Neonatal and maternal outcomes among twin pregnancies stratified by mode of conception in the United States

The rate of maternal and neonatal morbidity in twins conceived via fertility treatments is slightly increased compared with spontaneously conceived twins. Reassurance can be provided to patients undergoing fertility treatments.

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VOLUME 116, ISSUE 2, P514-521


Sara E. Arian, M.D, M.S.C.I., Hadi Erfani, M.D, M.P.H., Ghanshyam S. Yadav, M.D., Steven Clark, M.D., William E. Gibbons, M.D., Alireza A. Shamshirsaz, M.D.



To compare neonatal and maternal outcomes among twin pregnancies conceived as a result of different types of fertility treatments with those of spontaneously conceived twin pregnancies.


Retrospective Cohort.


Population-based analysis.


Population-based analysis of twin pregnancies in the United States based on their mode of conception using the natality data from the National Center for Health Statistics from the Centers for Disease Control and Prevention (from January 2015 through December 2017).



Main Outcome Measure(s)

Adverse neonatal and maternal outcomes.


The overall prevalence of early adverse maternal outcomes and medical complications and obstetric complications including the risk of unplanned hysterectomy, intensive care unit admission, maternal blood transfusion, and perineal laceration were significantly higher in the fertility treatment group (including both ovulation induction/intrauterine insemination and assisted reproductive technology groups) compared with those of the spontaneous conception group, even after adjusting for several potential confounders. The risk of adverse composite neonatal outcomes was slightly lower in the spontaneous conception live twin birth group even after adjustment for several potential confounders.


The rate of maternal and neonatal morbidity in twins conceived via different fertility treatments was slightly increased compared with those of twins conceived spontaneously. Because the absolute risks of maternal and neonatal morbidity were low, overall reassurance regarding these outcomes can be provided to the patients undergoing all types of fertility treatments.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.