PERINATAL AND NEONATAL OUTCOMES IN MULTIPLE GESTATIONS - ASSISTED REPRODUCTION VERSUS SPONTANEOUS CONCEPTION

OBJECTIVE: Our purpose was to test the hypothesis that multiple pregna ncies resulting from assisted reproductive therapy have a better outco me than those resulting from spontaneous conception. STUDY DESIGN: Thi s was a retrospective cohort study. Cases came from pregnancies from a ssisted reproductive techniques. Controls were identified from spontan eous multiple pregnancies delivered in the same time period. Matching was done for maternal age, parity, fetal number, and presence of mater nal medical problems. A total of 72 cases (56 twins and 16 triplets) a nd 124 controls (108 twins and 16 triplets) were studied. The primary outcome was perinatal mortality. Secondary outcomes were preterm deliv ery, birth weight, maternal complications, neonatal morbidity, and len gth of hospitalization. RESULTS: Perinatal mortality is significantly increased in spontaneous twin gestations compared with twins resulting from assisted reproductive techniques (24 vs 2, P = .003). No differe nce is seen in the perinatal mortality in triplets. Mean gestational a ge at diagnosis was lower for twins and triplets resulting from assist ed reproductive techniques (9.4 vs 13.3; P < .001 and 8.8 vs 15.8; P < .001, respectively). Rate of cerclage and number of prenatal visits w as higher for triplets in the assisted reproductive techniques group ( P = .05 and .02, respectively). Mean gestational age at delivery, birt h weight, rate of preterm labor, preterm premature rupture of membrane s, pregnancy-induced hypertension, and incidence of gestational diabet es were not significantly different between the groups. No significant differences in neonatal morbidity were detected. CONCLUSIONS: Assiste d reproductive techniques-associated twins have lower perinatal mortal ity than spontaneously conceived twins. Perinatal and neonatal morbidi ty, gestational age at delivery, and birth weight are not affected by assisted reproductive techniques, even with closer surveillance and ea rlier gestational age at diagnosis in this group. Differences may be d ue to a higher frequency of monochorionic placentation in the spontane ously conceived group.