Multifetal pregnancy reduction: A possible risk factor for periventricular leukomalacia in premature newborns

Objective: To investigate the possible role of multifetal pregnancy reduction as a risk factor for the development of periventricular leukomalacia, which has been associated with prematurity and twin pregnancies. Design: A case-control study. Setting: In Vitro Fertilization Unit and Intensive Care Nursery of the Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Patient(s): A total of 1,401 consecutive preterm infants who were born between January 1, 1994, and December 31, 1995. Intervention(s): Cranial ultrasonographic evaluation of each infant within 3 days of birth. Main Outcome Measure(s): Premature infants who developed periventricular leukomalacia (cases) were compared with premature infants who did not develop this disorder (controls) when multifetal pregnancy reduction was considered. Result(s): Fourteen premature infants developed periventricular leukomalacia. Of these, 28.6% (4 infants) were exposed to multifetal pregnancy reduction, compared with 1.9% of the controls, giving an odds ratio (OR) of 20.9 (95% confidence interval [CI] 5.5-79.4). Adjustment of this OR for IVF treatment (OR, 18.6; 95% CI 1.8-140.3), twinning (OR, 6.3; 95% CI, 1.3-30.3), and for both IVF treatment and twinning simultaneously (OR, 8,5; 95% CI, 1.7-42.2) did not explain all the observed associations between periventricular leukomalacia and multifetal pregnancy reduction. Conclusion(s): Our data suggest that multifetal pregnancy reduction may be an additional risk factor for periventricular leukomalacia among premature infants, regardless of twinning.