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Objective: To examine whether dichorionic twin pregnancies after assisted reproductive technology (ART) were at higher risk of adverse obstetric outcomes compared with those conceived naturally.Design: Meta-analysis.Setting: University-affiliated teaching hospital.Patient(s): Dichorionic twin pregnancies conceived with ART and naturally.Intervention(s): Studies comparing obstetric outcomes in dichorionic twin pregnancies conceived by ART and naturally were identified by searching PubMed, Google Scholar, Cochrane Libraries, and Chinese databases through July 2015 with no restrictions. Either a fixed-effects or a random-effects model was used to calculate the overall combined risk estimates. Subgroup analysis was performed to explore potential heterogeneity moderators.Main Outcome Measure(s): Maternal complications and adverse pregnancy outcomes.Result(s): Fifteen cohort studies involving 6,420 dichorionic twins after ART and 13,650 dichorionic twins conceived naturally were included. Most of maternal complications were similar in both groups, but placenta previa (relative risk [RR] = 2.99, 95% confidence interval [CI] 1.51-5.92; I(2) = 0) was significantly more common in the ART group. For neonatal outcomes, the ART group experienced higher risk of preterm birth (RR = 1.13, 95% CI 1.00-1.29; I(2) = 75%), very preterm birth (RR = 1.39, 95% CI 1.07-1.82; I(2) = 71%), low birth weight (RR = 1.11, 95% CI 1.00-1.23; I(2) = 61%), and congenital malformations (RR = 1.26, 95% CI 1.09-1.46; I(2) = 26%). In addition, the ART group had a higher proportion of elective cesarean sections (RR = 1.79, 95% CI 1.49-2.16; I(2) = 60%), but had a similar proportion for emergency cesarean sections. Relevant heterogeneity moderators have been identified by subgroup analysis. No evidence of publication bias was observed.Conclusion(s): The rates of placenta previa, elective cesarean section, preterm birth, very preterm birth, low birth weight, and congenital malformations were significantly higher in dichorionic twin pregnancies after ART. [ABSTRACT FROM AUTHOR]

Objective To provide an up-to-date comparison of pregnancy-related complications and adverse pregnancy outcomes of multiple pregnancies generated with assisted reproductive technology (ART) vs. spontaneous conception. Design Meta-analysis. Setting University-affiliated teaching hospital. Patient(s) Multiple pregnancies conceived by ART or naturally. Intervention(s) Searches through October 2014 were conducted on PubMed, Google Scholar, Cochrane Libraries, China Biology Medicine disc, Chinese Scientific Journals Fulltext Database, China National Knowledge Infrastructure, and Wanfang Data, to identify studies that met prestated inclusion criteria. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. Subgroup analysis was performed to explore potential heterogeneity moderators. Main Outcome Measure(s) Pregnancy-related complications and adverse pregnancy outcomes. Result(s) Thirty-nine cohort studies involving 146,008 multiple births were included in the meta-analysis. Multiple pregnancies from ART were associated with a higher risk of premature rupture of membranes (relative risk [RR] = 1.20, 95% confidence interval [CI]: 1.05–1.37; I 2 = 15%); pregnancy-induced hypertension (RR = 1.11, 95% CI: 1.04–1.19; I 2 = 6%); gestational diabetes mellitus (RR = 1.78, 95% CI: 1.25–2.55; I 2 = 42%); preterm birth (RR = 1.08, 95% CI: 1.03–1.14; I 2 = 83%); very preterm birth (RR = 1.18, 95% CI: 1.04–1.34; I 2 = 79%); low birth weight (RR = 1.04, 95% CI: 1.01–1.07; I 2 = 47%); very low birth weight (RR = 1.13, 95% CI: 1.01–1.25; I 2 = 62%); and congenital malformation (RR = 1.11, 95% CI: 1.02–1.22; I 2 = 30%). The relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded similar results. No evidence of publication bias was observed. Conclusion(s) Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, the present study suggests that multiple pregnancies generated via ART, vs. spontaneous conception, are associated with higher risks of pregnancy-related complications and adverse pregnancy outcomes. Further research is needed to determine which aspect of ART poses the most risk and how this risk can be minimized. [ABSTRACT FROM AUTHOR]