{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:11:04Z","timestamp":1790806264889,"version":"4.1.0"},"reference-count":85,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T00:00:00Z","timestamp":1648425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI21\/01244"],"award-info":[{"award-number":["PI21\/01244"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Triplet pregnancies are rare events that affect approximately 93 in 100,000 deliveries in the world, especially due to the increased use of assisted reproductive techniques and older maternal age. Triplet pregnancies are associated with a higher risk of fetal and maternal morbidity and mortality compared to twins and singletons. Chorionicity has been proposed as a major determinant of perinatal and maternal outcomes in triplet pregnancies, although further evidence is needed to clarify the extent and real influence of this factor. Thus, the aim of this study was to conduct a systematic review of the literature and a meta-analysis of the maternal and perinatal outcomes of triplet pregnancies, evaluating how chorionicity may influence these results. A total of 46 studies with 43,653 triplet pregnancies and 128,145 live births were included. Among the main results of our study, we found a broad spectrum of fetal and maternal complications, especially in the group of monochorionic and dichorionic pregnancies. Risk of admission to NICU, respiratory distress, sepsis, necrotizing enterocolitis, perinatal and intrauterine mortality were all found to be higher in non-TCTA pregnancies than in TCTA pregnancies. To date, our meta-analysis includes the largest population sample and number of studies conducted in this field, evaluating a wide variety of outcome measures. The heterogeneity and retrospective design of the studies included in our research represent the main limitations of this review. More evidence is needed to fully assess outcome measures that could not be studied in this review due to scarcity of publications or insufficient sample size.<\/jats:p>","DOI":"10.3390\/jcm11071871","type":"journal-article","created":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T21:44:52Z","timestamp":1648590292000},"page":"1871","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: A Systematic Review of the Literature and Meta-Analysis"],"prefix":"10.3390","volume":"11","author":[{"given":"Mireia","family":"Bernal Claverol","sequence":"first","affiliation":[{"name":"Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain"},{"name":"Group of Pathophysiology in Women, Pregnancy, Labor and Puerperium, Health Research Institute Gregorio Mara\u00f1\u00f3n, 28040 Madrid, Spain"},{"name":"Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Ruiz Minaya","sequence":"additional","affiliation":[{"name":"Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain"},{"name":"Group of Pathophysiology in Women, Pregnancy, Labor and Puerperium, Health Research Institute Gregorio Mara\u00f1\u00f3n, 28040 Madrid, Spain"},{"name":"Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1009-8446","authenticated-orcid":false,"given":"Irene","family":"Aracil Moreno","sequence":"additional","affiliation":[{"name":"Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain"},{"name":"Group of Pathophysiology in Women, Pregnancy, Labor and Puerperium, Health Research Institute Gregorio Mara\u00f1\u00f3n, 28040 Madrid, Spain"},{"name":"Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago Garc\u00eda","family":"Tiz\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain"},{"name":"Group of Pathophysiology in Women, Pregnancy, Labor and Puerperium, Health Research Institute Gregorio Mara\u00f1\u00f3n, 28040 Madrid, Spain"},{"name":"Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3706-3158","authenticated-orcid":false,"given":"Pilar","family":"Pintado Recarte","sequence":"additional","affiliation":[{"name":"Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain"},{"name":"Group of Pathophysiology in Women, Pregnancy, Labor and Puerperium, Health Research Institute Gregorio Mara\u00f1\u00f3n, 28040 Madrid, Spain"},{"name":"Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1309-7510","authenticated-orcid":false,"given":"Melchor","family":"Alvarez-Mon","sequence":"additional","affiliation":[{"name":"Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcal\u00e1, 28801 Alcal\u00e1 de Henares, Spain"},{"name":"Ram\u00f3n y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain"},{"name":"Immune System Diseases-Rheumatology and Oncology Service, University Hospital Pr\u00edncipe de Asturias, CIBEREHD, 28801 Alcal\u00e1 de Henares, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coral Bravo","family":"Arribas","sequence":"additional","affiliation":[{"name":"Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain"},{"name":"Group of Pathophysiology in Women, Pregnancy, Labor and Puerperium, Health Research Institute Gregorio Mara\u00f1\u00f3n, 28040 Madrid, Spain"},{"name":"Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2588-1708","authenticated-orcid":false,"given":"Miguel A.","family":"Ortega","sequence":"additional","affiliation":[{"name":"Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcal\u00e1, 28801 Alcal\u00e1 de Henares, Spain"},{"name":"Ram\u00f3n y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6320-2668","authenticated-orcid":false,"given":"Juan A.","family":"De Leon-Luis","sequence":"additional","affiliation":[{"name":"Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain"},{"name":"Group of Pathophysiology in Women, Pregnancy, Labor and Puerperium, Health Research Institute Gregorio Mara\u00f1\u00f3n, 28040 Madrid, Spain"},{"name":"Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1002\/pd.5852","article-title":"Triplet pregnancy: What do we tell the prospective parents","volume":"41","author":"Mhatre","year":"2020","journal-title":"Prenat. 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