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Available data on the role of assisted reproductive technology (ART) as a risk factor for maternal complications in multiple gestations is conflicting. Our objective is to compare pregnancy outcomes in twin pregnancies conceived spontaneously to those conceived by ART.
This is a secondary analysis of a randomized trial for 17 Alpha-Hydroxyprogesterone Caproate in preventing preterm delivery of multiple gestations. All women with twin gestations were considered. Exclusions were delivery before 20 weeks, history of fetal reduction/death, major anomaly, suspected twin to twin transfusion syndrome, monoamniotic placentation, uterine anomaly, cerclage in situ, need for anticoagulation, or major chronic maternal illness. Women that conceived by ART (in-vitro fertilization, ovulation induction, and/or intracytoplasmic sperm injection) were compared to those with spontaneous conception. The primary outcome was the rate of gestational hypertension /pre-eclampsia (gHTN/PEC). Secondary outcomes were rates of iatrogenic delivery for gHTN/PEC, oligohydramnios, gestational diabetes, small for gestational age (SGA), Cesarean delivery (CD), and composite neonatal morbidity. Multivariate logistic regression models were fit to determine adjusted odds ratios (aOR) with 95% confidence intervals (CI) for all outcomes.
626 women met inclusion criteria. Of those 206 (32.9%) were conceived by ART and 420 (67.1%) conceived spontaneously. Table 1 compares demographic and pregnancy characteristics by type of conception. Women that conceived by ART had higher rate of gHTN/PEC compared to those that conceived spontaneously (25.2% vs. 14.8%, OR 1.9; 95% CI 1.3 - 3.0, Table 1). After controlling for relevant explanatory variables found to be significant in univariate analysis, the rate of hHTN/PEC were similar between groups (aOR 1.7; 95% CI 0.9 - 3.0, Table 2). Similar findings were observed for the rates of iatrogenic delivery for gHTN/PEC, gestational diabetes, oligohydramnios, SGA, CD, or composite neonatal morbidity.
Women that conceived twin pregnancies by ART were more likely to have gHTN/PEC and more likely to require iatrogenic delivery because of hHTN/PEC than those that conceived spontaneously. These difference, however, appear to be related to pre-existing patient characteristics, rather than the use of ART.