IVF babies with ROP at higher gestational age and birth weight: implications of changing screening criteria
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《英国眼科学杂志》
Department of Paediatric Ophthalmology, Chelsea and Westminster Hospital London, UK
Correspondence to:
MissMeg Minasian
Chelsea and Westminster Hospital, 369, Fulham Road, London SW10 9NH, UK; megminasian@hotmail.com
Accepted for publication 14 January 2005
Keywords: retinopathy of prematurity; in vitro fertilisation; screening guidelines
There is interest in reducing the criteria for retinopathy of prematurity (ROP) screening below the current guidelines of less than 32 weeks gestation and birth weight less than 1501 g.
Here we present three babies conceived by in vitro fertilisation (IVF) who were close to the limits of the current criteria and would not be identified should such changes be made.
Case reports
A female baby, twin 2 of an IVF pregnancy, born at 31+4 weeks with a birth weight of 1.27 kg developed bilateral stage 3 ROP with mild vascular changes (pre-plus disease), but did not reach the threshold for treatment.
A male baby, twin 1 of an IVF pregnancy, born at 31+5 weeks with a birth weight of 1.245 kg developed ROP that although sub-threshold was considered to require treatment. This was undertaken at 44 weeks postmenstrual age (PMA) and he responded well to laser therapy, with regression in both eyes.
A female baby, triplet 2 of an IVF pregnancy, born at 32 weeks with a birth weight of 1.31 kg developed bilateral stage 3 ROP. There was minimal vascular congestion and the retinopathy resolved spontaneously.
Comment
Babies born after assisted conception are more likely to be born preterm and of low birth weight.1 This appears to be the result of increased numbers of multiple births with assisted conception (23% compared to 1% of those conceived naturally)2; both birth weight and gestational age fall in direct relation to the multiplicity of the pregnancy.
However, even singleton births resulting from assisted conception are more likely to be premature and of low birth weight than those conceived naturally.2–4
Watts and Adams reported that IVF infants with ROP had lower gestational age and birth weight than those IVF infants who did not develop ROP.5 They also reported that assisted conception using IVF appears to be a risk factor for development of threshold ROP. Additionally, they reported a non-statistical trend for the IVF infants with stage 3 ROP to have a higher gestational age and birth weight than the non-IVF infants with stage 3 disease.
Blumenfeld et al,6 in a large series, reported no difference in the incidence or severity of ROP between singleton and multiple gestation babies.
The different outcomes of assisted conception have been postulated to be because the gametes are exposed to a variety of drugs, physically manipulated, nurtured in potentially hazardous conditions, and perhaps placed in an inappropriate uterine environment.4
Retinopathy of prematurity may affect larger and more mature babies who are conceived by IVF than those who are not. The three babies described here all developed ROP despite gestational ages greater than 31 weeks and birth weights greater than 1200 g. If the criteria for ROP screening are changed in the future, it is possible that some babies who develop ROP might fall outside the guidelines for screening.
References
McKibbin M, Dabbs TR. Assisted conception and retinopathy of prematurity. Eye 1996;10:476–8.
MRC Working Party on Children Conceived by In Vitro Fertilisation. Birth in Great Britain resulting from assisted conception, 1978–87. BMJ 1990;300:1229–33.
Luke B. The changing pattern of multiple births in the United States: maternal and infant characteristics. 1973 and 1990. Obstet Gynecol 1994;84:101–6.
McFaul PB, Patel N, Mills J. An audit of the obstetric outcome of a 148 consecutive pregnancies from assisted conception: implications for neonatal services. Br J Obstet Gynaecol 1003;100:820–5.
Watts P, Adams GGW. In vitro fertilisation and stage 3 retinopathy. Eye 1996;10:476–8.
Blumenfeld LC, Siatowski RM, Feuer WJ, et al. Retinopathy of prematurity in multiple-gestation pregnancies. Am J Ophthalmol 1998;125:197–203.(M Minasian and A Fielder)
Correspondence to:
MissMeg Minasian
Chelsea and Westminster Hospital, 369, Fulham Road, London SW10 9NH, UK; megminasian@hotmail.com
Accepted for publication 14 January 2005
Keywords: retinopathy of prematurity; in vitro fertilisation; screening guidelines
There is interest in reducing the criteria for retinopathy of prematurity (ROP) screening below the current guidelines of less than 32 weeks gestation and birth weight less than 1501 g.
Here we present three babies conceived by in vitro fertilisation (IVF) who were close to the limits of the current criteria and would not be identified should such changes be made.
Case reports
A female baby, twin 2 of an IVF pregnancy, born at 31+4 weeks with a birth weight of 1.27 kg developed bilateral stage 3 ROP with mild vascular changes (pre-plus disease), but did not reach the threshold for treatment.
A male baby, twin 1 of an IVF pregnancy, born at 31+5 weeks with a birth weight of 1.245 kg developed ROP that although sub-threshold was considered to require treatment. This was undertaken at 44 weeks postmenstrual age (PMA) and he responded well to laser therapy, with regression in both eyes.
A female baby, triplet 2 of an IVF pregnancy, born at 32 weeks with a birth weight of 1.31 kg developed bilateral stage 3 ROP. There was minimal vascular congestion and the retinopathy resolved spontaneously.
Comment
Babies born after assisted conception are more likely to be born preterm and of low birth weight.1 This appears to be the result of increased numbers of multiple births with assisted conception (23% compared to 1% of those conceived naturally)2; both birth weight and gestational age fall in direct relation to the multiplicity of the pregnancy.
However, even singleton births resulting from assisted conception are more likely to be premature and of low birth weight than those conceived naturally.2–4
Watts and Adams reported that IVF infants with ROP had lower gestational age and birth weight than those IVF infants who did not develop ROP.5 They also reported that assisted conception using IVF appears to be a risk factor for development of threshold ROP. Additionally, they reported a non-statistical trend for the IVF infants with stage 3 ROP to have a higher gestational age and birth weight than the non-IVF infants with stage 3 disease.
Blumenfeld et al,6 in a large series, reported no difference in the incidence or severity of ROP between singleton and multiple gestation babies.
The different outcomes of assisted conception have been postulated to be because the gametes are exposed to a variety of drugs, physically manipulated, nurtured in potentially hazardous conditions, and perhaps placed in an inappropriate uterine environment.4
Retinopathy of prematurity may affect larger and more mature babies who are conceived by IVF than those who are not. The three babies described here all developed ROP despite gestational ages greater than 31 weeks and birth weights greater than 1200 g. If the criteria for ROP screening are changed in the future, it is possible that some babies who develop ROP might fall outside the guidelines for screening.
References
McKibbin M, Dabbs TR. Assisted conception and retinopathy of prematurity. Eye 1996;10:476–8.
MRC Working Party on Children Conceived by In Vitro Fertilisation. Birth in Great Britain resulting from assisted conception, 1978–87. BMJ 1990;300:1229–33.
Luke B. The changing pattern of multiple births in the United States: maternal and infant characteristics. 1973 and 1990. Obstet Gynecol 1994;84:101–6.
McFaul PB, Patel N, Mills J. An audit of the obstetric outcome of a 148 consecutive pregnancies from assisted conception: implications for neonatal services. Br J Obstet Gynaecol 1003;100:820–5.
Watts P, Adams GGW. In vitro fertilisation and stage 3 retinopathy. Eye 1996;10:476–8.
Blumenfeld LC, Siatowski RM, Feuer WJ, et al. Retinopathy of prematurity in multiple-gestation pregnancies. Am J Ophthalmol 1998;125:197–203.(M Minasian and A Fielder)