FOLLOW-UP OF PREGNANCIES, INFANTS, AND FAMILIES AFTER MULTIFETAL PREGNANCY REDUCTION

Objective: To evaluate the course of multifetal pregnancies and also the long-term pediatric and psychosocial follow-up of surviving offspring and their parents after selective reduction. Design: Follow-up study. Setting: University hospital and subject's homes. Patients: Twenty-one couples with high-order multiple pregnancies resulting from infertility treatment were referred from all over the Netherlands. A total of 36 infants (15 twins and 2 triplets) were included in the follow-up. Intervention: Pregnancy reduction by transabdominal approach at a median of 11 (9 to 13) weeks gestation. One assessment took place between the age of 9 months and 6 years after delivery. Main Outcome Measures: Pregnancy outcome, health of the infants, and psychosocial impact upon their parents after infertility treatment and the multifetal pregnancy reduction. Results: Abortion within 4 weeks after pregnancy reduction did not occur in this series. Six infants (13.7%) died perinatally. Two infants (4.4%) died at the ages of 12 days and 3 months, respectively. Early preterm delivery was the cause of death in all cases. The development of the infants was appropriate to gestational age and birth weight. At follow-up, 14 couples disclosed at the time they were unaware of the risks and the consequences of infertility treatment. Nine couples indicated they had feelings of guilt after pregnancy reduction. These feelings, however, were not disclosed at the time of the interviews, during which none of the families showed either regret or distress about their decision. Two couples only occasionally experienced some grief and mourning reactions for the reduced fetuses. Conclusions: Pregnancy reduction is an acceptable option in the case of excessive multifetal conceptions after infertility treatment regimes. There are no adverse effects on either the infants and their families provided that the procedure is carefully planned and performed and the couples are given full support both before and after the procedure.