Dizygotic twin pregnancies after medically assisted reproduction and after natural conception Maternal and perinatal outcomes

Authors:
Alexandra J. Bensdorp, M.D., Chantal W. Hukkelhoven, Ph.D., Fulco van der Veen, Ph.D., Ben W.J. Mol, M.D., Ph.D., Nils C.B. Lambalk, M.D., Ph.D., Madelon van Wely, M.D., Ph.D.

Abstract:

Objective:
To compare maternal and perinatal outcomes in dizygotic twin pregnancies conceived after medically assisted reproduction (MAR) with outcomes after natural conception (NC).

Design:
Nationwide registry based study.

Setting:
Academic medical center.

Patient(s):
Primiparous women who delivered opposite sex twins between January 2000 and December 2012 in the Netherlands, comprising dizygotic twin pregnancies: 6,694 women, 470 after ovulation induction (OI), 511 after intrauterine insemination with controlled ovarian hyperstimulation (IUI-COH), 2,437 after in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI), and 3,276 after NC.

Intervention(s):
None.

Main Outcome Measure(s):
Multivariable logistic regression and generalized linear mixed models to evaluate differences in outcomes: maternal outcomes of hypertension, preeclampsia, preterm delivery, hemorrhage, and delivery mode, perinatal outcomes including small for gestational age (SGA) with birth weight <10th percentile, birth weight <1,500 g, 5-minute Apgar score <7, admission to neonatal intensive care unit, congenital anomalies, and perinatal mortality. Result(s):
We found no statistically significant differences in maternal or perinatal outcomes after OI compared with NC. Women pregnant after IVF-ICSI had a lower risk for hypertension (adjusted odds ratio [aOR] 0.74; 95% confidence interval [CI], 0.66–0.83) compared with women pregnant after NC. After IUI-COH more children had Apgar scores <7 (adjusted odds ratio (aOR) 1.38; 95% confidence interval (CI) 1.05–1.81) and perinatal mortality rates were higher (aOR 1.56; 95% CI, 1.04–2.33) compared with NC. We found no differences in perinatal outcomes after IVF-ICSI compared with NC. Conclusion(s):
Overall, maternal and perinatal risks other than those due to multiplicity are similar for twin pregnancies conceived after MAR and after NC.

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