Maternal and neonatal outcomes in dichorionic diamniotic twin pregnancies: a comparison between assisted reproductive technology and spontaneous conception.

Objectives: To evaluate and compare maternal and neonatal outcomes in dichorionic diamniotic (DCDA) twin pregnancies conceived via assisted reproductive technology (ART) versus those conceived spontaneously (SC).

Material and methods: This single-center, retrospective cohort study included 852 DCDA twin pregnancies, with 591 conceived spontaneously (SC group) and 261 conceived via ART (ART group). Maternal and neonatal outcomes were extracted from the hospital's automation system and analyzed using statistical methods, including chi-square and Mantel-Haenszel chi-square tests, to account for potential confounding factors.

Results: Our findings indicate that ART twin pregnancies have significantly poorer outcomes compared to SC twin pregnancies. The risk of cerclage application is 12.6 times higher in the ART group. Furthermore, ART pregnancies exhibit a 19.2-fold increased risk of intrahepatic cholestasis of pregnancy (ICP). The rates of preterm birth, including late preterm, moderate preterm, very preterm, and extremely preterm, are significantly higher in the ART group. Moreover, ART pregnancies are associated with higher incidences of very low birth weight (VLBW), NICU admissions, and neonatal death. The ART group also experiences significantly higher rates of gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), postpartum hemorrhage, and cesarean section, with postpartum atony occurring 4 times more frequently.

Conclusions: Maternal and neonatal outcomes in ART-conceived DCDA twin pregnancies are markedly worse compared to those conceived spontaneously. The observed disparities underscore the necessity for intensive monitoring and tailored management strategies in ART twin pregnancies. Further research is essential to uncover the mechanisms driving these adverse outcomes.