Perinatal and Neonatal Outcomes of Multiple Pregnancies in Middle Black Sea Region: The Role of Assisted Reproductive Technology

INTRODUCTION: Due to the increased frequency of multiple pregnancies, associated with the increasing use of assisted reproductive technologies (ART), babies borned from multiple-pregnancies continue to attract global attention. Whether conceived through ART or spontaneously, newborns from multiple-pregnancies require neonatal intensive care services much more than singletons and have increased morbidity and mortality rates. Furthermore, some researchers argue that ART alone, regardless of the number of fetuses, may contribute to increased morbidity and mortality. With this study, we aimed to determine the rates of morbidity and mortality in multiple pregnancies and to identify factors influencing these outcomes.
METHODS: Data on babies born or miscarriaged from multiple-pregnancies between January 2008- June 2013 in a single university hospital were investigated. Data of patients and their mothers were collected retrospectively. The data about gestational age, birth weight, ART, plurality, gender was evaluated regarding morbidity and mortality.
RESULTS: 488 babies were borned from multiple-pregnancies during the study period and among them 49.6%, were conceived by ART. The number of ART-related multiple-pregnancies decreased over the years. 60.9% of babies were born between 32 and 37 weeks of gestation, and 53.9% had birth weights between 1500 and 2500 grams. Prematurity and its severity were found to be higher in infants born from ART-related multiple pregnancies (p=0.00). Newborns from conceived via ART had a significantly earlier gestational age at birth (32.59 ± 3.57 vs. 34.17 ± 3.36 weeks) and significantly lower birth weights (1953 ± 672 vs. 2088 ± 621 g).
DISCUSSION AND CONCLUSION: In conclusion, we observed an increased frequency and severity of prematurity among newborn from ART-related multiple-pregnancies. Mortality rates demonstrated a declining trend over time, in parallel with the reduced utilization of ART. These findings highlighting prematurity as a major risk factor in multiple births emphasize the critical importance of implementing strategies aimed at preventing multiple pregnancies in ART practices.

Keywords: Multiple pregnancy, twin, triplet, assisted reproductive technology, preterm