In Vitro Fertilization and Dichorionic-Diamniotic Twin Pregnancies in Nulliparous Women: A Retrospective Cohort Study Comparing Pregnancy Outcomes Between Advanced and Younger Maternal Age Groups

To compare pregnancy outcomes between advanced maternal age (AMA, ≥ 35 years) and younger maternal age (YMA, 20-34 years) nulliparous women with IVF-conceived dichorionic-diamniotic (DCDA) twin pregnancies. We conducted a retrospective analysis on 141 nulliparous women undergoing cesarean delivery at The Second Nanning People's Hospital (2020-2024). Propensity score matching (PSM, 1:1, caliper width=0.02) was conducted to balanced BMI, gravidity, and menarche age between AMA (n=47) and YMA (n=94) groups. Evaluated parameters included preterm birth (PTB), discordant twin growth, intraoperative blood loss, placental complications (previa/abruption), metabolic disorders (GDM, HDP, ICP), and postpartum hemorrhage (PPH). AMA women had significantly higher rates of discordant twin growth (P<0.05) and greater intraoperative blood loss versus YMA. No significant intergroup differences were observed in PTB, low birth weight, placental complications, GDM, HDP, ICP, or PPH. AMA nulliparous women with IVF DCDA twins face elevated risks of fetal growth discordance and surgical blood loss. However, risks of other maternal-fetal complications align with younger counterparts. Targeted prenatal surveillance for twin growth trajectories and intraoperative hemorrhage management may optimize outcomes in AMA populations. These findings support tailored clinical protocols for this high-risk demographic.