Maternal and Neonatal Outcomes of Monochorionic and Dichorionic Twin Pregnancies Following Assisted Reproductive Technology in Southern Iranian Women

摘要

Objectives: This study aimed to investigate the effect of assisted reproductive technology (ART) on both maternal and neonatal outcomes in monochorionic (MC) and dichorionic (DC) twin pregnancies. Methods: This retrospective cohort study was conducted on women with twin pregnancies who delivered at Hafez and Hazrat Zeinab hospitals (affiliated to the Shiraz University of Medical Sciences) from March 2013 to May 2018. Results: In this study, 651 twin pregnancies (122 MC and 529 DC) were analyzed. Among MC twin pregnancies, the adverse maternal and neonatal outcomes were similar between the ART and the spontaneous pregnancies, except for lower 1-minute and 5-minute Apgar scores (5.3 vs. 7.2; P = 0.036 and 6.4 vs. 8.5; P = 0.039, respectively) and a higher fetal death rate in ART group (19% vs. 3.5%, P = 0.001). Among the DC twin pregnancies, the risks for pregnancy-related hypertensive disorders, gestational diabetes mellitus, emergency cesarean section and antenatal corticosteroid exposure significantly increased in the ART group (P 0.001, P = 0.002, P = 0.014, and P = 0.001, respectively). Furthermore, DC twins showed significantly higher rates of deliveries before the 34 weeks of gestation (44.8% vs. 31.0%, P = 0.002), extremely low birth weight (11.9% vs. 4.0%, P 0.001), intrauterine fetal growth restriction (29.3% vs. 13.5%, P 0.001), lower 1-minute (P = 0.009 for fetus A and P = 0.003 for fetus B, respectively) and 5-minute (P 0.001 for fetus A and P 0.001 for fetus B, respectively) Apgar scores, perinatal mortality (14.4% vs. 6.9%, P 0.001) and congenital anomaly (8.3% vs. 2.3%, P = 0.001) after ART treatment. These results were confirmed by multivariate analysis after adjusting for the baseline variables. Conclusions: Despite the controversial perinatal outcomes in the literature, we found that ART is associated with an increased risk of perinatal morbidity and mortality, particularly in DC twin pregnancies. Therefore, ART twin pregnancies management requires closer surveillance and advanced facilities at tertiary care centers.