Neonatal outcome of spontaneous and assisted twin pregnancies

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Abstract

Objectives: Over the last 10 years, diffusion of assisted reproduction techniques (ovarian stimulation, IVF, GIFT) has led to an increased incidence of multiple pregnancies and consequently, of the related obstetric–neonatal problems. In this study, multiple births have been studied, with particular reference to the twin births occurring in the Gemelli hospital, Rome. The hospital is also a reference centre for obstetric pathologies and infertility treatment. In particular, attention has been focused on neonatal outcome, comparing twins born from spontaneous and assisted pregnancies. Study Design: 228 neonates from spontaneous twin pregnancies and 32 from assisted twin pregnancies were taken into consideration with regard to: premature birth, low birth-weight, intrauterine growth retardation, weight discordance, Apgar score, major neonatal diseases, and mortality. Results: Results showed a significant higher incidence of prematurity and low birth-weight, as well as a significant lower gestational age, occurring more frequently in twins resulting from assisted pregnancies than in twins from spontaneous pregnancies. Furthermore, the incidence of severe depression at birth and respiratory disease was significantly higher in twins from assisted pregnancies than in those from spontaneous pregnancies, despite similar gestational age and birth-weight.

Introduction

Over the last 10 years there has been an increase in the number of multiple pregnancies. In the USA, the incidence of twin deliveries has gradually risen from 1:105 to 1:80, and higher multiple deliveries from 1:10,000 to 1:3000 [1]. According to ISTAT (the National Institute for Statistics) data, the incidence of twin deliveries in Italy has progressively risen from 1:104 to 1:96 and higher multiple deliveries from 1:10,000 to 1:2800 [2].

The higher incidence of twin pregnancies is related principally to the increased diffusion of assisted reproduction techniques, involving ovarian stimulation with clomiphene, gonadotrophins and other hormones, ‘in vitro’ fertilisation (IVF) and gamete intra-fallopian transfer (GIFT) [3], [4].

An Italian study relating to 1994 reports that 9.7% of multiple pregnancies is a result of assisted reproduction techniques and gives the following percentages: 5.4% twin pregnancies and 69.8% triplet and higher order multiple pregnancies [2].

The aim of this study is to examine and assess the increased incidence of multiple pregnancies in our centre as well as eventual differences in neonatal outcome between spontaneous and assisted twin pregnancies. In fact, several other reports have shown an increased incidence in pre-term deliveries and low birth-weight following IVF and GIFT. This, however, does not seem to be related to the increased incidence of multiple deliveries since the same increased incidence has also been reported for singleton pregnancies resulting from GIFT and IVF [5], [6], [7].

Section snippets

Materials and methods

Two 5-year periods, 1988–1992 and 1993–1997, were taken into consideration with regard to multiple births of any order occurring during these timeframes at the Gemelli Hospital. The 3-year period, 1994–1996, was also examined for twin births: 260 twins were studied, 228 resulting from spontaneous pregnancies and 32 from assisted pregnancies. Assisted reproduction techniques were homogeneously distributed: clomiphene 25%, gonadotrophin 31.2%, IVF 25%, GIFT 18.8%. In 70% of the cases delivery

Results

Comparing the two 5-year periods, 1988–1992 and 1993–1997, we observed an increasing trend in the incidence of twin deliveries from 1:60 (1.66%) to 1:51 (1.94%). During the same period, the incidence of higher multiple deliveries remained the same, i.e. 1.6/1000 in the former and 1.4/1000 in the latter.

In the 3-year period 1994–1996, the 11.9% of twin pregnancies and 83.3% of higher multiple pregnancies were assisted; assisted reproduction represents 17.8% of all pregnancies resulting in

Discussion

As reported in relevant literature, epidemiological data covering the last 10 years at the A. Gemelli Hospital seems to confirm the increased incidence of multiple pregnancies, even if our evaluations are not performed on statistical basis. The incidence in our study period results are higher since our hospital is also a reference centre for foetal-maternal diseases and infertility treatments. A further point which should be taken into consideration is that increased incidence in multiple

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