Multiple pregnancy and solutions to the problem of its complications (a literature review)
DOI:
https://doi.org/10.14739/2310-1210.2022.1.243617Keywords:
multiple pregnancy, premature birth, assisted reproductive techniques, placental proteins, placental hormones, cervical cerclageAbstract
Currently, the number of multiple pregnancies has increased all over the world, and therefore it has become one of the urgent problems of modern obstetrics. The rise is due to both the widespread practical application of effective methods for infertility treatment in healthcare and the use of assisted reproductive technologies.
This review presents an opinion of most researchers about an association between multiple pregnancy and a significant number of complications that accompany it from early gestational age. Notable amongst these are miscarriage at different gestational age and premature birth, as well as an increase in probability of preeclampsia, anemia, gestational diabetes, postpartum hemorrhage, low birth weight, neurological complications, and intrauterine fetal death. The main cause of perinatal losses in multiple pregnancies is very low gestational age and low birth weight and length, with prematurity ranking first among other reasons. Perinatal mortality in multiple pregnancies is more than 6 times as high as in singleton pregnancies.
Thus, patients with multiple pregnancies constitute a high-risk group for the development of maternal and perinatal complications. In order to timely identify, prevent and reduce the severity of specific complications, it is necessary to know the features of multiple pregnancies course and the main risks associated with it. However, there are still no universal algorithms for determining proper follow-up, treatment and the choose of delivery mode among women with various variants of multiple pregnancies. In any single case, a personalized approach is needed to maintain and prolong pregnancy.
References
Nicolaides, K. H., Syngelaki, A., Poon, L. C., Picciarelli, G., Tul, N., Zamprakou, A., Skyfta, E., Parra-Cordero, M., Palma-Dias, R., & Rodriguez Calvo, J. (2016). A Randomized Trial of a Cervical Pessary to Prevent Preterm Singleton Birth. The New England Journal of Medicine, 374(11), 1044-1052. https://doi.org/10.1056/NEJMoa1511014
Kosyakova, O. V., & Bespalova, O. N. (2019). rofilaktika i terapiya ugrozhayushchikh prezhdevremennykh rodov pri mnogoplodii [Prevention and therapy of threatened preterm birth in multiple pregnancy]. Zhurnal akusherstva i zhenskikh boleznei, 68(4), 55-70. https://doi.org/10.17816/JOWD68455-70 [in Russian].
Roman, A., Rochelson, B., Martinelli, P., Saccone, G., Harris, K., Zork, N., Spiel, M., O'Brien, K., Calluzzo, I., Palomares, K., Rosen, T., Berghella, V., & Fleischer, A. (2016). Cerclage in twin pregnancy with dilated cervix between 16 to 24 weeks of gestation: retrospective cohort study. American Journal of Obstetrics and Gynecology, 215(1), 98.e1-98.e11. https://doi.org/10.1016/j.ajog.2016.01.172
Saccone, G., Ciardulli, A., Xodo, S., Dugoff, L., Ludmir, J., Pagani, G., Visentin, S., Gizzo, S., Volpe, N., Maruotti, G. M., Rizzo, G., Martinelli, P., & Berghella, V. (2017). Cervical Pessary for Preventing Preterm Birth in Singleton Pregnancies With Short Cervical Length: A Systematic Review and Meta-analysis. Journal of Ultrasound in Medicine, 36(8), 1535-1543. https://doi.org/10.7863/ultra.16.08054
Melcer, Y., Svirsky, R., Vaknin, Z., Levinsohn-Tavor, O., Feldman, N., & Maymon, R. (2017). Fetal abnormalities leading to termination of twin pregnancies: the 17-year experience of a single medical center. The Journal of Maternal-Fetal & Neonatal Medicine, 30(3), 347-351. https://doi.org/10.3109/14767058.2016.1173027
