Preterm Birth after Assisted Reproductive Technology in Twins: Are Neonates at Higher Risk of Respiratory Morbidity?

Area of Science:

• Neonatal Health
• Maternal-Fetal Medicine
• Reproductive Medicine

Background:

• Twin pregnancies face increased risks for adverse neonatal outcomes.
• Assisted reproductive technology (ART) is increasingly utilized in conception.
• The impact of ART on neonatal respiratory health in late preterm twins is not well-established.

Purpose of the Study:

• To compare adverse neonatal respiratory outcomes in twin pregnancies delivered between 32.0 and 36.6 weeks gestation.
• To determine if ART conception is associated with differences in respiratory outcomes compared to non-ART conception.

Main Methods:

• Retrospective cohort study (2008-2011) including 1,268 twin pregnancies delivered between 32.0-36.6 weeks.
• Exclusion of pregnancies with fetal anomalies.
• Primary outcome: composite of respiratory adverse outcomes in neonates (CRAO), analyzed using Poisson regression with overlap weighting.

Main Results:

• No significant difference in CRAO between ART (25.8%) and non-ART (74.2%) conceived groups (weighted aRR 0.61).
• ART group had different maternal characteristics (older, lower BMI, less smoking, less diverse, higher insurance/nulliparity).
• Sensitivity analyses by gestational age subgroups and antenatal corticosteroid use showed no differences.

Conclusions:

• ART conception is not associated with increased adverse neonatal respiratory outcomes in late preterm twin pregnancies.
• No significant difference in CRAO was observed between ART and non-ART groups.
• Findings suggest ART does not negatively impact respiratory health in this specific neonatal population.