Abstract：Objective To assess the risk of adverse pregnancy outcomes of twin pregnancies by assisted reproductive technology (ART). Methods PubMed, Cochrane Libraries, Google Scholar, CBMdisc, Wangfang Data, CNKI and VIP were searched till June 2015 to identify studies that met pre-stated inclusion criteria. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates and 95% confidence interval (CI). Subgroup analysis was performed to explore potential heterogeneity moderators. Funnel plot and Egger regression analysis were used to assess publication bias. Results Thirty-two literatures involving 33,465 twins conceived by ART and 99,089 twins conceived naturally were included from 3,432 literatures initially searched. Meta analysis revealed that the ART twin births had respectively a 8%, 5%, 12% and 12% increased risk of preterm birth (RR=1.08, 95%CI:1.02~1.15), low birth weight (RR=1.05, 95%CI:1.01~1.08), very low birth weight (RR=1.12, 95%CI:1.00~1.26) and congenital malformations (RR=1.12, 95%CI:1.02~1.24) as compared with the naturally conceived twins. No statistically significant difference was found in the risk of very preterm birth (RR=1.13, 95%CI:0.99~1.29), intrauterine growth restriction (RR=1.21, 95%CI:0.94~1.57), small size for gestational age (RR=0.87, 95%CI:0.70~1.09), perinatal mortality (RR=1.00, 95%CI:0.82~1.21) and neonatal respiratory distress syndrome (RR=0.99, 95%CI: 0.64~1.54) between the two groups. Funnel plot and Egger test (P≥0.124) indicated that there was no publication bias. Conclusions Twin pregnancies conceived by ART are at increased risk for adverse pregnancy outcomes compared with those conceived naturally.
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