Maruotti, G. M., Saccone, G., Morlando, M., & Martinelli, P. (2016). First-trimester ultrasound determination of chorionicity in twin gestations using the lambda sign: a systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 202, 66-70. https://doi.org/10.1016/j.ejogrb.2016.04.023
Marasinghe, J. P. (2016). Cervical Pessary and Vaginal Progesterone in Twin Pregnancies With a Short Cervix. Obstetrics & Gynecology, 128(2), 408. https://doi.org/10.1097/AOG.0000000000001546
Ramoğlu, M., Kavuncuoğlu, S., Aldemir, E., Yarar, C., & Eras, Z. (2016). Neurodevelopment of preterm infants born after in vitro fertilization and spontaneous multiple pregnancy. Pediatrics International, 58(12), 1284-1290. https://doi.org/10.1111/ped.13012
Levytska, K., Higgins, M., Keating, S., Melamed, N., Walker, M., Sebire, N. J., & Kingdom, J. C. (2017). Placental Pathology in Relation to Uterine Artery Doppler Findings in Pregnancies with Severe Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler Changes. American Journal of Perinatology, 34(5), 451-457. https://doi.org/10.1055/s-0036-1592347
Manuck, T. A., Esplin, M. S., Biggio, J., Bukowski, R., Parry, S., Zhang, H., Huang, H., Varner, M. W., Andrews, W., Saade, G., Sadovsky, Y., Reddy, U. M., Ilekis, J., & Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Genomics and Proteomics Network for Preterm Birth Research (GPN-PBR). (2016). Predictors of response to 17-alpha hydroxyprogesterone caproate for prevention of recurrent spontaneous preterm birth. American Journal of Obstetrics and Gynecology, 214(3), 376.e1-376.e3768. https://doi.org/10.1016/j.ajog.2015.12.010
Boiko, V. I., Nikitina, I. M., Babar, T. V., & Boiko, A. V. (2018). The problem of miscarriage in multiple pregnancy. Wiadomości lekarskie, 71(7), 1195-1199.
Vygivska, L. M., Nykoniuk, T. R., & Oleshko, V. F. (2017).The optimization ways of pregnancy and labor management tactics in women after application of assisted reproductive technologies. Zdorov'e zhenshchiny, (9), 111-113.
Babinchuk, O. V. (2017). Osoblyvosti hormonalnoho profiliu fetoplatsentarnoho kompleksu pry bahatoplidnii vahitnosti zalezhno vid typu platsentatsii [Features of placenta hormonal profile in multiple pregnancies depending on the type of placentation]. Bukovynskyi medychnyi visnyk, 21(1), 7-15. [in Ukrainian].
Babinchuk, O. V. (2017). Osoblyvosti matkovo-platsentarnoi hemodynamiky i plodovo-platsentarnoho arterialnoho krovotoku u zhinok iz bahatoplidnoiu vahitnistiu [Peculiarities of uteroplacental hemodynamics and fetoplacental arterial blood flow in women with multifetal pregnancy]. Aktualni problemy suchasnoi medytsyny, 17(2), 69-78. [in Ukrainian].
Hassani, M. E., Drissi, J., Benali, S., Habib, A. B., Kouach, J., & Moussaoui, D. (2020). Accouchement différé d´une grossesse multiple: à propos d´un cas et revue de la littérature. Pan African Medical Journal, 36, Article 373. https://doi.org/10.11604/pamj.2020.36.373.19797
Tkachenko, A. V. (2018). Bahatoplidna vahitnist u suchasnomu akusherstvi (Ohliad literatury) [Multiple pregnancy in contemporary obstetrics (Review of the literature)]. Semeinaya meditsina, (1), 116-120. [in Ukrainian].
Beglov, D. Е., Artymuk, N. V., & Novikova, O. N. (2019). Istmiko-tservikal'naya nedostatochnost': rasprostranennost' i kliniko-anamnesticheskie osobennosti [Istmiko-cervical insufficiency: prevalence and clinical and anamnestic features]. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie, 7(3), 21-24. https://doi.org/10.24411/2303-9698-2019-13003 [in Russian].
Melnik, O. V. (2016). Klinichni aspekty perebihu vahitnosti ta polohiv pry bahatoplidnii vahitnosti pislia zastosuvannia dopomizhnykh reproduktyvnykh tekhnolohii [Clinical aspects of current of pregnancy and labours at multipara pregnancy after auxiliary reproductive technologies]. Zdorov'e zhenshchiny, (3), 80-82. [in Ukrainian].
