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1 Med J Chin PLA, Vol. 42, No. 11, November 1, [ ] ( ) ( )518 ( )293 (P<0.05) (P<0.05) (P<0.05) ( )(P<0.05) (P>0.05) (P>0.05) [ ] [ ] R [ ] A [ ] (2017) [DOI] /j.issn Perinatal complications and neonatal outcomes of twin pregnancies conceived by assisted reproductive techniques and those conceived spontaneously: A retrospective analysis of 811 cases YU Jin, GUO Yu-na *, XIE Xian-jing The International Peace Maternity and Child Health Hospital of China Welfare Institute, Shanghai Jiaotong University School of Medicine, Shanghai , China * Corresponding author, gyuna@live.com [Abstract] Objective To investigate the general situations of gravida, pregnancy complications, childbirth and neonatal outcomes of twin pregnancies conceived by assisted reproductive techniques (ART) and those conceived spontaneously. Methods A retrospective analysis was carried out on the basic information, perinatal complications, delivery information and neonatal outcomes of twin pregnancies received by ART (ART group, n=518) and those conceived spontaneously (SC group, n=293). Results Gravida age was older in ART group than in SC group (P<0.05), while the gravidity and parity in ART group was more than that in SC group (P<0.05). There were more embryos and high proportion of diamniotic cyst in ART group than in SC group (P<0.05). The gestational incidence of diabetes, abnormal placenta (placental adherence, placenta accrete, placenta previa) and postpartum hemorrhage were higher in ART group than in SC group (P<0.05), while no statistically significant differences existed between the two groups in the incidence of gestational complications (such as gestational hypertension disease, cholestasis and amniotic fluid volume abnormality) and in neonatal outcomes including neonatal weight, incidence of asphyxia and congenital malformation and neonatal death (P>0.05). Conclusion Twin pregnancy conceived by ART may lead to higher incidences of gestational diabetes mellitus and abnormal placenta and more postpartum hemorrhage, but no significant difference existed in the neonatal outcomes between twin pregnancies conceived by ART and those conceived spontaneously. [Key words] twin pregnancy; assisted reproductive techniques; pregnancy complications; pregnancy outcome [ ] [ ] ( ) [ ] gyuna@live.com

2 ( ) [1-8] (>28 ) 811 ( 2.6%) ( n=518) (n=293) (PGD) 1.2 Apgar B B 8 [9] (5min Apgar <7 ) 7 [10] 1.3 SPSS 17.0 x±s t χ 2 P< (63.9%) (36.1%) ( ) ( P<0.05) 35 (P<0.05) (P<0.05) (P<0.05) (P>0.05 1) 1 Tab.1 Comparison of general situation and delivery modes between the two twin pregnancy groups Item ART group (n=518) SC group (n=293) Age (year) years [n(%)] 146(28.2) 36(12.3) Gravidity and parity Gravidity Parity Number of fertilized eggs [n(%)] 1 13(2.5) 101(34.5) (97.5) 192(65.3) Chorion prosperity [n(%)] Monochorionic 35(6.8) 100(34.1) Dichorionic 483(93.2) 193(65.9) Delivery mode [n(%)] Cesarean section 515(99.4) 291(99.3) Vaginal delivery 3(0.6) 2(0.7) Operation time [n(%)] Selective operation 437(84.3) 232(79.2) Emergency operation 81(15.7) 61(20.8) Gestational weeks of delivery ART. Assisted reproductive techniques; SC. Conceived spontaneously 2.2 (P<0.05) / (P<0.05) ( OR %CI 0.93~3.93) 1.91 ( OR %CI 0.93~2.63) 1.57 ( OR %CI 1.56~3.00) 2.17 / (P<0.05 2) χ 2 /t P

