'Do I want children later in life?' Reproductive intentions of 1700 adolescents.

PURPOSE: In the past decades, a positive attitude towards having children has been reported in young people. The current generation of adolescents is increasingly concerned about environmental cataclysm which may have an impact on their desire for children. The purpose of this study is to depict the current attitudes in Flemish adolescents towards having children. MATERIALS AND METHODS: All secondary schools in Flanders (Belgium) were invited to distribute an anonymous online survey among their pupils in the last two years of secondary education. In total, 1700 adolescents participated and provided quantitative and qualitative data on their reproductive intentions. RESULTS: Most pupils expressed a desire for children (60.2%), 24.7% were undecided and 10.8% were not willing to have children. Significantly more boys than girls would like to have children (67.0% versus 61.7%, p < 0.01). Adolescents who were uncertain about having children or not interested, reported financial reasons and loss of freedom as most important reasons. CONCLUSIONS: While most adolescents would like to have children in the future, one in four adolescents is undecided and one in ten indicates a wish to remain childless; reasons for wanting children are rather personal, reasons for not wanting children are rather pragmatic.

A desire for parenthood is no longer the norm: 60% of Flemish adolescents would like to build a family, but many are considering a future without children.

Women's view on shared decision making and autonomy in childbirth: cohort study of Belgian women.

BACKGROUND: Health care providers have an important role to share evidence based information and empower patients to make informed choices. Previous studies indicate that shared decision making in pregnancy and childbirth may have an important impact on a woman's birth experience. In Flemish social media, a large number of women expressed their concern about their birth experience, where they felt loss of control and limited possibilities to make their own choices. The aim of this study is to explore autonomy and shared decision making in the Flemish population. METHODS: This is a cross-sectional, non-interventional study to explore the birth experience of Flemish women. A self-assembled questionnaire was used to collect data, including the Pregnancy and Childbirth Questionnaire (PCQ), the Labor Agentry Scale (LAS), the Mothers Autonomy Decision Making Scale (MADM), the 9-item Shared Decision Making Questionnaire (SDM-Q9) and four questions on preparation for childbirth. Women who gave birth two to 12 months ago were recruited by means of social media in the Flemish area (Northern part of Belgium). Linear mixed-effect modelling with backwards variable selection was applied to examine relations with autonomy in decision making. RESULTS: In total, 1029 mothers participated in this study of which 617 filled out the survey completely. In general, mothers experienced moderate autonomy in decision-making, both with an obstetrician and with a midwife with an average on the MADM score of respectively 18.5 (± 7.2) and 29.4 (±10.4) out of 42. The linear mixed-effects model showed a relationship between autonomy in decision-making (MADM) for the type of healthcare provider (p < 0.001), the level of self-control during labour and birth (LAS) (p = 0.003), the level of perceived quality of care (PCQ) (p < 0.001), having epidural analgesia during childbirth (p = 0.026) and feeling to have received sufficient information about the normal course of childbirth (p < 0.001). CONCLUSIONS: Childbearing women in Flanders experience moderate levels of autonomy in decision- making with their health care providers, where lower autonomy was observed for obstetricians compared to midwives. Future research should focus more on why differences occur between obstetrics and midwives in terms of autonomy and shared decision-making as perceived by the mother.

Fertility awareness and parenthood intentions among medical students in three European countries.

PURPOSE: The aim of this study was to investigate medical undergraduate students' fertility awareness and parenthood intentions in three European countries, as well as possible differences across genders and countries. MATERIALS AND METHODS: A cross sectional survey among 656 medical students in Sweden, Belgium and Greece. The utilised questionnaire comprised 23 questions. RESULTS: Three fourth of participants (n = 472/629) correctly stated that women are most fertile at 20-25 years of age. Approximately 91% correctly answered that women's fertility starts to significantly decline before the age of 35, which differed among countries of participation. Social oocyte or sperm freezing was considered by 67% of Belgians, 49% Greeks, and 16.5% Swedes (p < 0.001). Approximately 95% expressed a wish of having a child in the future and the median age was 29 years for the first and 35 years for the last child. CONCLUSIONS: Knowledge about fertility among medical students was in general satisfactory, albeit varying by country and gender. Medical curricula and social policies for childbearing should be respectively updated in EU countries suffering population growth.

