Comparing Outcomes and Risks of Multiple Gestations: Assisted versus Spontaneous Conceptions.

Background: Multiple gestations are increasingly prevalent worldwide, largely due to the rising use of Assisted Reproductive Technology (ART). Compared with singleton pregnancies, they are associated with substantially higher maternal and neonatal risks, including preterm birth, pregnancy complications, and adverse neonatal outcomes. However, regional data are limited, particularly from Saudi Arabia, where cultural, demographic, and healthcare system factors may uniquely influence these outcomes. Addressing this gap is essential to improve obstetric care, support patient counseling, and inform region specific health policies. Objective: This study aimed to evaluate and compare maternal and neonatal outcomes in twin and triplet pregnancies conceived spontaneously versus via ART in Saudi Arabia. Methods: A retrospective chart review was conducted at the Women's Health Hospital, National Guard Hospital, Riyadh, covering the period from January 2022 to December 2023. Medical records of all twin and triplet pregnancies were reviewed. Data collected included maternal characteristics (age, BMI, gravida, parity, gestational age, complications) and neonatal outcomes (presentation, admission, birthweight, Apgar score). Results: A total of 233 pregnancies were analyzed (222 twins, 11 triplets). The mean gestational age was 37.1 weeks for twins and 33.5 weeks for triplets. Most births occurred at late preterm gestation (>32 weeks, 92.7%). Gestational diabetes mellitus (22.3%) and preterm birth (70.4%) were the most frequent complications. Triplet pregnancies were associated with earlier preterm deliveries, malpresentation, and a higher prevalence of ART use (30.5%). Cesarean delivery was the dominant mode of birth (88.8%). Neonatal admissions to NICU/ICN were mainly due to prematurity and neonatal respiratory distress syndrome. Independent predictors of ART included parity, chorionicity, amnionicity, and maternal morbidity. Conclusion: Multiple gestations carry significant maternal and neonatal risks, with triplet pregnancies conceived via ART showing increased vulnerability to preterm birth, lower gestational age, and malpresentation. Cesarean section was the predominant delivery mode, and neonatal complications were largely related to prematurity. These findings underscore the need for targeted obstetric care in ART conceived multiple gestations and call for larger studies to inform clinical management and improve outcomes in Saudi Arabia.