From the Research
Reduction to a singleton in triplet pregnancy does not consistently reduce the risk of gestational diabetes and pre-eclampsia. While multifetal pregnancy reduction (MFPR) can decrease some pregnancy complications associated with higher-order multiples, the evidence specifically for gestational diabetes and pre-eclampsia is mixed. Some studies suggest modest reductions in pre-eclampsia rates after reduction to singleton, but the effect is not as pronounced as the reduction in preterm birth risk. For gestational diabetes, the evidence is even less conclusive, as this condition is influenced by multiple factors beyond fetal number, including maternal age, BMI, and genetic predisposition, as seen in a study published in the American Journal of Obstetrics and Gynecology 1. The primary benefits of reduction to singleton in triplet pregnancies are decreased risks of extreme prematurity, low birth weight, and neonatal mortality. When considering MFPR, patients should understand that while it may reduce overall pregnancy complications, it cannot eliminate all risks associated with initially higher-order pregnancies, and the procedure itself carries risks including complete pregnancy loss (approximately 5-7%), as noted in a retrospective nationwide cohort study published in Fetal Diagnosis and Therapy 2. Key factors influencing the risk of gestational diabetes and pre-eclampsia include maternal characteristics such as age, BMI, and pre-existing medical conditions, as highlighted in studies published in the European Journal of Obstetrics, Gynecology, and Reproductive Biology 3 and the Journal of Diabetes 4. Additionally, twin pregnancies have been found to have a higher risk of hypertension but not gestational diabetes compared to singleton pregnancies, according to research published in the Archives of Gynecology and Obstetrics 5. The decision to undergo MFPR requires careful consideration of medical, ethical, and personal factors with guidance from maternal-fetal medicine specialists. Considering the most recent and highest quality evidence, the benefits of reduction to singleton in triplet pregnancies should be weighed against the potential risks and the individual patient's circumstances. In terms of gestational diabetes and pre-eclampsia specifically, the evidence does not strongly support a significant reduction in risk with MFPR, emphasizing the need for personalized counseling and management. Ultimately, the goal is to minimize morbidity, mortality, and improve quality of life for both the mother and the fetus, and decisions should be made with these outcomes in mind.