Abstract
INTRODUCTION: This study’s aim is to compare pregnancy outcomes in multifetal gestations that were conceived spontaneously compared to in vitro fertilization (IVF). Few population-based studies have addressed this topic. METHODS: This is a retrospective cohort study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database. Our study cohort included 90,552 multifetal gestations conceived spontaneously and 3,219 IVF conceptions, from 2008-2014, inclusively. Multivariate logistic regression analyses were performed comparing maternal and neonatal outcomes, while adjusting for confounding variables. Subject was conducted using ICD-9 codes 651.X and 76.1 for multifetal gestation and ICD-9 code 23.85 for IVF. Each pregnancy was included once. RESULTS: IVF multifetal gestations had increased risk of pregnancy induced hypertension (adjusted odds ratio [aOR]:1.31, 95% CI, 1.20–1.43), gestational hypertension (aOR: 1.21, 95% CI, 1.04–1.41), preeclampsia (aOR: 1.31, 95% CI, 1.19–1.45), gestational diabetes (aOR: 1.26, 95% CI, 1.13–1.41) and placenta previa (aOR: 1.7, 95% CI, 1.32–2.19). IVF delivery outcomes were more likely complicated by cesarean section (aOR: 1.21, 95% CI, 1.10–1.33), preterm premature rupture of membranes (aOR: 1.33, 95% CI, 1.16–1.52), chorioamnionitis (aOR: 1.71, 95% CI, 1.37–2.14), postpartum hemorrhage (aOR: 1.44, 95% CI, 1.26–1.63) and transfusions (aOR: 1.48, 95% CI, 1.26–1.74). IVF neonatal outcomes were more likely complicated by small for gestational age (aOR: 1.26, 95% CI, 1.12–1.41) and congenital anomalies (aOR: 1.82, 95% CI, 1.29–2.57). IVF was not found to increase risks of eclampsia, preterm delivery, operative vaginal delivery, hysterectomy, or intrauterine fetal demise. CONCLUSION: Women with IVF multifetal pregnancies were more likely to have complications, with risks increased 20% to 70%. The role of infertility versus the need for IVF and the type of IVF protocol used should be further evaluated.