Comparison of maternal, fetal, obstetric and neonatal outcomes for 234 triplet pregnancies conceived in vivo versus IVF and ICSI conceptions

Abstract

Research questionTriplet pregnancies have increased due to the rise in assisted reproductive techniques (ART). The objective of this study is to compare the results of natural versus ART triplet pregnancies. DesignThis is a single-center, retrospective cohort study that includes all triplet pregnancies followed up on at the La Paz University Hospital between 2000 and 2022. The characteristics of the pregnant women, maternal, fetal, obstetric, and perinatal outcomes were examined. Univariate and multivariate statistical analyses were performed. Results234 triplet pregnancies were analyzed: 92 triplet pregnancies in the spontaneous and artificial insemination conception group (natural conception) and 142 triplet pregnancies in the in vitro fertilization and intracytoplasmic sperm injection conception group (ART conception). Between 2000 and 2010, ART pregnancies were more frequent (p<0.01). The monochorionic triamniotic percentage was significantly higher (p<0.01) in the spontaneous group and the dichorionic triamniotic percentage (p=0.02) was higher in the ART group. After adjusting for confounders, the intrauterine growth restriction (IUGR) (p=0.01) result remained statistically significant with OR=8.65(1.66-45-03), being more frequent in the ART group. Maternal age (p=0.61; OR=1.08(0.99-1.18)) threatened preterm labor (p=0.10), Apgar test ≤5 at 5-minutes (p=0.99), pH<7.20 (p=0.99) and fetal death (p=0.99) differences disappearing upon adjustment for confounders. ConclusionTriplet pregnancies by ART had a higher rate of IUGR than natural triplet pregnancies. This could be related to the higher maternal age and the higher rates of lower Apgar test scores at 5-minutes and umbilical cord pH <7.20 in these pregnancies. In these cases, placental examination could provide valuable information.