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• W3210926624 abstract "We appreciate the comments by Guo et al1Guo Z. Ma J. Yang H. Is twin gestation an independent risk factor for placenta accreta spectrum?.Am J Obstet Gynecol. 2022; 226: 446-447Google Scholar,2Matsuzaki S. Mandelbaum R.S. Sangara R.N. et al.Trends, characteristics, and outcomes of placenta accreta spectrum: a national study in the United States.Am J Obstet Gynecol. 2021; 225: 534.e38Google Scholar regarding the association between multiple gestation and the incidence of placenta accreta spectrum (PAS), and we agree with the author's insights that, multiple gestations may be associated with an increased incidence of PAS. One of the compelling causalities to link the 2 would be the use of assisted reproductive technique (ART), suggesting the importance of the triad of ART, multiple gestation, and PAS.3Jiang F. Gao J. He J. et al.Obstetric outcomes for twins from different conception methods—a multicenter cross-sectional study from China.Acta Obstet Gynecol Scand. 2021; 100: 1061-1067Google Scholar As Guo et al noted, our study population was restricted only to cesarean deliveries; vaginal deliveries were not examined in the analysis.2Matsuzaki S. Mandelbaum R.S. Sangara R.N. et al.Trends, characteristics, and outcomes of placenta accreta spectrum: a national study in the United States.Am J Obstet Gynecol. 2021; 225: 534.e38Google Scholar Therefore, readers should be aware of this limitation and the potential for a skewed study population when interpreting the association between multiple gestation and PAS. Our analysis was also not designed to specifically explore the effect of multiple gestation on PAS. Thus, the observed result may possibly be an effect of multivariable modeling. In a post hoc approach, in attempts to examine the association between multiple gestation, ART, and PAS, we performed an exploratory analysis by fitting a multinomial regression model. The exposure allocation was based on the stratification of ART and multiple gestation. The main outcome measure was set as PAS subtypes, and the adjusting factors were similar to the recent study.4Miller H.E. Leonard S.A. Fox K.A. Carusi D.A. Lyell D.J. Placenta accreta spectrum among women with twin gestations.Obstet Gynecol. 2021; 137: 132-138Google Scholar The results showed that ART and multiple gestation were associated with PAS subtypes (Table). In particular, in the absence of ART, multiple gestation alone was modestly associated with placenta accreta but not placenta increta or percreta. Of interest is the observation that the effect size for placenta accreta was more robust in the 2 ART groups than the multiple gestation without ART group (adjusted odds ratio [aOR], 2.96–3.24 vs aOR, 1.28). Last, pregnancy after ART was significantly more likely to result in multiple gestation (unadjusted odds ratio, 10.5; 95% confidence interval, 10.1–10.8).TableAssociation of multiple gestation, assisted reproductive technology, and placenta accrete spectrum subtypesARTNoYesNoYesMultiple gestationNoNoYesYesAccretaReferent2.96 (2.50–3.52)1.28 (1.16–1.41)3.24 (2.45–4.24)Increta or percretaReferent1.55 (0.83–2.90)0.89 (0.68–1.17)2.23 (0.92–5.38)The study cohort was grouped into the following 4 exposures based on ART and multiple gestation: neither of the 2, ART alone, multiple gestation alone, and both. The outcome was PAS subtypes (accreta or increta/percreta). The exposure-outcome association was assessed in the multinominal regression model, adjusting for age, race or ethnicity, primary expected payer, grand multiparity, and previous cesarean delivery. The effect size was expressed with adjusted odds ratio and corresponding 95% confidence interval.ART, assisted reproductive technology; PAS, placenta accreta spectrum.Matsuzaki. Is twin gestation an independent risk factor for placenta accreta spectrum? Am J Obstet Gynecol 2022. Open table in a new tab The study cohort was grouped into the following 4 exposures based on ART and multiple gestation: neither of the 2, ART alone, multiple gestation alone, and both. The outcome was PAS subtypes (accreta or increta/percreta). The exposure-outcome association was assessed in the multinominal regression model, adjusting for age, race or ethnicity, primary expected payer, grand multiparity, and previous cesarean delivery. The effect size was expressed with adjusted odds ratio and corresponding 95% confidence interval. ART, assisted reproductive technology; PAS, placenta accreta spectrum. Matsuzaki. Is twin gestation an independent risk factor for placenta accreta spectrum? Am J Obstet Gynecol 2022. This finding may raise a plausible hypothesis that ART may increase the incidence of less severe forms of PAS. Together with Guo’s suggestion, the important triad of ART, multiple gestation, and abnormal placentation merits further investigation. Is twin gestation an independent risk factor for placenta accreta spectrum?American Journal of Obstetrics & GynecologyVol. 226Issue 3PreviewWe read with interest the article published in April 2021 by Matsuzaki et al1, which focused on one of the most severe maternal complications known as placenta accreta spectrum (PAS). The study found that among the women who underwent cesarean delivery, multiple gestation was associated with a lower likelihood of having PAS in a national representative sample of the United States. As the authors acknowledged, Miller et al2 reported the opposite results, in which twin gestation was associated with an increased risk of PAS. Full-Text PDF" @default.
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• W3210926624 title "In reply: Is twin gestation an independent risk factor for placenta accreta spectrum?" @default.
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