Knowledge about the impact of age on fertility: a brief review.

Delayed childbearing is currently a major challenge in reproductive medicine as increased age has an important impact on successful conception, both in natural and in assisted reproduction. There is a lack of knowledge about the impact of age on fertility, even in highly educated populations. A number of initiatives have been taken to increase fertility awareness. Health care providers have been encouraged to talk with patients about their reproductive life plan (RLP) for almost a decade based on recommendations from the Centres for Disease Control and Prevention. This concept has been explored successfully in Swedish contraception counselling. A growing number of online interventions aim to raise fertility awareness. These websites or interactive tools provide relevant information for individuals and couples as they consider whether they want children, when they should have them, and how many they may wish to have. These interventions are important, because research depicts that knowledge helps people in their decision-making process. With new fertility preservations such as egg freezing now available, additional education is needed to be sure that women and couples are well informed about the cost and low success rates of this intervention.

Results of a Dutch national and subsequent international expert meeting on interconception care.

Introduction: The potential value of preconception care and interconception care is increasingly acknowledged, but delivery is generally uncommon. Reaching women for interconception care is potentially easier than for preconception care, however the concept is still unfamiliar. Expert consensus could facilitate guidelines, policies and subsequent implementation. A national and subsequent international expert meeting were organized to discuss the term, definition, content, relevant target groups, and ways to reach target groups for interconception care.Methods: We performed a literature study to develop propositions for discussion in a national expert meeting in the Netherlands in October 2015. The outcomes of this meeting were discussed during an international congress on preconception care in Sweden in February 2016. Both meetings were recorded, transcribed and subsequently reviewed by participants.Results: The experts argued that the term, definition, and content for interconception care should be in line with preconception care. They discussed that the target group for interconception care should be "all women who have been pregnant and could be pregnant in the future and their (possible) partners". In addition, they opted that any healthcare provider having contact with the target group should reach out and make every encounter a potential opportunity to promote interconception care.Discussion: Expert discussions led to a description of the term, definition, content, and relevant target groups for interconception care. Opportunities to reach the target group were identified, but should be further developed and evaluated in policies and guidelines to determine the optimal way to deliver interconception care.

Psychometric properties of the Dutch version of the London Measure of Unplanned Pregnancy in women with pregnancies ending in birth.

OBJECTIVE: To evaluate the psychometric properties of the Dutch version of the London Measure of Unplanned Pregnancy in women with pregnancies ending in birth. METHODS: A two-phase psychometric evaluation design was set-up. Phase I comprised the translation from English into Dutch and pretesting with 6 women using cognitive interviews. In phase II, the reliability and validity of the Dutch version of the LMUP was assessed in 517 women giving birth recently. Reliability (internal consistency) was assessed using Cronbach's alpha, inter-item correlations, and corrected item-total correlations. Construct validity was assessed using principal components analysis and hypothesis testing. Exploratory Mokken scale analysis was carried out. RESULTS: 517 women aged 15-45 completed the Dutch version of the LMUP. Reliability testing showed acceptable internal consistency (alpha = 0.74, positive inter-item correlations between all items, all corrected item-total correlations >0.20). Validity testing confirmed the unidimensional structure of the scale and all hypotheses were confirmed. The overall Loevinger's H coefficient was 0.57, representing a 'strong' scale. CONCLUSION: The Dutch version of the LMUP is a reliable and valid measure that can be used in the Dutch-speaking population in Belgium to assess pregnancy planning. Future research is necessary to assess the stability of the Dutch version of the LMUP, and to evaluate its psychometric properties in women with abortions.

Preconception lifestyle changes in women with planned pregnancies.

