Retrospective comparison of monochorionic diamniotic twin pregnancies stratified by spontaneous or artificial conception.

OBJECTIVES: To compare outcomes of monochorionic diamniotic (MCDA) twin pregnancies by in vitro fertilization (IVF) vs. spontaneously conceived counterparts. METHODS: Retrospective comparison. Data about MCDA twin pregnancies, conceived spontaneously or by IVF, attending the Twin Pregnancy Care Unit of Sant'Anna Hospital in Turin (Italy) between January 1st 2010 and March 31st 2022, were collected retrospectively. Obstetric, fetal, and neonatal outcomes of MCDA twin pregnancies by IVF were compared to those of spontaneously conceived counterparts. Data were described by univariate and multivariate analysis. RESULTS: 541 MCDA twin pregnancies were included in the study, among which 45 conceived by IVF and 496 spontaneously conceived. Women with IVF twins were older than those who conceived spontaneously (36.7 ± 5.7 vs. 32.1 ± 5.2 years; p<0.001). No significant difference in the prevalence of pregnancy complications between the two groups was found, except for an increased incidence of hypertensive disorders among IVF pregnancies (17.8 vs. 8.5 %; p=0.039), which resulted nonsignificant after adjusting for maternal age and parity (aOR 1.9, 95 % CI 0.8-4.6). Data about 1,046 live born babies (90 conceived by IVF and 956 spontaneously) were also collected: perinatal outcomes did not differ between the two groups. CONCLUSIONS: Our results suggest that MCDA twin pregnancies following IVF are not at increased risk of adverse outcomes compared to spontaneous MCDA twin pregnancies.

Maternal Circulating Vitamin D Level, Targeted Supplementation, and Perinatal Outcomes in Twin Pregnancy.

BACKGROUND: Vitamin D deficiency is associated with several obstetric complications in singleton pregnancy. The aim of this study was to assess whether vitamin D levels affect the outcomes of twin pregnancy and if targeted supplementation can improve perinatal outcomes. METHODS: The serum vitamin D levels of 143 women with twin pregnancies were measured during their first trimester. Those with insufficient (10-30 ng/mL; IL group) or severely deficient (<10 ng/mL, DL group) vitamin D levels were supplemented. In the third trimester, vitamin D levels were reassessed. Perinatal outcomes of the IL and DL groups were compared with those of patients with sufficient levels (>30 ng/mL, SL group) since the beginning of pregnancy. RESULTS: Women in the IL and DL groups had a higher incidence of hypertensive disorders of pregnancy (HDP) compared to the SL group (24.8% and 27.8% vs. 12.5%, p = 0.045): OR = 1.58 for the IL group and 1.94 for the DL group compared to the SL group. In patients whose vitamin D levels were restored after supplementation, HDP incidence was lower than in patients who remained in the IL or DL groups (23.4% vs. 27.3%) but higher than those who were always in the SL group (12.5%). CONCLUSIONS: Insufficient or severely deficient levels of vitamin D in the first trimester are associated with an increased risk of HDP in twin pregnancy. The beneficial effect of targeted vitamin D supplementation in reducing HDP seems limited.

Gestational Diabetes Mellitus Does Not Worsen Obstetrical and Neonatal Outcomes of Twin Pregnancy.

The specific effects of gestational diabetes mellitus (GDM) on twin pregnancy outcomes, which are at high risk per se, are unclear. The present study analyzes outcomes of twin pregnancies complicated by GDM (n = 227) by comparing them with GDM singleton pregnancies (n = 1060) and with twin pregnancies without GDM (n = 1008), all followed up at Sant'Anna Hospital, Turin (Italy), between January 2010 and March 2020. The prevalence of GDM among twin pregnancies (n = 1235) was 18.4%. Compared to GDM singletons, GDM twins had higher rates of preeclampsia (aOR 2.0; 95% CI 1.2-3.8), cesarean section (aOR 7.5; 95% CI 5.2-10.8), and neonatal hypoglycemia (aOR 2.5; 95% CI 1.1-5.3). They had a higher incidence of abnormal 2 h OGTT values (aOR 7.1; 95% CI: 3.2-15.7) and were less likely to require insulin therapy (aOR 0.5; 95% CI: 0.3-0.7). In comparison with twin pregnancies without GDM, women with GDM twins were significantly older (35.0 vs. 33.0 years; p < 0.001) and had higher BMI (23.0 versus 22.0 kg/m2; p < 0.001); they had a higher incidence of LGA newborns (aOR 5.3; 95% CI 1.7-14.8), and lower incidence of low APGAR scores (0.5; 95% CI 0.3-0.9). Overall, GDM does not worsen outcomes of twin pregnancy, which is per se at high risk for adverse outcomes.