Comparing Outcomes and Risks of Multiple Gestations: Assisted versus Spontaneous Conceptions

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Medicine

Background:

• Multiple gestations, including twins and triplets, are rising globally, often due to Assisted Reproductive Technology (ART).
• These pregnancies carry significantly higher risks for both mothers and newborns compared to singleton pregnancies.
• Limited regional data exists, particularly from Saudi Arabia, necessitating localized research.

Purpose of the Study:

• To evaluate and compare maternal and neonatal outcomes in twin and triplet pregnancies in Saudi Arabia.
• To differentiate outcomes between pregnancies conceived spontaneously versus through ART.

Main Methods:

• A retrospective chart review was conducted at a Women's Health Hospital in Riyadh from January 2022 to December 2023.
• Data included maternal characteristics (age, BMI, gestational age, complications) and neonatal outcomes (birthweight, Apgar score, admissions).
• Analysis focused on twin and triplet pregnancies, comparing spontaneous conceptions with those from ART.

Main Results:

• 233 pregnancies were analyzed (222 twins, 11 triplets), with a mean gestational age of 37.1 weeks for twins and 33.5 weeks for triplets.
• Preterm birth (70.4%) and gestational diabetes mellitus (22.3%) were frequent complications; 92.7% of births were preterm (>32 weeks).
• Triplet pregnancies showed higher ART prevalence (30.5%), earlier preterm delivery, malpresentation, and predominantly Cesarean delivery (88.8%); neonatal admissions were mainly for prematurity and respiratory distress.

Conclusions:

• Multiple gestations, especially those conceived via ART, present substantial maternal and neonatal risks, including preterm birth and malpresentation.
• ART-conceived triplet pregnancies are particularly vulnerable, requiring specialized obstetric care.
• Findings highlight the need for enhanced management strategies and further research in Saudi Arabia to improve outcomes for ART-related multiple gestations.