OBJECTIVES: (1) to study preconception lifestyle changes and associated factors in women with planned pregnancies; (2) to assess the prevalence of risk factors for adverse pregnancy outcomes in women not reporting any preconception lifestyle changes; and (3) to explore the need for and use of preconception-related advice. DESIGN: secondary data analysis of a cross-sectional study about pregnancy planning. SETTING: six Flemish Hospitals (Belgium). PARTICIPANTS: four hundred and thirty women with a planned pregnancy ending in birth. MEASUREMENTS: preconception lifestyle changes were measured during the first 5 days postpartum using the validated London Measure of Unplanned Pregnancy. The following changes were assessed: folic acid or multivitamin intake, smoking reduction or cessation, alcohol reduction or cessation, caffeine reduction or cessation, eating more healthily, achieving a healthier weight, obtaining medical or health advice, or another self-reported preconception lifestyle change. FINDINGS: most women (83%) that planned their pregnancy reported ≥1 lifestyle change in preparation for pregnancy. Overall, nulliparous women (OR 2.18, 95% CI 1.23-3.87) and women with a previous miscarriage (OR 2.44, 95% CI 1.14-5.21) were more likely to prepare for pregnancy, while experiencing financial difficulties (OR 0.20, 95% CI 0.04-0.97) or having a lower educational level (OR 0.56, 95% CI 0.32-0.99) decreased the likelihood of preparing for pregnancy. Half of the women (48%) obtained advice about preconception health, and 86% of these women received their advice from a professional caregiver. Three-quarters (77%) of the women who did not improve their lifestyle before conceiving reported one or more risk factors for adverse pregnancy outcomes. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: multiparous women and women of lower socio-economic status were less likely to change their lifestyle before conception. Strategies to promote preconception health in these women need to be tailored to their needs and characteristics to overcome barriers to change. It may be advantageous to reach these women through non-medical channels, such as schools or other community organizations.

Needs of fathers during labour and childbirth: A cross-sectional study.

Fathers play an important role in the childbearing process, but are sometimes sidelined by midwives. The objectives were: identify fathers' needs during the labor and childbirth process; determine if their needs were met by midwives; and identify variables influencing these needs. The questionnaire was designed based on a systematic literature search and validated by a multistage consensus method. Data were collected during a cross-sectional study in two maternity wards in Belgium, where a medical-led model is used. Fathers present during natural childbirth were recruited via consecutive sampling. Based on multivariate analyses, fathers with a higher education level and multiparous fathers needed less information about the process of birth compared to less educated fathers (p<0.05; OR=4.08; 95% CI=1.02-16.31) or first-time fathers (p<0.001; OR=0.04; 95% CI=0.01-0.18). For multiparous fathers, a tour of the delivery room was less important than for primiparous fathers (p=0.005; OR=0.14; 95% CI=0.03-0.54). Married fathers needed less information on how to support their partners physically (p<0.005; OR=0.18; 95% CI=0.06-0.59) and emotionally (p=0.01; OR=0.24; 95% CI=0.08-0.72) compared to cohabiting fathers. Information needs are more important to fathers compared to needs focusing on the birth experience or their involvement. Socio-demographic variables like educational level, parity, and marital status were associated with fathers' needs. Midwives need to be aware of fathers' needs during the birth process and to fulfill these needs appropriately.

Systematic development of an evidence-based website on preconception care.

INTRODUCTION: In February 2015, the Flemish Minister of Welfare, Public Health and Family launched a website on preconception care: 'gezondzwangerworden.be'. The website was developed in response to the lack of comprehensive communication on preconception care and the inadequate intake of folic acid among Flemish women. Despite the international recommendation to take 400 µg folic acid on a daily basis one month before conception until 12 weeks of pregnancy, studies show a lack of compliance in women wanting to become pregnant. PROCEDURE: A compilation of evidence was made through reviewing well-established guidelines on preconception and prenatal care. The quality of guidelines was assessed by means of AGREE II. The topics included in the website were selected by an internal committee of 5 experts and an external committee of 16 experts. Content validation was carried out by 40 experts in preconception care or related topics. RESULTS: The above-described procedure resulted in an evidence-based website with a selection of relevant, validated information for both women and men who plan a pregnancy and professionals who are consulted by these people. Evaluation and recommendation: The website is currently attracting a constant number of 100 to 200 visitors a day. The information on folic acid is among the most requested, which is an important finding with regard to the policy objectives on preconception care. More research is needed in order to evaluate the use and effect of the website more thoroughly.

Preconception-related needs of reproductive-aged women.

