Impact of Conception Method on Twin Pregnancy Course and Outcome

Abstract

!Objective: The aim of the study was to investigate the course and outcomes of twin pregnancies conceived by different methods of assisted reproduction (ART) compared to those conceived spontaneously. Methods: The study involved patients with twin pregnancies who delivered at the Ob/Gyn Clinic of the Clinical Center of Serbia over a period of three years. Patients were differentiated according to method of conception and type of ART. Age, parity, etiology of infertility, pregnancy complications, time of membrane rupture and type of delivery was recorded for each patient. Gestational week at delivery, presentation, birth weight, Apgar score, chorionicity and accompanying disorders were separately recorded for each twin. The data were analyzed statistically. Results: A total of 431 patients were included in the study. Although more twins were conceived by ART, the difference was not statistically significant (p = 0.092). The most common ART procedure was IVF/ICSI (p = 0.001). ART procedures, particularly IVF/ICSI, were significantly correlated with more advanced maternal age, fewer previous pregnancies and delivery by cesarean sections, usually planned (p = 0.001). Preterm membrane rupture was more common after ICSI, but preterm delivery and pregnancy complications were infrequent, irrespective of the method of conception (p = 0.001). ART twins were mostly dichorionic (p = 0.036). Monochorionic twins were conceived either spontaneously or with ICSI. Conception by ART was not correlated with twinsʼ outcome (weight, Apgar score, disorders

Twin pregnancies concieved by assisted reproduction - early prediction of preterm birth

“…ART conceived twins are at significantly increased risks of preterm birth both early and late, althouhg according to majority of studes ART twins were mostly de- livered moderately preterm (32-34 GW) 2, 10 . However, the rate of preterm birth of ART conceived twins in several investigations was similar to that of spontaneously conceived ones or that very preterm deliveries even occurred more frequently in spontaneous twin pregnancies 4 . In our study, similarly, more women delivered at term than preterm (51% vs. 49%, respectively), while late preterm birth was predominant time of delivery of preterm twins (33%).…”

“…Twin pregnancies, in general, are at higher risk of numerous pregnancy complications including miscarriage or preterm birth caused by a development of two fetuses instead of one 1,2 . Adverse obstetric outcome after ART might be caused by the very procedure 4 . Moreover, ART conceived twins can be at even higher risk of pregnancy complications and adverse obstetric outcomes due to maternal age, pre-existing maternal medical conditions such as polycystic ovary syndrome or thyroid diseases that are associated with miscarriages and aneuploidies [7][8][9] .…”

“…Literature data show that in twin pregnancies there is also an increased risk of gestational hypertensive disorders of the mother 2, 3 . Nevertheless, there are conflicting reports on whether conception by ART further increases these risks when compared to spontaneously conceived pregnancies 4,5 . Pregnancies concieved by ART are found to be more often complicated with preterm delivery and fetal low birth weigh, placental abruption, gestational diabetes and hypertension [2][3][4] .…”

“…Nevertheless, there are conflicting reports on whether conception by ART further increases these risks when compared to spontaneously conceived pregnancies 4,5 . Pregnancies concieved by ART are found to be more often complicated with preterm delivery and fetal low birth weigh, placental abruption, gestational diabetes and hypertension [2][3][4] . Consequently, ART conceived twins are the most susceptible for various perinatal complications among which the most severe is premature pregnancy ending 6 .…”

A Comparison of Perinatal Outcomes in Multiple Pregnancies: Assisted Versus Spontaneous Conception: A Cross-Sectional Study

“…Thus, there is no consensus when individual papers are reviewed with regards to assisted conception twins and perinatal outcome, with some demonstrating no association with preterm and low birth weight [7,8], and others reporting increased risk [9][10][11]. Other studies have concluded twins conceived by assisted methods have similar obstetric and neonatal outcomes [12][13][14].…”