European journal of obstetrics, gynecology, and reproductive biology · 2026
Twin pregnancies conceived by assisted reproductive treatments and the risk of long-term offspring pediatric neurological morbidity.
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Leybovitz-Haleluya Noa, Wainstock Tamar, Sheiner Eyal
Аннотация
OBJECTIVES: Evidence is conflicting whether twins conceived by assisted reproductive treatment (ART(have higher rate of adverse outcomes than twins conceived spontaneously. Specifically, scarce data exist regarding the long-term neurological implications. Therefore, we studied the association between ART leading to twin pregnancy and short and long- term neurological morbidity of offspring.
STUDY DESIGN: A retrospective cohort study including twins born between the years 1991-2021 at a tertiary medical center was conducted. Total and subtypes of neurological morbidity among twins born following in vitro fertilization (IVF) versus ovulation induction (OI) and no ART (Spontaneous) were compared. A Kaplan-Meier survival curve was used to compare cumulative neurological morbidity incidence, and a Cox proportional hazards models were constructed to adjust forconfounders.
RESULTS: The study population included 7790 twins; 1380 (17.7%) were conceived by IVF, 696 (8.9%) by OI and 5741 (73.7%) were conceived spontaneously. An independent significant association was found between IVF and preterm delivery <37 weeks and cesarean delivery (CD). Higher rates of total neurological morbidity were noted in ART groups (30.1% in IVF, 34.4% in OI and 20.5% in spontaneous group, p < 0.001). Cumulative rates of long-term total neurological morbidity were significantly higher among offspring in ART groups. Using a Cox proportional hazards model, controlling for potential confounders, the association between IVF and the risk for neurological pediatric morbidity remained significant (Adjusted HR = 1.16, 95% CI 1.02-1.33, p = 0.029). However, no independent association was found between OI and neurological morbidity.
CONCLUSIONS: Twins conceived by IVF are at increased risk for long-term pediatric neurological morbidity.
STUDY DESIGN: A retrospective cohort study including twins born between the years 1991-2021 at a tertiary medical center was conducted. Total and subtypes of neurological morbidity among twins born following in vitro fertilization (IVF) versus ovulation induction (OI) and no ART (Spontaneous) were compared. A Kaplan-Meier survival curve was used to compare cumulative neurological morbidity incidence, and a Cox proportional hazards models were constructed to adjust forconfounders.
RESULTS: The study population included 7790 twins; 1380 (17.7%) were conceived by IVF, 696 (8.9%) by OI and 5741 (73.7%) were conceived spontaneously. An independent significant association was found between IVF and preterm delivery <37 weeks and cesarean delivery (CD). Higher rates of total neurological morbidity were noted in ART groups (30.1% in IVF, 34.4% in OI and 20.5% in spontaneous group, p < 0.001). Cumulative rates of long-term total neurological morbidity were significantly higher among offspring in ART groups. Using a Cox proportional hazards model, controlling for potential confounders, the association between IVF and the risk for neurological pediatric morbidity remained significant (Adjusted HR = 1.16, 95% CI 1.02-1.33, p = 0.029). However, no independent association was found between OI and neurological morbidity.
CONCLUSIONS: Twins conceived by IVF are at increased risk for long-term pediatric neurological morbidity.