title: Obstetrical and neonatal outcomes of triplet births - spontaneous versus assisted reproductive technology conception.
abstract: OBJECTIVE
  To determine the average gestational age at birth and to compare obstetrical and neonatal outcomes of triplet births conceived spontaneously versus via assisted reproductive technology (ART).
  
  
  METHODS
  A retrospective chart review of triplet pregnancies that resulted in three live babies was conducted at Mount Sinai Hospital (Toronto, Canada) from January 2000 to June 2013.
  
  
  RESULTS
  A total of 230 women and 690 fetuses were identified. The mean gestational age at birth was 32.0 ± 3.8 weeks. Obstetrical outcomes included preterm premature rupture of the membranes in 29%, preterm labor in 26%, preeclampsia or HELLP syndrome in 19% and gestational diabetes in 10%. The mean birth weight of infants born after 24 weeks was 1655 ± 550 g and the rate of small for gestational age was 28%. The neonatal mortality rate prior to discharge was 7%. Aside from respiratory distress syndrome (30.6 versus 46.6%; p = 0.02), there were no differences in gestational age at birth, obstetrical or neonatal outcomes between spontaneous versus ART triplet conception. Monochorionicity carried a higher risk of small for gestational age, congenital anomalies and neonatal mortality compared to trichorionicity.
  
  
  CONCLUSIONS
  Rates of preterm birth and related complications remain high in triplet gestation. However, obstetrical and neonatal outcomes were similar for triplets conceived spontaneously versus via ART.
authors.affiliation: a Department of Obstetrics & Gynaecology , Maternal-Fetal Medicine Division, Mount Sinai Hospital , Toronto , Ontario , Canada .
authors.forename: Anne-Maude
authors.initials: AM
authors.lastname: Morency
authors.affiliation: b Department of Paediatrics , Mount Sinai Hospital , Toronto , Ontario , Canada , and.|c Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto , Ontario , Canada.
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
authors.affiliation: a Department of Obstetrics & Gynaecology , Maternal-Fetal Medicine Division, Mount Sinai Hospital , Toronto , Ontario , Canada .|c Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto , Ontario , Canada.
authors.forename: P Gareth R
authors.initials: PG
authors.lastname: Seaward
authors.affiliation: a Department of Obstetrics & Gynaecology , Maternal-Fetal Medicine Division, Mount Sinai Hospital , Toronto , Ontario , Canada .
authors.forename: Wendy
authors.initials: W
authors.lastname: Whittle
authors.affiliation: a Department of Obstetrics & Gynaecology , Maternal-Fetal Medicine Division, Mount Sinai Hospital , Toronto , Ontario , Canada .
authors.forename: Kellie E
authors.initials: KE
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D059286:Pregnancy, Triplet / Q000706:statistics & numerical data*; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014310:Triplets / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Assisted reproductive technology; spontaneous conception; triplet gestation