Problem statement

Twin pregnancies have a variable incidence throughout the world, but it has globally increased due to the advancing maternal age and the use of fertility treatments and assisted reproductive technology (ART). Some studies demonstrated that twins born after ART pregnancies are at a higher risk of perinatal morbidity and mortality, such as birth defects and low birth weight. The research aim is to compare maternal and neonatal complications between spontaneous and ART pregnancies.

Methods

The retrospective analysis of all twin pregnancies delivered at the Hospital de Braga between January 2004 and June 2019. Triplets and stillbirths were excluded. 616 cases were analysed for demographic data, type of conception, chorionicity, gestational age at birth, delivery route and perinatal morbidity. Using SPSS Statistics version 23.0, a comparative analysis between groups was done, evaluating possible associations.

Results

517 (83,93%) were spontaneous and 99 (16,07%) were ART pregnancies. From the data analysis, mean maternal age proved to be significantly higher at the ART pregnancy group: 31,28 vs 34,16 years (p value <0.001)

No difference was observed between spontaneous and ART pregnancies, respectively, regarding mean gestational age 35,03 vs 35,20 weeks (p value = 0.972), weight of first fetus 2269,24 vs 2303,35g (p value = 0,739), weight of second fetus 2205,69 vs 2054,34g (p value = 0,209) and birth weight discordance 11,69 vs 14,15% (p value = 0,148 ).

About the route of delivery, 66,7 % of ART pregnancies and 62,3% of spontaneous were caesarean (p value = 0,627). Regarding APGARscore the results obtained were not statistically different, except at 5th minute on second fetus (p value = 0,016): means of 9,65 e 9,77 in spontaneous and ART pregnancies, respectively.

Conclusion

With the advancing maternal age the physiological reduction in fertility leads more women to use ART, as verified in our research. Although some studies suggest that worse neonatal outcomes are associated with ART pregnancies, in our investigation, this difference was not verified. Greater figures of caesarean section in ART pregnancies, which can be explained by the increased maternal age and morbidity of women that use ART, although it was not statically significant.

TYPE OF CONCEPTION IN TWIN PREGNANCIES - OBSTETRIC AND NEONATAL IMPACTS AT THE MOMENT OF DELIVERY