OBJECTIVE: to assess women׳s interest in preconception care, their organisational preferences, and their preconception-related information and support needs. DESIGN: cross-sectional study design. SETTING: participants were recruited online through social media and discussion forums for issues relating to (in)fertility, pregnancy and parenting, and at the Women׳s Clinic of Ghent University Hospital. PARTICIPANTS: 242 reproductive-aged women with a desire to have (more) children. FINDINGS: the majority of women (75%) wanted to receive preconception care in the future. Gynaecologists (93%) were the preferred source of preconception care, followed by midwives (73%) and general practitioners (63%). Most women wanted information about lifestyle, environmental exposures, working conditions and medical issues. Information needs were higher among women with (history of) mental illness [odds ratio (OR) 3.50, 95% confidence interval (CI) 1.08-11.36], (history of) eye and otolaryngological problems (OR 2.22, 95% CI 0.95-5.21) and overweight (OR 2.22, 95% CI 1.01-4.93). A few women indicated that they needed preconception-related support. Overweight women reported greater need for lifestyle-related support compared with women of healthy weight (p=0.001). KEY CONCLUSIONS: reproductive-aged women are interested in preconception care, and would prefer to receive this care directly from a professional caregiver. Most women had high preconception-related information needs and lower support needs. IMPLICATIONS FOR PRACTICE: although women reported that they would prefer to receive preconception care from gynaecologists, the results indicate that midwives can also play an important role in the provision of preconception care. They would need further training to improve their knowledge, skills and awareness regarding preconception care.

The difference in learning culture and learning performance between a traditional clinical placement, a dedicated education unit and work-based learning.

BACKGROUND: An experiment was carried out on the bachelor's degree course in nursing with two new clinical placement concepts: workplace learning and the dedicated education centre. The aim was to establish a learning culture that creates a sufficiently high learning performance for students. OBJECTIVES: The objectives of this study are threefold: (1) to look for a difference in the "learning culture" and "learning performance" in traditional clinical placement departments and the new clinical placement concepts, the "dedicated education centre" and "workplace learning"; (2) to assess factors influencing the learning culture and learning performance; and (3) to investigate whether there is a link between the learning culture and the learning performance. METHOD: A non-randomised control study was carried out. The experimental group consisted of 33 final-year nursing undergraduates who were following clinical placements at dedicated education centres and 70 nursing undergraduates who undertook workplace learning. The control group consisted of 106 students who followed a traditional clinical placement. The "learning culture" outcome was measured using the Clinical Learning Environment, Supervision and Nurse Teacher scale. The "learning performance" outcome consisting of three competencies was measured using the Nursing Competence Questionnaire. RESULTS: The traditional clinical placement concept achieved the highest score for learning culture (p<0.001). The new concepts scored higher for learning performance of which the dedicated education centres achieved the highest scores. The 3 clinical placement concepts showed marked differences in learning performance for the "assessment" competency (p<0.05) and for the "interventions" competency (p<0.05). CONCLUSIONS: Traditional clinical placement, a dedicated education centre and workplace learning can be seen as complementary clinical placement concepts. The organisation of clinical placements under the dedicated education centre concept and workplace learning is recommended for final-year undergraduate nursing students.

Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom.

OBJECTIVES: Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries. METHODS: In 2013, an electronic search and investigation was undertaken of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. Findings were compared within five categories: Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites. RESULTS: All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations for healthy women and men were fragmented and inconsistent. Preconception guidance was often included in antenatal and pregnancy guidelines. Differences between countries were seen with regard to nutritional and lifestyle advice particularly in relation to fish, caffeine and alcohol consumption, and vitamin supplementation. CONCLUSIONS: Current guidelines are heterogeneous. Collaborative research across Europe is required in order to develop evidence-based guidelines for preconception health and care. There is a need to establish a clear strategy for promoting advice and guidance within the European childbearing population.

Communication difficulties and the experience of loneliness in patients with cancer dealing with fertility issues: a qualitative study.

PURPOSE/OBJECTIVES: To explore communication difficulties and the experience of loneliness among patients with cancer dealing with fertility issues. DESIGN: Qualitative study based on grounded theory principles. SETTING: One university hospital and two general hospitals in Flanders, Belgium. SAMPLE: 21 female and 7 male patients with cancer with potential fertility problems as a result of treatment. METHODS: Grounded theory approach using the constant comparison method; data collection (semistructured face-to-face interviews) and analysis occurred simultaneously. FINDINGS: Loneliness was a central theme in the experience of potential fertility loss among patients with cancer. Feelings of loneliness resulted from communication difficulties between the patient and members of his or her social environment or healthcare professionals because of several underlying processes and influencing factors. CONCLUSIONS: Loneliness was a strong and common feeling among patients with cancer. Patients, members of their social environment, and healthcare professionals experienced difficulties in communicating about fertility in the context of cancer, leading to patients' feelings of loneliness. IMPLICATIONS FOR NURSING: Healthcare professionals must be attentive to signs indicating loneliness regarding fertility concerns, and they should provide adequate information and appropriate guidance to support patients. Professionals need further training to improve knowledge and skills.