Melnik, O. V. (2017). Osoblyvosti hormonalnoi funktsii fetoplatsentarnoho kompleksu pry bahatoplidnii vahitnosti pislia zastosuvannia dopomizhnykh reproduktyvnykh tekhnolohii [Features of hormonal function fetoplacental to complex at multipara pregnancy after auxiliary genesial technologies]. Zdorov'e zhenshchiny, (10), 133-136.
Bulavenko, O. V., & Vozniuk, A. V. (2017). Efektyvnist profilaktychnoi interventsii u zhinok iz bahatoplodovoiu vahitnistu ta sonohrafichno vkorochenoiu shyikoiu matky [Effectiveness of preventive interventions in women with multiple pregnancy and sonographically short cervix]. Biomedical and biosocial anthropology, (29), 129-133. [in Ukrainian].
Vasilishyna, V. R. (2014). Porivnialni aspekty bahatoplidnoi vahitnosti bez i pislia dopomizhnykh reproduktyvnykh tekhnolohii. (Avtoref. dis. … kand. med. nauk). [Comparative aspects multipara pregnancy without and after auxiliary reproductive technologies]. (Extended abstract of candidate’s thesis). Kyiv. [in Ukrainian].
Ventskivskiy, B. M., Poladych, I. V., & Avramenko, S. O. (2016). Rol prozapalnykh tsytokiniv u patohenezi peredchasnoi polohovoi diialnosti pry bahatoplidnii vahitnosti, yaka nastala vnaslidok zastosuvannia dopomizhnykh reproduktyvnykh tekhnolohii [The role of inflammatory cytokines in the pathogenesis of premature labor in multiple pregnancy as a result of ART]. Zdorov'e zhenshchiny, (5), 73-76. [in Ukrainian].
Ventskivsky, B. M., & Poladych, I. V. (2016). Patohenetychni mekhanizmy nevynoshuvannia u zhinok z bahatoplidnoiu vahitnistiu, zumovlenoiu zastosuvanniam dopomizhnykh reproduktyvnykh tekhnolohii [Pathogenetic mechanisms of miscarriage in women with a multiple pregnancy, due to the use of ART]. Zdorov'e zhenshchiny, (6), 173-176. [in Ukrainian].
Gnatko, О. P., & Kryvopustov, О. S. (2017). Efektyvnist prohesteronovoi terapii u zhinok iz zahrozlyvym abortom zalezhno vid polimorfizmu hena retseptora prohesteronu [Threatened abortion treatment efficacy depending on progesterone receptor gene polymorphism]. Bukovynskyi medychnyi visnyk, 21(1), 44-48. [in Ukrainian].
Golyanovsky, V. (2018). Bahatoplodovi vahitnosti pislia vykorystannia dopomizhnykh reproduktyvnykh tekhnolohii [Multiple pregnancies following assisted reproductive technologies]. Z turbotoiu pro Zhinku, (3). https://extempore.info/component/content/article/9-joornal/1228-bahatoplodovi-vahitnosti-pislya-vykorystannya-dopomizhnykh-reproduktyvnykh-tekhnolohiy.html?Itemid=357 [in Ukrainian].
Golyanovskyy, O. V., Rubinshtein, A. M., & Bachinska, M. A. (2015). Efektyvnist kombinovanoho zastosuvannia sublinhvalnoi ta vahinalnoi form mikronizovanoho prohesteronu v terapii zahrozy peredchasnykh polohiv [The effectiveness of micronized progesterone sublingual and vaginal forms combined use of in the treatment of preterm labor]. Zdorov'e zhenshchiny, (8), 19-24. [in Ukrainian].
Devyatova, E. A. (2018). Prezhdevremennye rody: vozmozhna li effektivnaya profilaktika? [Preterm labor: is effective prophylaxis possible?]. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie, 6(3), 21-28. https://doi.org/10.24411/2303-9698-2018-13002 [in Russian].
Dykusarova, S. M., Platonova, O. М., & Khilobok-Jakovenko, O. V. (2018). Perynatalni vyslidy bahatoplidnoi vahitnosti pislia zaplidnennia in vitro ta pry spontannykh vahitnostiakh [Рerinatal outcomes of multiple gestation after in vitro fertilization and spontaneous pregnancies]. Perinatologiya i pediatriya. Ukraina, (1), 70-73. https://doi.org/10.15574/PP.2018.73.70 [in Ukrainian].
