(531) Outcomes of IVF Versus Non-IVF Conceived Monochorionic-Diamniotic Twin Gestations

A single-center retrospective cohort study was conducted amongst all MD twin pregnancies between 2005 and 2025 in an urban academic medical center. Pregnancies involving twin-twin transfusion syndrome (TTTS), uterine anomalies, major fetal anomalies, and fetal losses prior to 20 weeks were excluded. For the preeclampsia (PEC) outcome, we excluded patients with chronic hypertension (cHTN). SPSS was used to perform descriptive and comparative statistics. A significance level of 0.05 was used.

Results:

A total of 83 IVF and 160 non-IVF MD pregnancies were included. The IVF group was significantly older (37.2±5.9 vs. 31.8±5.8, p< 0.001) than the non-IVF group. There was significantly higher baseline cHTN among the IVF group (4.8% vs. 0.6%, p=0.029). No significant difference was noted in pre-pregnancy BMI.

On univariate analysis, IVF was significantly associated with an increased rate of PEC spectrum diagnosis (25.3% vs. 11.9%, p=0.009), gestational diabetes (20.5% vs. 6.9%, p=0.002), and cesarean delivery (CD; 78.3% vs. 45.6%, p< 0.001).  After controlling for maternal age and BMI, IVF was independently associated with PEC (aOR 2.49, 95% CI 1.14, 5.37) and CD (aOR 2.97, 95% CI 1.55, 5.69), but not gestational diabetes (aOR 2.15, 95% CI 0.88, 5.33).

IVF was not significantly associated with gestational age at delivery, preterm birth, placental abruption, birthweight, fetal growth restriction, birthweight discordancy, APGAR scores, NICU admission, or fetal demise.

Conclusion:
Among MD pregnancies, IVF is significantly and independently associated with increased rates of PEC and CD. This is amongst the largest studies of MD twins examining IVF as a risk factor that excludes TTTS/other major anomalies.