Cancer patients' and professional caregivers' needs, preferences and factors associated with receiving and providing fertility-related information: a mixed-methods systematic review.

OBJECTIVES: Cancer treatment can impair fertility. The aim of this review was to investigate (1) fertility information needs, receipt and provision, (2) fertility information preferences, and (3) factors associated with receiving/providing fertility information. Cancer patients' and professional caregivers' perspectives were considered. DESIGN: Mixed-methods systematic review. DATA SOURCES: Six electronic databases (PubMed, Web of Science, CINAHL, CRD, Embase) were systematically screened to retrieve articles published between January 2001 and March 2012. Reference lists and conference abstracts were checked for additional publications. REVIEW METHODS: The principles outlined in the Cochrane Handbook for Systematic Reviews of Intervention were applied. Publications were included if they explored fertility-related information/communication in cancer patients/survivors of reproductive age or professional caregivers. The Critical Appraisal Skills Programme for Qualitative Studies and the Quality Assessment Tool for Quantitative Studies were used to assess the methodological quality. A standardised form based on the Cochrane guidelines for systematic reviews was used to extract the data. Two independent reviewers performed all methodological steps. RESULTS: Of the 1872 papers found, 27 were included in this review. The majority (66-100%) of the cancer patients wanted information about the impact of cancer therapy on fertility. The need and importance were higher in younger and childless patients, and in patients having childbearing plans. The number of patients receiving this information ranged from 0% to 85%. Several factors were associated with the lack of information receipt, including female gender and age 35 years or older. Patients preferred information via an individual consultation. In the diagnostic phase patients needed information about the impact of the treatment on fertility and preservation options. At the end or after the treatment, information needs shifted towards long term effects. Professional caregivers experienced several barriers in providing fertility information, including caregiver-, patient- and institutional-related factors. Nurses in particular, perceived difficulty in providing fertility-related information due to additional barriers associated with limited responsibility and opportunity in fertility information provision. CONCLUSION: Professional caregivers experienced multiple barriers that hinder information provision. Further exploration of the role of Advanced Nurse Practitioners/Midwifes and the development of an evidence based intervention to overcome caregiver-related barriers are recommended to improve information provision.

Limiting the caesarean section rate in low risk pregnancies is key to lowering the trend of increased abdominal deliveries: an observational study.

BACKGROUND: As the rate of Caesarean sections (CS) continues to rise in Western countries, it is important to analyze the reasons for this trend and to unravel the underlying motives to perform CS. This research aims to assess the incidence and trend of CS in a population-based birth register in order to identify patient groups with an increasing risk for CS. METHODS: Data from the Flemish birth register 'Study Centre for Perinatal Epidemiology' (SPE) were used for this historic control comparison. Caesarean sections (CS) from the year 2000 (N = 10540) were compared with those from the year 2008 (N = 14016). By means of the Robson classification, births by Caesarean section were ordered in 10 groups according to mother - and delivery characteristics. RESULTS: Over a period of eight years, the CS rise is most prominent in women with previous sections and in nulliparous women with a term cephalic in spontaneous labor. The proportion of inductions of labor decreases in favor of elective CS, while the ongoing inductions of labor more often end in non-elective CS. CONCLUSIONS: In order to turn back the current CS trend, we should focus on low-risk primiparae. Avoiding unnecessary abdominal deliveries in this group will also have a long-term effect, in that the number of repeat CS will be reduced in the future. For the purpose of self-evaluation, peer discussion on the necessity of CS, as well as accurate registration of the main indication for CS are recommended.

Perinatal outcome of twin pregnancies in women of advanced age.

