title: Maternal and perinatal outcomes in spontaneous versus assisted conception twin pregnancies.
abstract: OBJECTIVE
  To compare maternal and perinatal outcomes in twin pregnancies conceived via assisted reproductive techniques (ART) compared with spontaneous twin pregnancies.
  
  
  METHODS
  This retrospective study examined 345 dichorionic, di-amniotic twin pregnancies (207 conceived spontaneously and 138 conceived via ART), delivered between January 2007 and June 2011 at the San Pietro Fatebenefratelli Hospital, Rome, a tertiary medical centre. Maternal and perinatal outcomes were compared. A multiple logistic regression analysis was performed to calculate risk estimates as odds ratios (OR) adjusted for maternal age, parity and systemic diseases. Patient data were obtained from a computerized database and analyzed using Statistical Package for the Social Sciences Version 17.
  
  
  RESULTS
  Gestational age and birth weight were lower in the ART group, and preterm delivery, gestational diabetes and placental abruption were higher in the ART group compared with the spontaneous conception group. The incidence rates of respiratory complications, patent ductus arteriosus and admission to the neonatal intensive care unit were higher among ART newborns. Length of hospital stay for mothers and newborns was longer in the ART group. No differences in mode of delivery, Apgar score at 5min, congenital anomalies, perinatal mortality, and other considered pregnancy and neonatal complications were found between the two groups. Multivariate analysis adjusted for maternal age, parity and systemic diseases revealed that only the rates of placental abruption [OR 7.45, 95% confidence interval (CI) 2.05-26.98] and patent ductus arteriosus (OR 3.39, 95% CI 1.01-11.46) were significantly higher for the ART group.
  
  
  CONCLUSIONS
  Twin pregnancies conceived via ART are at greater risk of poorer outcomes than spontaneous twin pregnancies. This may be related to the type of conception and specific negative features of subfertile patients undergoing infertility treatment.
authors.affiliation: Department of Gynaecologic-Obstetrical Sciences and Urological Sciences, University of Rome Sapienza, S. Andrea Hospital, Rome, Italy. Electronic address: donatella.caserta@uniroma1.it.
authors.forename: D
authors.initials: D
authors.lastname: Caserta
authors.affiliation: Department of Gynaecologic-Obstetrical Sciences and Urological Sciences, University of Rome Sapienza, S. Andrea Hospital, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bordi
authors.affiliation: Department of Gynaecologic-Obstetrical Sciences and Urological Sciences, University of Rome Sapienza, S. Andrea Hospital, Rome, Italy; Neonatal Unit of S. Pietro Fatebenefratelli Hospital, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Stegagno
authors.affiliation: Neonatal Unit of S. Pietro Fatebenefratelli Hospital, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Filippini
authors.affiliation: Neonatal Unit of S. Pietro Fatebenefratelli Hospital, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Podagrosi
authors.affiliation: Department of Obstetrics and Gynaecology, S. Pietro Fatebenefratelli Hospital, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Roselli
authors.affiliation: Department of Gynaecologic-Obstetrical Sciences and Urological Sciences, University of Rome Sapienza, S. Andrea Hospital, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Moscarini
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology; D000328:Adult; D001724:Birth Weight; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D005307:Fertilization in Vitro; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin; D047928:Premature Birth / Q000453:epidemiology; D027724:Reproductive Techniques, Assisted; D020554:Sperm Injections, Intracytoplasmic; D050497:Stillbirth / Q000453:epidemiology
keywords: Assisted reproductive techniques; Neonatal complications; Perinatal outcomes; Twin pregnancies