Comparison of Feto-maternal Effects of Twin Pregnancies and Twin Pregnancies Caused By Assisted Reproductive Technology

Objective: Comparison of the effects of twin pregnancies using assisted reproductive technology (ART) and spontaneous twin pregnancies on maternal-fetal parameters. Methods: A total of 5,670 patients who were deliveried in our clinic between 01.01.2011 and 31.12.2017 were analyzed retrospectively. The fetomaternal results of 94 mothers who deliveried to twins and their infants were compared. Results: Of the 5,670 patients who gave birth, 94 were twins (1/60) and 8 were triplets (1/709). Twin births account for 92% of multiple births. The incidence of spontaneous twin pregnancy was 1/77 and constituted 79% of all the twin deliveries. The effect of ART on was found to be 21% [17% in vitro fertilization (IVF), 4% ovulation induction]. Mean maternal age was 29.25 +/- 6.00 years in twin pregnancy deliveries, 28.50 +/- 6.09 years in mothers who had spontaneous twin group, and 32.54 +/- 5.09 years in twin births due to ART. When anemia was excluded, maternal morbidity was 27% in twin pregnancy deliveries. Pre-eclampsia was determined in 19% of the cases and anemia in 63%. Delivery before 37 gestational weeks was recorded in 72.3% of IVF twins and 70.2% of spontaneous twins. The rate of live births was found to be higher in spontaneously conceived twins (p=0.004). The fetal mortality rate was 5.4% in spontaneous twin pregnancies and 20% in twin pregnancies with ART (p=0.003). The perinatal mortality index was determined to be 81 in spontaneously conceived twins, and 250 in the twin pregnancies obtained with ART (p=0.006). Conclusion: Premature birth and fetal mortality rates are higher in twin pregnancies obtained with ART than in spontaneous twins. The mortality associated with multiple pregnancies may be reduced with preventive measures such as low-dose gonadotropin use, single embryo transfer, and multifetal embryo reduction.