BACKGROUND: The aim of this study was to assess the outcome of twin pregnancies in women of advanced age (>or=35 years) compared with women aged 25-29 years old. METHODS: This population-based retrospective study compared perinatal outcome of twin pregnancies in primiparae aged 35 or older (N = 240) to that of twin pregnancies in primiparae aged 25-29 years (N = 940). Observed outcomes are adjusted for intermediate (mode of conception and hypertension during pregnancy) and confounding variables (level of education). The possible effect of zygosity and chorionicity was tested in a subset of this database, recorded in the East Flanders Prospective Twin Survey (EFPTS). RESULTS: In twin pregnancies, maternal age of 35 or over is associated with a lower incidence of preterm birth [adjusted odds ratio (AOR) 0.59, 95% confidence interval (CI) 0.44-0.79] and low birthweight (AOR 0.75, 95% CI 0.58-0.98) compared with younger women. Differences in zygosity and chorionicity between both cohorts do not seem to affect the result. CONCLUSIONS: In comparison with primiparae aged 25-29 years, perinatal outcome of twin pregnancies is more favourable in primiparae aged 35 or over.

Should we adjust for gestational age when analysing birth weights? The use of z-scores revisited.

Birth weight is the single most important risk indicator for neonatal and infant mortality and morbidity, which has led to the idiom that 'every ounce counts'. Birth weight in turn, however, tends to vary widely across populations as a result of differential fetal growth velocity with such demographic factors as ethnicity, maternal and paternal height and altitude of residence. Accordingly, it has been acknowledged that the appraisal of birth weight should rely on its position relative to the birth weight distribution of the background population. This is commonly done by standardizing birth weight through its deviation from the population mean in the given gestational age stratum, as can be obtained from population-customized birth weight nomograms. This issue was recently revisited in 'Human Reproduction' through a plea for reporting birth weight as z-scores. In this article, we argue that adjustment for factors, such as gestational age, which may lie on the causal pathway from exposures present at the time of conception [e.g. single-embryo transfer (SET) versus double-embryo transfer (DET)] to birth weight, may induce bias, regardless of whether the adjustment happens via stratification, regression or through the use of z-scores.

Pregnancy outcome in primiparae of advanced maternal age.

OBJECTIVE: To investigate the impact of maternal age on singleton pregnancy outcome, taking into account intermediate and confounding factors. STUDY DESIGN: In this population-based retrospective cohort study, perinatal data of primiparous women aged 35 years or more (n = 2970), giving birth to a singleton child of at least 500 g, were compared to data of primiparous women aged 25-29 years old (n = 23,921). Univariate analysis was used to assess the effect of maternal age on pregnancy outcomes. The effects of intermediate (hypertension, diabetes and assisted conception) and confounding factors (level of education) were assessed through multivariable logistic regression analysis. RESULTS: Older maternal age correlated, independently of confounding and intermediate factors, with very preterm birth (gestational age <32 weeks) [adjusted odds ratio (AOR) 1.51, 95% confidence intervals (CI) 1.04-2.19], low birth weight (birth weight <2500 g) (AOR 1.69, 95% CI 1.47-1.94) and perinatal death (AOR 1.68, 95% CI 1.06-2.65). CONCLUSION: Maternal age is an important and independent risk factor for adverse pregnancy outcome.

Birthweight of singletons after assisted reproduction is higher after single- than after double-embryo transfer.

BACKGROUND: Single-embryo transfer (SET) has proven efficient in reducing multiple pregnancy rates after assisted reproduction technologies (ART). This study compares outcome of singletons after SET and double-embryo transfer (DET). METHODS: We studied 404 SET and 431 DET patients, who delivered a singleton child of >500 g after fresh embryo transfer in a first, second or third cycle. Preterm birth and low birthweight incidences and gestational age and birthweight were compared between both groups. Adjustments were made for maternal age, parity, cycle rank number, treatment indication, ART method, embryo characteristics and sex of the child. RESULTS: Singletons born after DET have a significantly lower birthweight than that after SET (3204.3 +/-617.5 g versus 3324.6+/-509.7 g , P<0.01). Also preterm birth (<37 weeks) [odds ratio (OR) 1.77, 95% confidence interval (CI) 1.06-2.94] and low birthweight (<2500 g) (OR 3.38, 95% CI 1.86-6.12) are significantly more common in DET singletons. CONCLUSIONS: Singleton birth after SET is advantageous compared with DET. This sheds new light on the reasons why singleton births following ART do worse than spontaneously conceived singletons in IVF programs, where double- or multiple-embryo transfer is standard.