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Maternal and neonatal outcomes of dichorionic twin pregnancies achieved with assisted reproductive technology: meta-analysis of contemporary data

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Abstract

Purpose

Assisted reproductive technology (ART) is commonly used to achieve pregnancy and often results in dichorionic diamniotic (DCDA) twin pregnancies. However, the potential risks of ART on maternal and neonatal outcomes in these pregnancies are not well understood. The objective is to compare the maternal and neonatal outcomes in DCDA twin pregnancies between those achieved through ART and those spontaneously conceived (SC).

Methods

We carried out a systematic comprehensive search of electronic databases; namely, PubMed, Embase, Scopus, and the Cochrane Library, from inception to March 2023 with a study period of recruitment between 2003 and 2023. We included all studies comparing the maternal and neonatal outcomes of DCDA twin pregnancies between those achieved by ART and those SC.

Results

We analyzed data from 18 cohort studies involving 10,485 women with DCDA twin pregnancies. The meta-analysis showed that ART-conceived pregnancies had a significantly higher risk of preeclampsia or gestational hypertension (GH), gestational diabetes mellitus (GDM), placenta previa (PP), placental abruption (PA), postpartum hemorrhage (PPH), and elective and emergency cesarean sections than SC twin pregnancies. The absolute risks of these complications remained relatively low. We also found a slightly higher risk of respiratory distress syndrome (RDS) and congenital malformations in ART-conceived infants compared to the risks in SC infants. Finally, the risk of neonatal intensive care unit (NICU) admissions was significantly higher in ART-conceived infants than in SC infants, but with high heterogeneity.

Conclusion

We found associations between DCDA twin pregnancies conceived through ART and increased frequencies of adverse maternal outcomes. However, the absolute risks of these complications remained low, and the benefits of ART for achieving successful pregnancies may well outweigh the potential risks. Additionally, ART-conceived DCDA twin pregnancies may pose higher risks of RDS, congenital malformations and NICU, admissions than SC DCDA twin pregnancies.

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Authors and Affiliations

  1. Reproductive Medicine Centre/Huzhou Maternity & Child Health Care Hospital, No. 2, East Street, Yuehe Street, Wuxing District, Huzhou City, Zhejiang Province, China

    Li Chen, Qiyin Dong & Rongqin Weng

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  1. Li Chen
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  2. Qiyin Dong
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  3. Rongqin Weng
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Corresponding author

Correspondence to Rongqin Weng.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 725 KB) Pre-eclampsia

Supplementary file2 (PDF 758 KB) Gestational Diabetes

Supplementary file3 (PDF 423 KB) Placenta Previa

Supplementary file4 (PDF 422 KB) Placental abruption

Supplementary file5 (PDF 524 KB) Premature rupture of membrane

Supplementary file6 (PDF 548 KB) Post partum hemorrhage

Supplementary file7 (PDF 525 KB) Elective cesarean section

Supplementary file8 (PDF 319 KB) Emergency cesarean section

Supplementary file9 (PDF 661 KB) Pre-term birth less than 37 weeks

Supplementary file10 (PDF 487 KB) Very pre-term birth less than 32 weeks

Supplementary file11 (PDF 432 KB) Low birth weight

Supplementary file12 (PDF 444 KB) Very low birth weight

Supplementary file13 (PDF 362 KB) Small at gestational age

Supplementary file14 (PDF 525 KB) Prenatal mortality

Supplementary file15 (PDF 454 KB) Congenital malformations

Supplementary file16 (PDF 461 KB) Intra-uterine growth restrictions

Supplementary file17 (PDF 664 KB) Neonatal Intensive Care Unit admission

Supplementary file18 (PDF 608 KB) Respiratory distress syndrome

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Chen, L., Dong, Q. & Weng, R. Maternal and neonatal outcomes of dichorionic twin pregnancies achieved with assisted reproductive technology: meta-analysis of contemporary data. J Assist Reprod Genet 41, 581–589 (2024). https://doi.org/10.1007/s10815-024-03035-7

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