(237) In-vitro Fertilization vs Spontaneous Conception and Risk of Hypertensive Disease in Twin Pregnancies

This was a retrospective cohort study of all twin deliveries at a single institution from 2001-2018. Pregnancies with unknown mode of conception, fetal demise, major fetal anomaly or hydrops were excluded. The primary exposure, mode of conception, was divided into two groups: IVF or spontaneous conception (including pregnancies conceived via ovulation induction). The primary outcome was the development of hypertensive disorders of pregnancy. Chi Square and Student’s t-test were performed for univariate analyses. Logistic regression modeling was performed to control for baseline differences between groups.

Results:

785 twin pregnancies were identified; 547 (70%) were dichorionic-diamniotic, 233 (30%) were monochorionic-diamniotic, and 5 ( < 1%) were monochorionic-monoamniotic. 33% of patients were advanced maternal age, 49% nulliparous, and 7% had chronic hypertension (Table 1). History of chronic hypertension, gestational diabetes, and gestational age at delivery were similar between groups. The overall rate of GHTN was 4%, preeclampsia/eclampsia/HELLP was 21%, and any hypertensive disorder of pregnancy was 25%. In multivariable analysis controlling for baseline differences between groups, IVF (aOR 1.8, p= < 0.02, 95% CI 1.1-2.8) was independently associated with increased risk of hypertensive disorders, in addition to nulliparity (aOR 2.0, p= < 0.01, 95% CI 1.3-3.0), and chronic hypertension (aOR 4.2, p= < 0.01, 95% CI 2.1-8.3).

Conclusion:

Twin pregnancies conceived via IVF appear to have increased rates of hypertensive disorders of pregnancy compared to spontaneously conceived twin pregnancies. Additional measures for prevention of and early detection of preeclampsia may be warranted for this population.