biomed Online. 2009;  19 61-65
• 70 Yang Q, Wen SW, Phillips K. et al . Comparison of maternal risk factors between placental abruption and placenta previa.  Am J Perinatol. 2009;  26 279-286
• 71 Romundstad LB, Romundstad PR, Sunde A. et al . Increased risk of placenta previa in pregnancies following IVF/ICSI; A comparison of ART and non-ART pregnancies in the same mother.  Hum Reprod. 2006;  21 2353-2358
• 72 Suzuki S, Kikuchi F, Ouchi N. et al . Risk factors for postpartum hemorrhage after vaginal delivery of twins.  J Nippon Med Sch. 2007;  74 414-417
• 73 Winkler M, Rath W. A risk-benefit assessment of oxytocics in obstetric practice.  Drug Saf. 1999;  20 323-345
• 74 Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour.  Cochrane Database Syst Rev. 2000;  3 CD000007
• 75 The ESHRE Capri Workshop Group . Multiple gestation pregnancy.  Hum Reprod. 2000;  15 1856-1864
• 76 Diedrich K, Felberbaum R, Griesinger G. et al .Reproduktionsmedizin im internationalen Vergleich. Wissenschaftlicher Sachstand, medizinische Versorgung und gesetzlicher Regelungsbedarf. Stabsabteilung der Friedrich-Ebert-Stiftung, Hrsg. Berlin 2008 http://library.fes.de/pdf-files/stabsabteilung/05642.pdf
• 77 Vilska S, Unkila-Kallio L, Punamäki RL. et al . Mental health of mothers and fathers of twins conceived via assisted reproduction treatment: A 1-year prospective study.  Hum Reprod. 2009;  24 367-377
• 78 Dennis CL, Creedy D. Psychosocial and psychological interventions for preventing postpartum depression.  Cochrane Database Syst Rev. 2004;  4 CD001134
• 79 Howard LM, Hoffbrand S, Henshaw C. et al . Antidepressant prevention of postnatal depression.  Cochrane Database Syst Rev. 2005;  2 CD004363
• 80 Dennis CL, Ross LE, Herxheimer A. Oestrogens and progestins for preventing and treating postpartum depression.  Cochrane Database Syst Rev. 2008;  4 CD001690

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