260: Perinatal outcomes in women with twin gestations who conceived spontaneously versus by assisted reproductive techniques (ART)

Abstract

Recent large retrospective reports have found an increase in adverse pregnancy outcomes in women with multiple gestations who conceive by ART. We sought to evaluate whether differences exist in pregnancy outcomes by method of conception in women with a twin gestation in a prospective multicenter study. Perinatal outcomes were compared between women who conceived spontaneously or after ART from a multicenter randomized, placebo controlled trial regarding the effect of 17-alpha-hydroxyprogesterone on preterm birth in women with twin gestations. A p value of < 0.05 was considered significant. Of 661 women with twin gestations, 430 conceived spontaneously and 231 by ART. Women who conceived by ART were older (34.7 vs. 27.0 years; p< 0.0001), more likely married (99.1% vs. 60.9%, p<0.0001), less likely African American (3.5% vs. 34.2%, p<0.0001), more educated (15.5 vs. 12.6 years, <0.0001) and had a lower BMI (24.9 vs. 28.0; p<0.0001). In multivariable analysis, correcting for potential confounders and accounting for correlated outcomes in the twin clusters, there was no difference in any outcome variable between groups, including preterm birth, stillbirth, birth weight, Apgar scores, or neonatal IVH, RDS, sepsis, NEC, BPD, seizures, PDA or death. On further comparison of pregnancies conceived by IVF, by other ART, or spontaneously, no outcome was significantly different. This analysis has approximately 70% power to detect odds ratio &cjs0062;1.6 for neonatal morbidities after controlling for other relevant factors with multiple correlation coefficient of 0.2 and α.05 by logistic regression These data, collected within the context of a prospectively designed study, suggest that women with twin gestations who conceive by ART are not at an increased risk for untoward pregnancy outcomes.