Objective — to study the specific features of the course of induced and spontaneous multiple pregnancy for the optimization of pregnancy and labor management tactics in multiple pregnancy resulting from assisted reproductive technologies (ART). Subject and methods. The investigation enrolled 253 pregnant women who were divided into three clinical groups: 1) 51 pregnant women with multiple pregnancy occurring after in vitro fertilization and embryo transfer (a study group); 2) 151 women with spontaneous twin pregnancy (a control group); 3) 51 women with spontaneous singleton pregnancy (a comparison group). Results. Induced multiple pregnancy was complicated by a threatened abortion in 74.5% of cases, which was 3.5 times higher than that in the control and comparison groups. Threatened miscarriage was caused by isthmicocervical insufficiency in 47.1% of cases. In induced multiple pregnancy, preeclampsia was observed twice more often (56.9%) than that in the population, depended on the type of placentation, and accounted for 80, 66.6, and 28.1% in cases of trichorionic triamniotic triplets, monochorionic diamniotic twins, and dichorionic diamniotic twins, respectively. In this pregnancy, fetoplacental insufficiency was detected in 70.6% of cases and manifested itself as fetal growth restriction in 16.7% and as dissociated fetal development in 16.7%. Dissociated development of fetuses was accompanied by their growth restriction in 17.6% of the patients. Conclusion. Induced multiple pregnancy confers a high risk due to the high frequency of gestational complications (threatened miscarriage, preeclampsia, anemia) and to the morphofunctional changes of the cervix uteri at 17—22 weeks’ gestation, which requires more detailed evaluation of the cervix uteri over time by obstetric examination or cervicometry, followed by correction of isthmicocervical insufficiency. Infertile patients need pregravid preparation with regard to their somatic, gynecological, and reproductive histories and, when ART programs are used, they should have a limited number of transferred embryos in order to reduce complications of multiple pregnancy. The authors declare no conflicts of interest.