Neonatal Outcomes of Triplet Pregnancies Conceived via In Vitro Fertilization versus Other Methods of Conception

Abstract

Objective This study aims to investigate neonatal outcomes of triplet gestations conceived via in vitro fertilization (IVF) compared with those not conceived by IVF.

Study Design This is a retrospective cohort study of women who delivered a triplet gestation ≥24 weeks at a large academic center (2005–2016). Women with unknown mode of conception were excluded. Women who conceived via IVF were compared with those conceiving spontaneously or through non-IVF fertility treatments. The primary outcome was a composite severe neonatal morbidity (respiratory distress syndrome, necrotizing enterocolitis, severe intraventricular hemorrhage, retinopathy of prematurity, neonatal sepsis, or death). Bivariate comparisons were made by mode of conception and unadjusted generalized estimating equations were used to estimate odds ratios (OR) after accounting for the clustering of neonate by mother.

Results Among 82 women included in this analysis, 51 (62%) conceived via IVF. Women who conceived via IVF were older (35.2 vs. 30.7, p < 0.001) and more likely to be of non-Hispanic white race/ethnicity (91.8 vs. 70.0%, p < 0.01) and married (100 vs. 90.0%, p = 0.02) when compared with women who did not conceive via IVF. Although women who conceived via IVF delivered at an earlier gestational age than those who did not (32.9 ± 3.0 vs. 33.7 ± 2.6 weeks, p = 0.02), there was no significant difference in composite neonatal morbidity (34.0 vs. 28.0%, p = 0.32; OR: 1.33, 95% CI: 0.60–2.91). Additionally, there were no significant differences between the groups with regard to other neonatal outcomes examined, including fetal growth restriction, birthweight, umbilical artery pH <7, neonatal intensive care unit admissions, duration in the NICU, need for mechanical ventilation, or duration of mechanical ventilation.

Conclusion Neonatal outcomes among triplet gestations did not differ by IVF in this well-characterized, single-center cohort.

Keywords

in vitro fertilization - morbidity - neonatal - pregnancy - preterm birth - triplet

Note

This abstract was presented at the 64th Society for Reproductive Investigation Annual Scientific Meeting, Orlando, FL, March 15 to 18, 2017.

Publication History

Received: 13 November 2019

Accepted: 26 November 2019

Article published online:
07 January 2020

• References

• 1 Sunderam S, Kissin DM, Crawford S. et al; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Assisted reproductive technology surveillance–United States, 2010. MMWR Surveill Summ 2013; 62 (09) 1-24 Accessed November 6, 2019 at: http://www.ncbi.nlm.nih.gov/pubmed/24304902
• 2 Kulkarni AD, Jamieson DJ, Jones Jr. HW. et al. Fertility treatments and multiple births in the United States. N Engl J Med 2013; 369 (23) 2218-2225
• 3 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Mathews TJ. Births: final data for 2015. Natl Vital Stat Rep 2017; 66 (01) 1 Accessed November 13, 2018 at: http://www.ncbi.nlm.nih.gov/pubmed/28135188
• 4 Yeo KT, Lee QY, Quek WS, Wang YA, Bolisetty S, Lui K. Australian and New Zealand Neonatal Network. Trends in morbidity and mortality of extremely preterm multiple gestation newborns. Pediatrics 2015; 136 (02) 263-271
• 5 Luke B, Keith LG. The contribution of singletons, twins and triplets to low birth weight, infant mortality and handicap in the United States. J Reprod Med 1992; 37 (08) 661-666 Accessed October 15, 2019 at: http://www.ncbi.nlm.nih.gov/pubmed/1432978
• 6 Jackson RA, Gibson KA, Wu YW, Croughan MS. Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol 2004; 103 (03) 551-563
• 7 Belanoff C, Declercq ER, Diop H. et al. Severe maternal morbidity and the use of assisted reproductive technology in Massachusetts. Obstet Gynecol 2016; 127 (03) 527-534
• 8 Moini A, Shiva M, Arabipoor A, Hosseini R, Chehrazi M, Sadeghi M. Obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproductive technology compared with twin pregnancies conceived spontaneously: a prospective follow-up study. Eur J Obstet Gynecol Reprod Biol 2012; 165 (01) 29-32
• 9 Bell MJ, Ternberg JL, Feigin RD. et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
• 10 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
• 11 International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005; 123 (07) 991-999
• 12 Bamberg C, Fotopoulou C, Neissner P. et al. Maternal characteristics and twin gestation outcomes over 10 years: impact of conception methods. Fertil Steril 2012; 98 (01) 95-101
• 13 Qin J, Wang H, Sheng X, Liang D, Tan H, Xia J. Pregnancy-related complications and adverse pregnancy outcomes in multiple pregnancies resulting from assisted reproductive technology: a meta-analysis of cohort studies. Fertil Steril 2015; 103 (06) 1492-1508
• 14 Zuppa AA, Scorrano A, Cota F, D'Andrea V, Fracchiolla A, Romagnoli C. Neonatal outcomes in triplet pregnancies: assisted reproduction versus spontaneous conception. J Perinat Med 2007; 35 (04) 339-343
• 15 Yee LM, Liu LY, Grobman WA. The relationship between obstetricians' cognitive and affective traits and their patients' delivery outcomes. Am J Obstet Gynecol 2014; 211 (06) 692.e1-692.e6
• 16 Yee LM, Liu LY, Grobman WA. Relationship between obstetricians' cognitive and affective traits and delivery outcomes among women with a prior cesarean. Am J Obstet Gynecol 2015; 213 (03) 413.e1-413.e7