Objective: To evaluate monochorionic twins conceived by assisted reproductive technology (ART). Design: We compared perinatal outcomes of monochorionic twins conceived by ART with their dichorionic counterparts and with spontaneous monochorionic twins. Setting: Referral center. Patient(s): Mothers to monochorionic and dichorionic twins conceived by ART and spontaneous monochorionic twins. Intervention(s): None. Main Outcome Measure(s): Maternal characteristics, pregnancy complications, and perinatal outcomes. Result(s): Monochorionic twin pregnancies (n ¼ 25) comprise 7.2% of all ART twins and 4.9% of all monochorionic twins in this data set. Monochorionic pairs have a significantly worse outcome compared with dichorionic sets in terms of lower gestational age and birth weight. ART appears to increase the already high risk of monochorionicity compared with spontaneous conception: odds ratio (OR), 2.9 (1.1-7.3) for preterm birth at <32 weeks and OR, 5.9 (2.5-1.49) for birth weight <1,500 g.

Intensive prenatal surveillance might decrease the unexpected fetal death rates after 33 week's gestation and our data do not support elective preterm birth for uncomplicated MCBA twins.

Objective: To assess the effect of the concurrence of gestational diabetes mellitus (GDM) and pre-gravid obesity in twin gestations (''diabesity''). Methods: We compared perinatal outcomes of twin gestation in mothers with GDM and pregravid obesity (1.7%), mothers with GDM but with normal BMI (6.2%), and obese mothers without GDM (7.0%). Results: Twin pregnancies with ''diabesity'' were associated with significantly higher incidence of stillbirth (OR ¼ 6.4; 95%CI ¼ 1.4, 33.4) and existing chronic hypertension (OR ¼ 4.2; 95%CI ¼ 1.2, 14.8) than in GDM pregnancies without obesity, and with births at 33-36 weeks as compared with the other groups. Otherwise, the comparisons showed remarkable similar results in terms of gestational age, birth weight, preeclampsia, cesarean section rate, and fetalneonatal outcomes.Conclusion: It appears that diabesity has a relatively minor effect in twins. If this will be confirmed by other studies, it would be important to elucidate how twins ameliorate the adverse outcomes of diabesity.

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