Dizygotic twin pregnancies after medically assisted reproduction and after natural conception: maternal and perinatal outcomes.
OBJECTIVE
To compare maternal and perinatal outcomes in dizygotic twin pregnancies conceived after medically assisted reproduction (MAR) with outcomes after natural conception (NC).


METHODS
Nationwide registry based study.


METHODS
Academic medical center.


METHODS
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.


METHODS
None.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Overall, maternal and perinatal risks other than those due to multiplicity are similar for twin pregnancies conceived after MAR and after NC.
Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: a.j.bensdorp@amc.uva.nl.
Alexandra J
AJ
Bensdorp
The Netherlands Perinatal Registry, Utrecht, the Netherlands.
Chantal W
CW
Hukkelhoven
Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
Fulco
F
van der Veen
The Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia.
Ben W J
BW
Mol
VU University Medical Centre, Centre for Reproductive Medicine, Amsterdam, the Netherlands.
Cornelis B
CB
Lambalk
Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
Madelon
M
van Wely
D000328:Adult; D001034:Apgar Score; D005260:Female; D005298:Fertility; D005306:Fertilization; D005307:Fertilization in Vitro; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000209:etiology / Q000503:physiopathology; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016014:Linear Models; D050498:Live Birth; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D010062:Ovulation Induction; D010298:Parity; D011247:Pregnancy; D059285:Pregnancy, Twin; D012042:Registries; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D020554:Sperm Injections, Intracytoplasmic; D016896:Treatment Outcome; D014429:Twins, Dizygotic
Intrauterine insemination; in vitro fertilization; natural conception; ovulation induction; twin pregnancy