3 Med J Chin PLA, Vol. 42, No. 11, November 1, Tab.2 Comparison of gestational complications between the two twin pregnancy groups Item ART group (n=518) SC group (n=293) χ 2 /t P Adjusted OR 95% CI Placenta abnormalities [n(%)] 63(12.2) 17(5.8) Placenta previa 16(3.1) 5(1.7) Placenta abruption 2(0.4) 2(0.7) Placenta accrete 7(1.4) Placenta adhesion 26(5.0) 6(2.0) Racket/Velum placenta 12(2.3) 4(1.4) Gestational diabetes mellitus [n(%)] 104(20.1) 39(13.3) Hypertensive disorder complicating pregnancy [n(%)] 97(18.7) 44(15.0) Gestational hypertension 35(6.8) 14(4.8) Pre-eclampsia 58(11.2) 28(9.6) Eclampsia 0 0 HELLP 4(0.8) 2(0.7) Intrahepatic cholestasis of pregnancy [n(%)] 22(4.2) 8(2.7) Twin transfusion syndrome [n(%)] 1(0.2) 3(1.0) Premature rupture of membranes [n(%)] 60(11.6) 35(11.9) Postpartum hemorrhage volume (ml) ART. Assisted reproductive techniques; HELLP. Hemolysis elevated liver enzymes and low platelets syndrome; SC. Conceived spontaneously;. No data 2.3 ( g) ( g) (P>0.05) (P>0.05 3) 3 Tab.3 Comparison of neonatal outcomes between the two twin pregnancy groups Item ART group (n=1036) SC group (n=586) χ 2 /t P Average weight of newborn (g) Low birth weight (<2500g) infants [n(%)] 471(45.5) 273(46.6) Neonatal asphyxia [n(%)] 4(0.4) 2(0.3) Neonatal death [n(%)] 1(0.1) 1(0.2) Neonatal malformation [n(%)] 6(0.6) 4(0.7) ART. Assisted reproductive techniques; SC. Conceived spontaneously 3 80% [11] - (in vitro fertilization and embryo transfer IVF-ET) % 71.0% [6] [1-8] >35 [3-4] [12] ( ) [1-8]

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5 Med J Chin PLA, Vol. 42, No. 11, November 1, assisted reproductive technology[ J]. Chin J Obstet Gynecol, 2002, 37(6): [,,,. [J]., 2002, 37(6): ] [9] Xie X, Gou WL. Obstetrics and gynecology[m]. 8th ed. Beijing: People's Health Publishing House, [,. [M]. 8. :, ] [10] Huo YM, Jiang ZF. Zhu Fu-tang practical pediatrics[m]. 7th ed. Beijing: People's Health Publishing House, [,.. 7. :, ] [11] Nassar AH, Usta IM, Rechdan JB, et al. Pregnancy outcome in spontaneous twins versus twins who were conceived through in vitro fertilization[ J]. Am J Obstet Gynecol, 2003, 189(2): [12] Thomopoulos C, Tsioufis C, Michalopoulou H, et al. Assisted reproductive technology and pregnancy-related hypertensive complications: a systematic review[ J]. J Hum Hypertens, 2013, 27(3): [13] Li XM, Zhuang GL, Li DC, et al. Obstetric outcomes of pregnant women after in vitro fertilization and embryo transfer[ J]. Chin J Obstet Gynecol, 1996, 31(8): [,,,. - [ J]., 1996, 31(8): ] [14] Dhont M, De Sutter P, Ruyssinck G, et al. Perinat al outcome of pregnancies after assisted reproduction: a case-control study[ J]. Am J Obstet Gynecol, 1999, 181(3): [15] Ashrafi M, Gosili R, Hosseini R, et al. Risk of gestational diabetes mellitus in patients undergoing assisted reproductive techniques[ J]. Eur J Obstet Gynecol Reprod Biol, 2014, 176: [16] Dornhorst A, Paterson CM, Nicholls JS, et al. High prevalence of gestational diabetes in women from ethnic minority groups[ J]. Diabet Med, 1992, 9(9): [17] Li J, Yang J, Xu WM, et al. Comparison of the perinatal outcome of twins conceived after assisted reproductive technologies versus those conceived naturally[ J]. J Reprod Med, 2015, 60(1-2): [18] Daniel Y, Ochshorn Y, Fait G, et al. Analysis of 104 twin pregnancies conceived with assisted reproductive technologies and 193 spontaneously conceived twin pregnancies[ J]. Fertil Steril, 2000, 74(4): [19] Sunderam S, Kissin DM, Crawford SB, et al. Assisted reproductive technology surveillance -- United States, 2012[ J]. MMWR Surveill Summ, 2015, 64(6): [20] Halliday J. Outcomes of IVF conceptions: are they different?[ J]. Best Pract Res Clin Obstet Gynaecol, 2007, 21(1): ( ) ( )

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