Download PDF
Am J Perinatol 2019; 36(08): 798-805
DOI: 10.1055/s-0038-1675218
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Risk of Neonatal and Infant Mortality in Twins and Singletons by Gestational Age

Han-Yang Chen
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
,
Suneet P. Chauhan
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
› Author Affiliations
Further Information

Publication History

26 June 2018

04 September 2018

Publication Date:
31 October 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Objective To compare neonatal and infant mortality rates stratified by gestational age (GA) between singletons and twins and examine the three leading causes of death among them.

Study Design This was a retrospective cohort study using the U.S. vital statistics datasets. The study was restricted to nonanomalous live births at 24 to 40 weeks delivered in 2005 to 2014. We used multivariable Poisson regression models with robust error variance to examine the association between birth plurality (singleton vs. twin) and mortality outcomes within each GA, while adjusting for confounders. The results were presented as adjusted risk ratios (aRRs) with 95% confidence intervals (CIs).

Results Of 26,292,747 live births, 96.6% were singletons and 3.4% were twins. At 29 to 36 weeks of GA, compared with singletons, twins had a lower risk of neonatal mortality (aRR: 0.37–0.78) and infant mortality (aRR: 0.54–0.86). When examined by GA, the three leading causes of neonatal and infant mortality varied between singletons and twins.

Conclusion When stratified by GA, the risk of neonatal and infant mortality was lower at 29 to 36 weeks in twins than in singletons, though the cause of death varied.

Keywords

gestational age - mortality - singleton - twin

Note

The abstract of this manuscript was presented in the Oral Session at the 2017 Central Association of Obstetricians and Gynecologists annual meeting.


 

