Neonatal outcomes among twins born through assisted reproduction, compared to those born naturally

The growing prevalence of assisted reproductive technology (ART) is leading to a continuous rise in twin pregnancies. This study assessed the influence of ART on neonatal outcomes of twin pregnancies. Clinical records of twin deliveries at Fujian Maternity and Child Health Hospital between 2019 and 2021 were retrospectively selected and grouped based on the method of conception: ART-conceived and naturally conceived. Neonatal outcomes of interest included low birth weight (LBW), intrauterine growth restriction (IUGR), prematurity, low Appearance, Pulse, Grimace, Activity and Respiration scores, and neonatal intensive care unit admission. Univariate and multivariable logistic regression analyses were conducted to adjust for potential confounders. The results were expressed as odds ratio (OR) with 95% confidence interval (CI). A total of 1270 pairs of twins were included in the analysis. ART-conceived twins had significantly lower odds of being born with LBW (adjusted OR 0.57, 95% CI: 0.43, 0.75), prematurity (adjusted OR 0.71, 95% CI: 0.55, 0.91), and IUGR (adjusted OR 0.21, 95% CI: 0.10, 0.39) compared to naturally conceived twins. Rates of other outcomes were comparable in both groups. Twins born through ART had reduced odds of LBW, prematurity, and IUGR, with no impact on other neonatal outcomes. These findings suggest that ART may have a protective effect on twin fetal growth, although the risks associated with multiple gestations remain. Further studies should explore the mechanisms and long-term effects of these outcomes.