A Method for Quantifying Birthweight Discordance in Quadruplets and Potential Use in Predicting Early Mortality

Hamisu M. Salihu; Suparna Bagchi; Sibylle Kristensen; Puza P. Sharma; J. Grimes-Dennis; C. Ayers

doi:10.1055/s-2006-939538

American Journal of Perinatology, Table of Contents

Am J Perinatol 2006; 23(4): 223-228
DOI: 10.1055/s-2006-939538

A Method for Quantifying Birthweight Discordance in Quadruplets and Potential Use in Predicting Early Mortality

Hamisu M. Salihu¹ , Suparna Bagchi² , Sibylle Kristensen² , Puza P. Sharma³ , J. Grimes-Dennis¹ , C. Ayers¹

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jeresy
²Department of Maternal and Child Health, University of Alabama at Birmingham, Alabama
³Department of Epidemiology, UMDNJ-School of Public Health, New Jersey

Abstract

ABSTRACT

We describe an approach to quantify birthweight discordance in quadruplets and assessed its potential use in predicting infant mortality. Retrospective cohort study on quadruplets delivered in the United States from 1995 through 2000 inclusive. The main outcome measures were infant, neonatal, and postneonatal mortality. A total of 2692 quadruplet live births (673 complete clusters) with complete information on gestational age, birthweight, and survival within the first year. Of the total 673 quadruplet clusters, discordance occurred in 180 sets (26.7%). The predominant discordant type was a single discordant individual within a cluster (177 sets or 99.8%), whereas only three sets (0.2%) recorded up to two discordant quadruplets within a cluster. The period of pronounced risk for the occurrence of birthweight discordance was between 28 and 35 gestational weeks. Discordant individuals exhibited elevated risk for infant (adjusted odds ratio [aOR] = 2.1; 95% confidence interval [CI], 1.4 to 3.0), neonatal (aOR = 1.8; 95% CI, 1.2 to 2.6), and postneonatal (aOR = 2.9; 95% CI, 1.1 to 8.4) mortality. After adjusting for small for gestational age, the risk for postneonatal mortality among discordant infants quadrupled (aOR = 4.1; 95% CI, 1.5 to 10.8). The population-attributable risks were 18, 20, and 46% for neonatal, infant, and postneonatal mortality, respectively. The new method is predictive of mortality at all stages of infancy. Discordance accounts for 18 to 46% of all quadruplet deaths during infancy in the United States.

KEYWORDS

Quadruplets - discordance - mortality

Full Text

References

REFERENCES

1 Blickstein I, Kalish R B. Birthweight discordance in multiple pregnancy. Twin Res. 2003; 6 526-531
2 Branum A M, Schoendorf K C. The effect of birth weight discordance on twin neonatal mortality. Obstet Gynecol. 2003; 101 570-574
3 Jacobs A R, Demissie K, Jain N J, Kinzler W L. Birth weight discordance and adverse fetal and neonatal outcomes among triplets in the United States. Obstet Gynecol. 2003; 101 909-914
4 Salihu H M, Aliyu M H, Rouse D J, Kirby R S, Alexander G R. Potentially preventable excess mortality among higher-order multiples. Obstet Gynecol. 2003; 102 679-684
5 Kiely J L, Kiely M. Epidemiologic trends in multiple births in the United States, 1997-1998. Twin Res. 2001; 14 131-133
6 Martin J A, Hamilton B E, Sutton P D, Ventura S J, Menacker F, Munson M L. Births: final data for 2002. Natl Vital Stat Rep. 2003; 52 1-113
7 Martin J, Curtin S, Saulnier M, Mousavi J. Development of the Matched Multiple Birth File. In: 1995-2000 Matched Multiple Birth Dataset. NCHS CD-ROM series 21. Hyattsville, MD; National Center for Health Statistics 2004
8 Alexander G R, Kogan M, Martin J, Papiernik E. What are the fetal growth patterns of singletons, twins, and triplets in the United States?. Clin Obstet Gynecol. 1998; 41 114-125
9 Blickstein I, Jacques D L, Keith L G. A novel approach to intertriplet birth weight discordance. Am J Obstet Gynecol. 2003; 188 1026-1030
10 Blickstein I, Shoham-Schwartz Z, Lancet M, Borenstein R. Characterization of the growth-discordant twin. Obstet Gynecol. 1987; 70 11-15
11 Alexander G R, Kotelchuk M. Quantifying the adequacy of prenatal care: a comparison of indices. Public Health Rep. 1996; 3 408-418
12 Alexander G R, Comely D A. Prenatal care utilization: its measurement and relationship to pregnancy outcome. Am J Prevent Med. 1987; 3 243-253
13 Kogan M D, Martin J A, Alexander G R, Kotelchuck M, Ventura S J, Frigoletto F D. The changing pattern of prenatal care utilization in the United States, 1981-1995, using different prenatal care indices. JAMA. 1998; 279 1623-1628
14 Alexander G R, Kogan M, Martin J, Papiernik E. What are the fetal growth patterns of singletons, twins and triplets in the United States?. Clin Obstet Gynecol. 1998; 41 114-125
15 Zeger S L, Liang K Y. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986; 42 121-130
16 American College of Obstetricians and Gynecologists .Special problems of multiple gestation. Educational bulletin No. 253. Washington, DC; ACOG 1998
17 Francois K, Alperin A, Elliott J P. Outcomes of quintuplet pregnancies. J Reprod Med. 2001; 46 1047-1051

Hamisu M SalihuM.D. Ph.D.

Department of Obstetrics, Gynecology, and Reproductive Sciences

UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08901-1977