Obstetric and Perinatal Outcomes of Dichorionic Twin Pregnancies According to Methods of Conception: Spontaneous Versus In-Vitro Fertilization

Abstract

We have observed the inconsistent findings from various studies on twin pregnancy outcomes obtained by assisted reproductive technology and spontaneous conception. In most studies, however, the concrete chorionicity, regarded as a confounding factor for predicting the perinatal outcomes of twin pregnancies, has not been determined. The purpose of this study was to compare obstetric and perinatal outcomes of only the dichorionic twin pregnancies according to the methods of conception: spontaneous and in-vitro fertilization (IVF). The twin pairs with dichorionicity reported from 1995 to 2008 were investigated and we divided them into two groups which consisted of 286 and 134 twins by spontaneous conception and IVF, respectively. Odds ratios for associations between IVF and pregnancy outcomes were analyzed after adjustment for maternal age and parity. There were no risk differences between the two groups regarding the obstetric complications, which include preterm delivery, preterm labor, preterm premature rupture of membranes, preeclampsia, placenta previa, and abruption. Any differences were not shown in the two groups for the risk estimates of perinatal outcomes, such as low birthweight, very low birthweight, small for gestational age, Apgar scores of < 7 at 5 minutes, discordance in birthweights, congenital anomalies and mortality. However, twins conceived after IVF were less likely to be admitted to the neonatal intensive care unit than those conceived spontaneously (adjusted OR 0.488; 95% confidence interval 0.261–0.910). In the cases of dichorionic twins, IVF may not be associated with adverse perinatal and obstetric outcomes compared with spontaneous conception.

Effect of maternal chronic disease on obstetric complications in twin pregnancies in a United States cohort

“…We did not observe independent effects of ART on the timing of delivery of twins, which is consistent with previous studies of twins 44, 45, 45, 46, 46, 47 . We observed an increased risk for hemorrhage among ART users but this risk did not vary by chronic disease status.…”

In-vitro fertilization and spontaneous pregnancies: matching outcomes in Douala, Cameroon

“…Filicori et al [19] and other studies attributed the high rates of preterm deliveries in IVF cases to the increased rates of multiple pregnancies after infertility treatments [20, 21]. On the contrary, Yang et al [22] did not find any differences amongst the two groups.…”

Perinatal outcomes of multiple pregnancies after assisted reproductive technology

“…YÜT çoğul gebeliklerinin perinatal akıbet-leri ile ilgili yapılan çalışmaların bazıları yüksek perinatal riske işaret ederken, [14,15] bazıları da spontan çoğul gebeliklerle benzer akıbet gösterdiklerini bildirmiştir. [12,16,17] Bu farklı sonuçlar çalışmalardaki hasta grubu ve çoğul gebelik takip protokol heterojenliğinden ileri gelmektedir. Çalışmamızda tüm hastaları aynı ekip tarafından sabit obstetrik protokollere göre takip ettik.…”

“…[4][5][6][7][8][9][10][11][12] Kimi araştırmacılar YÜT çoğul gebeliklerinin spontan gebeliklerden perinatal özellik-ler açısından bir fark içermediğini iddia ederken, kimi araştırmacılar da YÜT çoğul gebeliklerinin ekstra risk taşıdığını ileri sürmüşlerdir. [9][10][11][12] Risk olarak belirtilen durumlar doğumsal malformasyon, preterm doğum, iri doğum ağırlığı ve sezaryen ile doğum olarak sırala-nabilir. [9][10][11] Biz de çalışmamızda YÜT ile elde edilen ço-ğul gebelikler ile spontan çoğul gebeliklerin perinatal akıbetlerini karşılaştırmayı amaçladık.…”

“…Yang ve ark. [12] spontan ve IVF ile gelişen dikoryonik ikiz gebeliklerin perinatal akıbetlerini karşılaştırdıkları çalış-malarında, IVF'nin perinatal akıbete negatif bir etkisi olmadığını belirtmişlerdir. Bizim çalışmamızda gruplarımız arasında doğumsal anomali, doğum ağırlıkları ve yenidoğan yoğun bakım ihtiyacı oranları açısından bir fark yoktu.…”