BACKGROUND ART is associated with higher rates of twin pregnancies than singleton pregnancies. Whether twin pregnancies conceived following ART have additional maternal and neonatal complications compared with non-ART twin pregnancies is not known. OBJECTIVE AND RATIONALE The objective was to quantify the risk of adverse maternal and perinatal outcomes among twin pregnancies conceived following ART compared with non-ART and natural conception. Existing reviews vary in the reported outcomes, with many studies including triplet pregnancies in the study population. Therefore, we aimed to perform an up-to-date review with an in-depth analysis of maternal and perinatal outcomes limited to twin pregnancies. SEARCH METHODS We searched electronic databases MEDLINE and EMBASE from January 1990 to May 2023 without language restrictions. All cohort studies reporting maternal and perinatal outcomes following ART compared with non-ART twin pregnancies and natural conception were included. Case–control studies, case reports, case series, animal studies, and in vitro studies were excluded. The Newcastle–Ottawa Scale was used to assess the methodological quality of the studies. Using random-effects meta-analysis, the estimates were pooled and the findings were reported as odds ratios (OR) with 95% CI. OUTCOMES We included 111 studies (802 462 pregnancies). Twin pregnancies conceived following ART were at higher risk of preterm birth at <34 weeks (OR 1.33, 95% CI 1.14–1.56, 29 studies, I2 = 73%), <37 weeks (OR 1.26, 95% CI 1.19–1.33, 70 studies, I2 = 76%), hypertensive disorders in pregnancy (OR 1.29, 95% CI 1.14–1.46, 59 studies, I2 = 87%), gestational diabetes mellitus (OR 1.61, 95% CI 1.48–1.75, 51 studies, I2 = 65%), and caesarean delivery (OR 1.80, 95% CI 1.65–1.97, 70 studies, I2 = 89%) compared with non-ART twins. The risks for the above maternal outcomes were also increased in the ART group compared with natural conception. Of the perinatal outcomes, ART twins were at significantly increased risk of congenital malformations (OR 1.17, 95% CI 1.05–1.30, 39 studies, I2 = 59%), birthweight discordance (>25% (OR 1.31, 95% CI 1.05–1.63, 7 studies, I2 = 0%)), respiratory distress syndrome (OR 1.32, 95% CI 1.09–1.60, 16 studies, I2 = 61%), and neonatal intensive care unit admission (OR 1.24, 95% CI 1.14–1.35, 32 studies, I2 = 87%) compared with non-ART twins. When comparing ART with natural conception, the risk of respiratory distress syndrome, intensive care admissions, and birthweight discordance >25% was higher among the ART group. Perinatal complications, such as stillbirth (OR 0.83, 95% CI 0.70–0.99, 33 studies, I2 = 49%), small for gestational age <10th centile (OR 0.90, 95% CI 0.85–0.95, 26 studies, I2 = 36%), and twin–twin transfusion syndrome (OR 0.45, 95% CI 0.25–0.82, 9 studies, I2 = 25%), were reduced in twin pregnancies conceived with ART versus those without ART. The above perinatal complications were also fewer amongst the ART group than natural conception. WIDER IMPLICATIONS ART twin pregnancies are associated with higher maternal complications than non-ART pregnancies and natural conception, with varied perinatal outcomes. Women seeking ART should be counselled about the increased risks of ART twin pregnancies and should be closely monitored in pregnancy for complications. We recommend exercising caution when interpreting the study findings owing to the study’s limitations.

中文翻译：

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辅助生殖后双胎妊娠的孕产妇和围产期结局：涉及 802 462 例妊娠的系统评价和荟萃分析


背景 ART 与双胎妊娠率高于单胎妊娠相关。与非 ART 双胎妊娠相比，ART 后受孕的双胎妊娠是否具有额外的孕产妇和新生儿并发症尚不清楚。目的和基本原理 目的是量化与非 ART 和自然受孕相比，ART 后受孕的双胞胎双胞胎孕产妇和围生儿不良结局的风险。现有的综述在报告的结局方面有所不同，许多研究在研究人群中包括三胞胎妊娠。因此，我们旨在进行最新的综述，对仅限于双胎妊娠的孕产妇和围产期结局进行深入分析。检索方法 我们检索了 1990 年 1 月至 2023 年 5 月的电子数据库 MEDLINE 和 EMBASE，没有语言限制。纳入所有报告了 ART 后孕产妇和围产期结局与非 ART 双胎妊娠和自然受孕相比的队列研究。病例对照研究、病例报告、病例系列、动物研究和体外研究被排除在外。使用纽卡斯尔-渥太华量表评估研究的方法学质量。使用随机效应荟萃分析，合并估计值，并以比值比 （OR） 和 95% CI 报告结果。结局 我们纳入了 111 项研究 （802 462 例妊娠）。ART 后受孕的双胞胎妊娠在 <34 周（OR 1.33,95% CI 1.14-1.56,29 项研究，I2 = 73%）、<37 周（OR 1.26,95% CI 1.19-1.33,70 项研究，I2 = 76%）、妊娠期高血压疾病（OR 1.29,95% CI 1.14-1.46,59 项研究，I2 = 87%）、妊娠糖尿病（OR 1.61、 95% CI 1.48-1.75,51 项研究，I2 = 65%）和剖宫产 （OR 1.80,95% CI 1.65-1.97， 70 项研究，I2 = 89%）与非 ART 双胞胎相比。与自然受孕相比，ART 组发生上述孕产妇结局的风险也增加。在围产期结局中，ART 双胞胎发生先天性畸形（OR 1.17,95% CI 1.05-1.30,39 项研究，I2 = 59%）、出生体重不一致（>25%（OR 1.31,95% CI 1.05-1.63,7 项研究，I2 = 0%））、呼吸窘迫综合征（OR 1.32,95% CI 1.09-1.60,16 项研究，I2 = 61%）和新生儿重症监护病房收治（OR 1.24,1.24， 95% CI 1.14-1.35,32 项研究，I2 = 87%）与非 ART 双胞胎相比。当将 ART 与自然受孕进行比较时，ART 组呼吸窘迫综合征、重症监护入院和出生体重不一致 >25% 的风险更高。围产期并发症，如死产（OR 0.83,95% CI 0.70-0.99,33 项研究，I2 = 49%）、小于胎龄儿 <第 10 个百分位数（OR 0.90,95% CI 0.85-0.95,26 项研究，I2 = 36%）和双胎-双胎输血综合征（OR 0.45,95% CI 0.25-0.82,9 项研究，I2 = 25%），与未接受 ART 的双胞胎妊娠相比有所减少。ART 组的上述围产期并发症也比自然受孕少。更广泛的影响 ART 双胎妊娠与比非 ART 妊娠和自然受孕更高的孕产妇并发症相关，具有不同的围产期结局。应告知寻求 ART 的女性 ART 双胎妊娠风险增加，并应在妊娠期间密切监测并发症。由于研究的局限性，我们建议在解释研究结果时谨慎行事。