The Relationship of Assisted Reproductive Technology on Perinatal Outcomes in Triplet Gestations

Abstract

Objective To assess whether assisted reproductive technology (ART) is associated with increased risk of adverse perinatal outcomes in triplet gestations compared with spontaneous conception.

Study Design Secondary analysis of a multicenter randomized trial for the prevention of preterm birth in multiple gestations. Triplets delivered at ≥ 24 weeks were studied. The primary outcome was the rate of composite neonatal morbidity (CNM) that included one or more of the following: bronchopulmonary dysplasia, respiratory distress syndrome, necrotizing enterocolitis, culture proven sepsis, pneumonia, retinopathy of prematurity, intraventricular hemorrhage, periventricular leukomalacia, or perinatal death.

Results There were 381 triplets (127 women) of which 89 patients conceived via ART and 38 patients spontaneously. Women with ART were more likely to be older, Caucasian, married, nulliparous, have higher level of education, and develop pre-eclampsia. Spontaneously conceived triplets were more likely to delivery at an earlier gestation (31.2 ± 3.5 vs 32.8 ± 2.7 weeks) (p = 0.009) with a lower birth weight (p < 0.001). After adjusting for confounders, no differences were noted in culture proven sepsis, perinatal death, CNM, respiratory distress syndrome, or Apgar score < 7 at 5 minutes. All remaining perinatal outcomes were similar.

Conclusion Triplets conceived by ART had similar perinatal outcomes compared with spontaneously conceived triplets.

Keywords

triplet pregnancy - assisted reproductive technology - perinatal outcomes - multiple gestations

• References

• 1 Bajoria R, Ward SB, Adegbite AL. Comparative study of perinatal outcome of dichorionic and trichorionic iatrogenic triplets. Am J Obstet Gynecol 2006; 194 (02) 415-424
• 2 Adegbite AL, Ward SB, Bajoria R. Perinatal outcome of spontaneously conceived triplet pregnancies in relation to chorionicity. Am J Obstet Gynecol 2005; 193 (04) 1463-1471
• 3 Sunderam S, Kissin DM, Crawford SB. , et al; Centers for Disease Control and Prevention (CDC). Assisted reproductive technology surveillance - United States, 2013. MMWR Surveill Summ 2015; 64 (11) 1-25
• 4 Fennessy KM, Doyle LW, Naud K, Reidy K, Umstad MP. Triplet pregnancy: is the mode of conception related to perinatal outcomes?. Twin Res Hum Genet 2015; 18 (03) 321-327
• 5 Revello R, De la Calle M, Moreno E, Duyos I, Salas P, Zapardiel I. Maternal morbidity on 147 triplets: single institution experience. J Matern Fetal Neonatal Med 2013; 26 (02) 193-196
• 6 Martin JA, Hamilton BE, Ventura SJ. , et al. Births: final data for 2009. Natl Vital Stat Rep 2011; 60 (01) 1-70
• 7 Morency A-M, Shah PS, Seaward PGR, Whittle W, Murphy KE. Obstetrical and neonatal outcomes of triplet births - spontaneous versus assisted reproductive technology conception. J Matern Fetal Neonatal Med 2016; 29 (06) 938-943
• 8 Wen SW, Demissie K, Yang Q, Walker MC. Maternal morbidity and obstetric complications in triplet pregnancies and quadruplet and higher-order multiple pregnancies. Am J Obstet Gynecol 2004; 191 (01) 254-258
• 9 Qin JB, Wang H, Sheng X, Xie Q, Gao S. Assisted reproductive technology and risk of adverse obstetric outcomes in dichorionic twin pregnancies: a systematic review and meta-analysis. Fertil Steril 2016; 105 (05) 1180-1192
• 10 Hansen M, Colvin L, Petterson B, Kurinczuk JJ, de Klerk N, Bower C. Twins born following assisted reproductive technology: perinatal outcome and admission to hospital. Hum Reprod 2009; 24 (09) 2321-2331
• 11 Moini A, Shiva M, Arabipoor A, Hosseini R, Chehrazi M, Sadeghi M. Obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproductive technology compared with twin pregnancies conceived spontaneously: a prospective follow-up study. Eur J Obstet Gynecol Reprod Biol 2012; 165 (01) 29-32
• 12 Geisler ME, O'Mahony A, Meaney S, Waterstone JJ, O'Donoghue K. Obstetric and perinatal outcomes of twin pregnancies conceived following IVF/ICSI treatment compared with spontaneously conceived twin pregnancies. Eur J Obstet Gynecol Reprod Biol 2014; 181: 78-83
• 13 Zuppa AA, Scorrano A, Cota F, D'Andrea V, Fracchiolla A, Romagnoli C. Neonatal outcomes in triplet pregnancies: assisted reproduction versus spontaneous conception. J Perinat Med 2007; 35 (04) 339-343
• 14 Rouse DJ, Caritis SN, Peaceman AM. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A trial of 17 alpha-hydroxyprogesterone caproate to prevent prematurity in twins. N Engl J Med 2007; 357 (05) 454-461
• 15 Caserta D, Bordi G, Stegagno M. , et al. Maternal and perinatal outcomes in spontaneous versus assisted conception twin pregnancies. Eur J Obstet Gynecol Reprod Biol 2014; 174 (01) 64-69
• 16 Valenzuela-Alcaraz B, Crispi F, Manau D. , et al. Differential effect of mode of conception and infertility treatment on fetal growth and prematurity. J Matern Fetal Neonatal Med 2016; 29 (23) 3879-3884
• 17 Lopes Perdigao J, Straub H, Zhou Y, Gonzalez A, Ismail M, Ouyang DW. Perinatal and obstetric outcomes of dichorionic vs trichorionic triplet pregnancies. Am J Obstet Gynecol 2016; 214 (05) 659.e1-659.e5
• 18 Hansen M, Kurinczuk JJ, Milne E, de Klerk N, Bower C. Assisted reproductive technology and birth defects: a systematic review and meta-analysis. Hum Reprod Update 2013; 19 (04) 330-353
• 19 Murray SR, Norman JE. Multiple pregnancies following assisted reproductive technologies--a happy consequence or double trouble?. Semin Fetal Neonatal Med 2014; 19 (04) 222-227
• 20 Shah V, Alwassia H, Shah K, Yoon W, Shah P. Neonatal outcomes among multiple births ≤ 32 weeks gestational age: does mode of conception have an impact? A cohort study. BMC Pediatr 2011; 11 (01) 54
• 21 Gleicher N, Kushnir VA, Barad DH. Risks of spontaneously and IVF-conceived singleton and twin pregnancies differ, requiring reassessment of statistical premises favoring elective single embryo transfer (eSET). Reprod Biol Endocrinol 2016; 14 (01) 25
• 22 Grobman WA, Parker CB, Willinger M. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) Network. Racial disparities in adverse pregnancy outcomes and psychosocial stress. Obstet Gynecol 2018; 131 (02) 328-335