Neonatal outcomes in triplet pregnacies: assisted reproduction versus spontaneous conception

Introduction: The incidence of triplet gestations in the developed world has increased over the last two decades mostly as a consequence of assisted reproduction techniques (ART). The aim of the study is to compare neonatal outcomes of spontaneous versus assisted conceived triplets. Methods: Twelve years retrospective study (1 January 1996 to 31 December 2007)of triplet newborns. Maternal demographic and pregnancy related variables were recorded. For all newborns neonatal data, major neonatal and perinatal morbidities and mortality, congenital malformations were registered. Results: A total of 219 triplets were studied:18% spontaneously conceived, 82% ART. There were no significant differences in the rates of small for gestational age, birth weight, mortality, maternal age, mode of delivery, malformations, bronchopulmonary dysplasia, patent ductus arteriosus, periventricular leucomalacia or sepsis. Spontaneously conceived triplets were delivered 1 week before ART triplets (31.23 vs 32.33; p50.005) and in a univariate analysis had a significantly higher risk of respiratory distress syndrome[RDS] (36% vs 21% OR. 0.59; CI¼0.36– 0.98), intraventricular haemorrhage[IVH] (20.5% v s8% OR. 0.38; CI¼0.13–0.85) and retinopathy of prematurity[ROP]( 23% vs 4.5% OR. 0.19; CI¼0.05–0.43). In a multivariable analysis the increased risk of RDS was related to GA, while an increased risk of IVH and ROP resulted still significantly associated to spontaneous conception. Conclusions: Triplet birth rate in our centre has progressively increased, reaching 0.6% in the last three years. In literature there is still limited information about the comparison between ART versus spontaneous triplet gestations. We observed an independent association between spontaneous conception and outcomes like ROP and IVH. Further studies are necessary in order to confirm and discuss these results.