Zhabchenko, I. A. (2015). Akusherskaya taktika pri istmiko-tservikal'noi nedostatochnosti: reshenie osnovnykh i soputstvuyushchikh problem [Obstetric management in case of istmic-cervical incompetence: solving main and associated problems]. Okhrana materinstva i detstva, (1), 58-65. [in Russian].
Zagorodnya, O. S., Leush, S. S., & Kolesnic, N. (2015). Dynamika interleikinu 8 v tservikalnomu slyzovi pry vkrai peredchasnykh polohakh - kryterii vyboru taktyky [Interleukin 8 in Cervical Mucus Dynamic by Very Preterm Labour As Criterium of Tactic Choice]. Visnyk problem biolohii i medytsyny, 1(3), 133-136 [in Ukrainian].
Poladich, I. V., Avramenko, S. O., Malanchuk, O. B., & Kostenko, O. Yu. (2021). Osoblyvosti tsyrkuliatsii interleikiniv riznykh klasiv pry bahatoplidnii vahitnosti zalezhno vid sposobu zaplidnennia i terminu hestatsii [Peculiarities of circulation of interleukins of different classes in multiple pregnancy depending on the method of fertilization and the term of gestation]. Reproduktyvne zdorovia zhinky, (1), 44-48. https://doi.org/10.30841/2708-8731.1.2021.229711 [in Ukrainian].
Nikitina, I. N., Boychuk, A. V., Kondratiuk, V. K., & Babar, T. V. (2017). Zastosuvannia neinvazyvnoho serkliazhu u poiednanni z mikronizovanym prohesteronom pry nevynoshuvanni bahatoplidnoi vahitnosti [Use of Noninvasive Cerclage in Combination of Micronized Progesterone in Miscarriage of Multifetal Pregnancy]. Halytskyi likarskyi visnyk, 24(4), 26-30. [in Ukrainian].
Bulavenko, O. V., Vozniuk, А. V., Tytarenko, N. V., & Kukuruza, I. L. (2018). Interleikin 6 ta intehratyvnyi indeks anamnezu, vykhidnoho stanu zdorovia, perebihu vahitnosti yak predyktory peredchasnykh polohiv u zhinok iz bahatopliddiam [Interluekin 6 and integrated index of anamnesis, initial health status and gestation course as predictors of preterm delivery in women with multiple gestation]. Perinatologiya i pediatriya. Ukraina, (1), 41-47. https://doi.org/10.15574/PP.2018.73.41 [in Ukrainian].
Kaplan, Yu. D., & Zakharenkova, Т. N. (2016). Klinicheskoe znachenie biokhimicheskikh markerov І trimestra beremennosti dlya razvitiya nesostoyatel'nosti sheiki matki [Clinical significance of biochemical markers of the first trimester of pregnancy for cervical insufficiency]. Akusherstvo. Hinekolohiia. Henetyka, 2(2), 34-38. [in Russian].
Konkov, D. H., Bulavenko, O. V., Chaika, H. V., Starovier, A. V., & Rud, V. O. (2016). Kompleksna prohnostychna otsinka stanu shyiky matky shchodo vynyknennia istmiko-tservikalnoi nedostatnosti [Comprehensive prognostic assessment of the cervical status for isthmo-cervical insufficiency (No. 170-2016)]. Ukrmedpatentinform. [in Ukrainian].
Dobrokhotova, Yu. E., Kuznetsov, P. A., Dzhokhadze, L. S., & Konstantinova, K. I. (2017). Korrektsiya istmiko-tservikal'noi nedostatochnosti pri mnogoplodnoi beremennosti. Diskussionnye voprosy [Correction of isthmic-cervical insufficiency in multiple pregnancies: Debating points]. Akusherstvo i ginekologiya, (11), 10-15. https://doi.org/10.18565/aig.2017.11.10-15 [in Russian].
Кrotyk, O. I. (2016). Profilaktyka peredchasnykh polohiv na tli istmiko-tservikalnoi nedostatnosti. (Avtoref. dis. … kand. med. nauk). [Prevention of preterm delivery in the setting of isthmic cervical insufficiency]. (Extended abstract of candidate’s thesis). Kyiv. [in Ukrainian].
