〔Abstract〕 Objective To investigate the differences in pregnancy outcomes between dichorionic diamniotic (DCDA) twin pregnancies conceived via assisted reproductive technology (ART) and those from spontaneous conception, in order to provide evidence for the perinatal management of ART-conceived DCDA twins. Methods A retrospective analysis was conducted on the clinical data of 549 DCDA twin parturients who delivered at the Department of Obstetrics, The First Affiliated Hospital of Anhui Medical University. Based on the mode of conception, they were divided into ART group (423 cases) and spontaneous conception group (126 cases). The baseline characteristics, pregnancy complications and neonatal outcomes were compared between the two groups. Results Regarding baseline characteristics, the ART group had higher maternal age, number of previous abortions, proportions of primiparas, proportions of advanced maternal age and greater 24-hour postpartum blood loss, but lower parity and proportion of scarred uterus compared to the spontaneous conception group (P＜0.05). For pregnancy complications, the ART group exhibited higher incidences of hypertensive disorders of pregnancy, placental adhesion, postpartum hemorrhage and a higher application rate of uterine artery ascending branch ligation (P＜0.05). There were no statistically significant differences in neonatal-related indicators between the two groups (P＞0.05). After adjusting for confounding factors such as age, number of abortions and parities, ART remained an independent risk factor for hypertensive disorders of pregnancy, placental adhesion and postpartum hemorrhage (P＜0.05), while it did not increase the risk of adverse neonatal outcomes(P＞0.05). Further subgroup analysis by gestational age showed that in the late preterm subgroup, the risk of ART-related pregnancy complications remained elevated (P＜0.05). Additionally, neonatal outcomes showed no significant difference between the two groups in both the late preterm and term subgroups (P＞0.05). Conclusion ART increases the risk of hypertensive disorders of pregnancy, placental adhesion and postpartum hemorrhage in DCDA twin parturients. Clinically, enhanced monitoring of blood pressure during pregnancy and blood loss during delivery and postpartum, along with targeted prevention and management of these complications, are crucial for improving pregnancy outcomes.