Objective — to reveal the incidence of fetal growth retardation and hypotrophy in multiple pregnancy to timely prevent perinatal losses. Subject and methods. The investigation enrolled 202 pregnant women who were divided into two clinical groups. A study group consisted of 51 pregnant women with multiple pregnancy occurring after in vitro fertilization and embryo transfer. A comparison group included 151 women with spontaneous twin pregnancy. Standard clinical and laboratory studies and placental morphohistological examination were applied. Results. This investigation established that in both induced and spontaneous multiple pregnancies, there was a high incidence of fetal growth retardation (29.4 and 28.5%, respectively), developmental dissociation (29.4 and 18.5%), and neonatal hypotrophy (19.6 and 25.2%). The histological structural feature of the individual placenta(s) was the uneven ripening of individual cotyledons. The found structural changes in the placentas of women with multiple pregnancy suggest that placental insufficiency may develop. Conclusion. Pregravid preparation, prevention of multiple pregnancy in an in vitro fertilization program, early diagnosis of multiple pregnancy and prevention of complications, and the choice of a rational delivery method, by taking into account the gestational age, are an important reserve to reduce perinatal and maternal morbidity and mortality. The authors declare no conflicts of interest.