Sulimenko, O. М. (2021). Klinichnyi analiz somatychnoho ta reproduktyvnoho anamnezu u vahitnykh dviineiu pislia dopomizhnykh reproduktyvnykh tekhnolohii. [Clinical analysis of somatic and reproductive anamnesis in pregnant with twins after assisted reproductive technologies]. Perynatolohiia ta reproduktolohiia: vid naukovykh doslidzhen do praktyky, 1(3), 141-151. https://doi.org/10.52705/2788-6190-2021-3-15 [in Ukrainian].
Nikitina, I. N., & Boychuk, A. V. (2017). Vozmozhnosti prognozirovaniya nevynashivaniya beremennosti pri mnogoplodii s pomoshch'yu otsenki geneticheskikh prediktorov [The ability to predict miscarriage in multiple pregnancy by evaluating genetic predictors]. Zhurnal Grodnenskogo gosudarstvennogo meditsinskogo universiteta, (1), 76-79. [in Russian].
Nikitina, I. M. (2017). Dosvid vykorystannia rozvantazhuvalnoho akusherskoho pessariiu u profilaktytsi nevynoshuvannia pry bahatoplidnii vahitnosti [Experience of using load-carrying cervical pessaries for prevention of preterm birth in women with a multiple pregnancy]. Perinatologiya i pediatriya, (1), 51-58. https://doi.org/10.15574/PP.2017.69.51 [in Ukrainian].
Nikitina, I. N. (2017). Efektyvnist mikronizovanoho prohesteronu pry nevynoshuvanni bahatoplidnoi vahitnosti [Efficiency micronized progesterone for miscarriage multiple pregnancy]. Visnyk Vinnytskoho natsionalnoho medychnoho universytetu, 21(1), 283-289. [in Ukrainian].
Nikitina, I. M. (2017). Kombinovane zastosuvannia riznykh form mikronizovanoho prohesteronu v likuvanni zahrozy pereryvannia vahitnosti pry bahatopliddi [The combined use of various forms of micronized progesterone in the treatment of the threat of termination of pregnancy in multiple pregnancies]. Reproduktyvna endokrynolohiia, (3), 68-73. https://doi.org/10.18370/2309-4117.2017.35.68-73 [in Ukrainian].
Elzhorukaeva, Z. A., Linde, V. A., Lysenko, A. A., Kudinova, E. I., Martynenko, E. A., & Grigoryants, A. A. (2015). Novyi vzglyad na problemu razvitiya platsentarnoi nedostatochnosti [New view on the problem of development of placentary insufficiency]. Sovremennye problemy nauki i obrazovaniya, (1-1), Article 1382. [in Russian].
Ventskivsky, B. M., Poladich, I. V., Belayay, V. V., Kostenko, O. Yu., & Kazydub, K. S. (2015). Osoblyvosti perebihu vahitnosti ta polohiv u zhinok z bahatopliddiam [The specific features of the course of pregnancy and delivery in women with multiple pregnancy]. Medytsyna transportu Ukrainy, (3-4), 8-15. [in Ukrainian].
Poladich, I. V. (2016). Profilaktyka perynatalnykh uskladnen pry bahatoplidnii vahitnosti vnaslidok dopomizhnykh reproduktyvnykh tekhnolohii. (Avtoref. dis. … kand. med. nauk). [Prevention of perinatal complications in multiple pregnancies resulting from assisted reproductive technologies]. (Extended abstract of candidate’s thesis). Kyiv. [in Ukrainian].
Ministry of Health of Ukraine. (2015, April 08). Pro zatverdzhennia Poriadku nadannia medychnoi dopomohy zhinkam z bahatoplidnoiu vahitnistiu [On approval of the Procedure for providing medical care to women with multiple pregnancies (No. 205)]. https://zakon.rada.gov.ua/laws/show/z0501-15#Text
Nikitina, I., Boyko, V., Smyian, S., Ikonopisceva, N., Sukharev, A., Babar, T., & Kalachnik, N. (2015). Rol' geneticheskikh prediktorov v prognozirovanii nevynashivaniya beremennosti pri mnogoplodii [Role of genetic predictors in forecasting during multiple pregnancy miscarriage]. Sovremennaya meditsina: aktual'nye voprosy, (50), 25-32. [in Russian].
