Risk factors for adverse outcomes in spontaneous versus assisted conception twin pregnancies

Objective: To evaluate risk factors for adverse outcomes in spontaneous vs. assisted conception twin pregnancies. Design: Historical cohort study. Setting: Four academic tertiary medical centers. Patient(s): Women with twin pregnancies, including 2,143 spontaneous and 424 assisted conception; 2,492 nonreduced and 75 reduced. Intervention(s): None (observational). Main Outcome Measure(s): Preeclampsia, preterm premature rupture of membranes, birth <32 weeks and <30 weeks, low birth weight, very low birth weight, and slowed midgestation fetal growth (<10th percentile between 20 and 28 weeks). Result(s): Among nonreduced pregnancies, assisted conception was not significantly associated with any adverse outcomes; among nulliparas, the risk for preeclampsia was increased regardless of method of conception; among spontaneous conceptions, the risks for preterm premature rupture of membranes, low birth weight, very low birth weight, and slowed midgestation fetal growth were increased. Among all pregnancies, fetal reduction increased risks for birth <32 weeks and <30 weeks, low birth weight, very low birth weight, and slowed midgestation fetal growth. Among nulliparas with assisted conceptions, fetal reduction increased the risks for birth <30 weeks, very low birth weight, and slowed midgestation fetal growth. Conclusion(s): These findings indicate that in twin pregnancies, assisted conception is not a risk factor for adverse outcomes, but rather specific factors that are more common among these pregnancies, such as nulliparity and fetal reduction, increase risks.