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

Alexandra J Bensdorp; Chantal W Hukkelhoven; Fulco van der Veen; Ben W J Mol; Cornelis B Lambalk; Madelon van Wely

doi:10.1016/j.fertnstert.2016.03.042

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

Fertil Steril. 2016 Aug;106(2):371-377.e2. doi: 10.1016/j.fertnstert.2016.03.042. Epub 2016 Apr 21.

Authors

Alexandra J Bensdorp¹, Chantal W Hukkelhoven², Fulco van der Veen³, Ben W J Mol⁴, Cornelis B Lambalk⁵, Madelon van Wely³

Affiliations

¹ Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: [email protected].
² The Netherlands Perinatal Registry, Utrecht, the Netherlands.
³ Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
⁴ The Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia.
⁵ VU University Medical Centre, Centre for Reproductive Medicine, Amsterdam, the Netherlands.

PMID: 27108393
DOI: 10.1016/j.fertnstert.2016.03.042

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.

Keywords: Intrauterine insemination; in vitro fertilization; natural conception; ovulation induction; twin pregnancy.

Publication types

Comparative Study

MeSH terms

Adult
Apgar Score
Female
Fertility
Fertilization in Vitro
Fertilization*
Humans
Hypertension, Pregnancy-Induced / etiology
Hypertension, Pregnancy-Induced / physiopathology
Infertility / diagnosis
Infertility / physiopathology
Infertility / therapy*
Linear Models
Live Birth
Logistic Models
Male
Multivariate Analysis
Netherlands
Odds Ratio
Ovulation Induction
Parity
Pregnancy
Pregnancy, Twin*
Registries
Reproductive Techniques, Assisted* / adverse effects
Risk Assessment
Risk Factors
Sperm Injections, Intracytoplasmic
Treatment Outcome
Twins, Dizygotic*