Romanenko, T. H., Tkachenko, A. V., & Chaika, O. I. (2015). Diahnostyka bahatoplidnoi vahitnosti ta antenatalnyi dohliad (klinichna lektsiia) [Diagnosis of multiple pregnancy and antenatal care (a clinical lecture)]. Zdorov'e zhenshchiny, (6), 11-15. [in Ukrainian].
Sichinava, L. G., Panina, O. B., & Gamsakhurdiya, K. G. (2015). Diskordantnyi rost plodov u beremennykh s monokhorial'noi dvoinei [Fetal discordancy in monochorionic twins]. Akusherstvo, ginekologiya i reproduktsiya, 9(1), 6-12. https://doi.org/10.17749/2313-7347.2015.9.1.006-012 [in Russian].
Boiko, V. I., Nikitina, I. M., Sukhariev, A. B., & Kalashnyk, N. V. (2018). Sravnitel'naya osenka effektivnosti razlichnyh metodov lecheniya nevynashivaniya pri mnogoplodnoj beremennosti [Comparative assessment of various methods of miscarriage treatment efficacy in multifetal pregnancy]. Zaporozhye medical journal, 20(5), 681-686. https://doi.org/10.14739/2310-1210.2018.5.141803 [in Russian].
Tkachenko, A. V. (2018). Profilaktyka peredchasnykh polohiv pry bahatoplidnii vahitnosti [Prevention of preterm delivery in women with multiple pregnancy]. Visnyk Vinnytskoho natsionalnoho medychnoho universytetu, 22(1), 126-132. https://doi.org/10.31393/reports-vnmedical-2018-22(1)-24 [in Ukrainian].
Tumanova, L. E., Molchanova, O. O., & Kolomietc, O. V. (2014). Perebih vahitnosti, polohiv ta stan novonarodzhenykh u zhinok pislia EKZ metodom IKSI [Pregnancy period, childbirth and state of health of newborns among women after IVF with ICSI method]. Perinatologiya i pediatriya, (4), 34-38. https://doi.org/10.15574/PP.2014.60.34 [in Ukrainian].
Boychuk, A. V., Boyko, V. I., Nikitina, I. M., & Begosh, B. M. (2015). Ultrazvukovi kryterii stanu shyiky matky v diahnostytsi zahrozy peredchasnykh polohiv pry bahatoplidnii vahitnosti [Cervical ultrasound criteria for the diagnosis of threatened preterm labor in multiple pregnancy]. Aktualni pytannia pediatrii, akusherstva ta hinekolohii, (1), 99-103. [in Ukrainian].
Fatkullin, I. F., Ahmadeev, N. R., & Fatkullin, F. I. (2015). Kesarevo sechenie s izvlecheniem plodov v tselom plodnom puzyre pri beremennosti dvoinei [Cesarean section with fetal extraction in the whole fetal bladder during twin pregnancy]. Akusherstvo i ginekologiya, (6), 35-39. [in Russian].
Franchuk, O. A., & Franchuk, M. O. (2015). Zastosuvannia rozvantazhuiuchoho akusherskoho pesariiu u zhinok z bahatoplidnoiu vahitnistiu dlia profilaktyky nevynoshuvannia i peredchasnykh polohiv [Using the unloading obstetric of caesarean section in the women with multiple pregnancy for profilaction of miscarriage a pregnancy and prematurely birth]. Aktualni pytannia pediatrii, akusherstva ta hinekolohii, (2), 175-177. https://doi.org/10.11603/24116-4944.2015.2.4817 [in Ukrainian].
Bulavenko, О. V., Vozniuk, A. V., Kostyuchenko, А. V., Tytarenko, N. V., Balabueva, S. V., Mykhalchuk, M. A., Prolygina, O. V., & Lovkina, O. L. (2018). Shcho my mozhemo zminyty v profilaktytsi peredchasnykh polohiv u zhinok iz bahatopliddiam? [What can we change in the prevention of preterm birth in women with multiple pregnancies?]. Perinatologiya i pediatriya. Ukraina, (4), 49-53. https://doi.org/10.15574/PP.2018.76.49 [in Ukrainian].
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
