223: Pregnancy outcome in twins gestations: Spontaneous vs. assisted reproductive modes of conception


      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.

      Study Design

      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.
      Figure thumbnail fx1
      Figure thumbnail fx2