  • References

  • 1 Martin JA, Hamilton BE, Osterman MJK. Three decades of twin births in the United States, 1980–2009. NCHS data brief, no 80. Hyattsville: National Center for Health Statistics. 2012 . Available at: https://www.cdc.gov/nchs/data/databriefs/db80.pdf . Accessed October 4, 2018
    PubMedGoogle Scholar
  • 2 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Mathews TJ. Births: Final data for 2015. National vital statistics report. Hyattsville, MD: National Center for Health Statistics. 2017 ;66(1). Available at: https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_01.pdf . Accessed October 4, 2018
    PubMedGoogle Scholar
  • 3 Hardin J, Carmichael SL, Selvin S, Lammer EJ, Shaw GM. Increased prevalence of cardiovascular defects among 56,709 California twin pairs. Am J Med Genet A 2009; 149A (05) 877-886
    CrossrefPubMedGoogle Scholar
  • 4 Pharoah PO, Price TS, Plomin R. Cerebral palsy in twins: a national study. Arch Dis Child Fetal Neonatal Ed 2002; 87 (02) F122-F124
    CrossrefPubMedGoogle Scholar
  • 5 Chauhan SP, Shields D, Parker D, Sanderson M, Scardo JA, Magann EF. Detecting fetal growth restriction or discordant growth in twin gestations stratified by placental chorionicity. J Reprod Med 2004; 49 (04) 279-284
    PubMedGoogle Scholar
  • 6 Misra DP, Ananth CV. Infant mortality among singletons and twins in the United States during 2 decades: effects of maternal age. Pediatrics 2002; 110 (06) 1163-1168
    CrossrefPubMedGoogle Scholar
  • 7 Scher AI, Petterson B, Blair E. , et al. The risk of mortality or cerebral palsy in twins: a collaborative population-based study. Pediatr Res 2002; 52 (05) 671-681
    CrossrefPubMedGoogle Scholar
  • 8 American College of Obstetricians and Gynecologists. Practice bulletin no. 169 summary: multifetal gestations twin, triplet, and higher-order multifetal. Obstet Gynecol 2016; 128 (04) 926-928
    CrossrefPubMedGoogle Scholar
  • 9 Cheung YB, Yip P, Karlberg J. Mortality of twins and singletons by gestational age: a varying-coefficient approach. Am J Epidemiol 2000; 152 (12) 1107-1116
    CrossrefPubMedGoogle Scholar
  • 10 Vasak B, Verhagen JJ, Koenen SV. , et al. Lower perinatal mortality in preterm born twins than in singletons: a nationwide study from The Netherlands. Am J Obstet Gynecol 2017; 216 (02) 161.e1-161.e9
    CrossrefPubMedGoogle Scholar
  • 11 Alexander GR, Slay Wingate M, Salihu H, Kirby RS. Fetal and neonatal mortality risks of multiple births. Obstet Gynecol Clin North Am 2005; 32 (01) 1-16
    CrossrefPubMedGoogle Scholar
  • 12 Patel RM, Kandefer S, Walsh MC. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med 2015; 372 (04) 331-340
    CrossrefPubMedGoogle Scholar
  • 13 Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment. Pediatrics 2016; 138 (05) e20162938
    CrossrefPubMedGoogle Scholar
  • 14 Borse NN, Gilchrist J, Dellinger AM, Rudd RA, Ballesteros MF, Sleet DA. CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0-19 Year Olds in the United States, 2000–2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2008. . Available at: https://www.cdc.gov/safechild/pdf/cdc-childhoodinjury.pdf . Accessed October 11, 2018
    Google Scholar
  • 15 Osterman MJ, Martin JA, Mathews TJ, Hamilton BE. Expanded data from the new birth certificate, 2008. Natl Vital Stat Rep 2011; 59 (07) 1-28
    PubMedGoogle Scholar
  • 16 World Health Organization. International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva: World Health Organization; . Available at: http://apps.who.int/classifications/icd10/browse/Content/statichtml/ICD10Volume2_en_2016.pdf . Accessed October 11, 2018
    Google Scholar
  • 17 Heron M. Deaths: leading causes for 2013. National Vital Statistics Reports. Hyattsville, MD: National Center for Health Statistics. 2016;65(2). Available at: https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_02.pdf . Accessed October 4, 2018
    PubMedGoogle Scholar
  • 18 National Center for Health Statistics. Instruction Manual, Part 9: ICD-10 Cause-of-Death Lists for Tabulating Mortality Statistics. Hyattsville, MD: National Center for Health Statistics; 2002
    Google Scholar
  • 19 Mamdani M, Sykora K, Li P. , et al. Reader's guide to critical appraisal of cohort studies: 2. Assessing potential for confounding. BMJ 2005; 330 (7497): 960-962
    CrossrefPubMedGoogle Scholar
  • 20 Austin PC. Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat Simul Comput 2009; 38 (06) 1228-1234
    CrossrefPubMedGoogle Scholar
  • 21 Yeh TF, Lin YJ, Lin HC. , et al. Outcomes at school age after postnatal dexamethasone therapy for lung disease of prematurity. N Engl J Med 2004; 350 (13) 1304-1313
    CrossrefPubMedGoogle Scholar
  • 22 O'Shea TM, Washburn LK, Nixon PA, Goldstein DJ. Follow-up of a randomized, placebo-controlled trial of dexamethasone to decrease the duration of ventilator dependency in very low birth weight infants: neurodevelopmental outcomes at 4 to 11 years of age. Pediatrics 2007; 120 (03) 594-602
    CrossrefPubMedGoogle Scholar
  • 23 Kersbergen KJ, de Vries LS, van Kooij BJ. , et al. Hydrocortisone treatment for bronchopulmonary dysplasia and brain volumes in preterm infants. J Pediatr 2013; 163 (03) 666-671
    CrossrefPubMedGoogle Scholar
  • 24 Glass HC, Costarino AT, Stayer SA, Brett CM, Cladis F, Davis PJ. Outcomes for extremely premature infants. Anesth Analg 2015; 120 (06) 1337-1351
    CrossrefPubMedGoogle Scholar
  • 25 Tarnow-Mordi W, Stenson B, Kirby A. , et al; BOOST-II Australia and United Kingdom Collaborative Groups. Outcomes of two trials of oxygen-saturation targets in preterm infants. N Engl J Med 2016; 374 (08) 749-760
    CrossrefPubMedGoogle Scholar
  • 26 Bakhuizen SE, de Haan TR, Teune MJ. , et al. Meta-analysis shows that infants who have suffered neonatal sepsis face an increased risk of mortality and severe complications. Acta Paediatr 2014; 103 (12) 1211-1218
    Google Scholar
  • 27 Rao SC, Athalye-Jape GK, Deshpande GC, Simmer KN, Patole SK. Probiotic Supplementation and Late-Onset Sepsis in Preterm Infants: A Meta-analysis. Pediatrics 2016; 137 (03) e20153684
    CrossrefPubMedGoogle Scholar
  • 28 AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev 2014; 4 (04) CD005496
    Google Scholar
  • 29 Lau CS, Chamberlain RS. Probiotic administration can prevent necrotizing enterocolitis in preterm infants: A meta-analysis. J Pediatr Surg 2015; 50 (08) 1405-1412
    CrossrefPubMedGoogle Scholar
  • 30 Turner S, Arthur G, Lyons RA. , et al. Modification of the home environment for the reduction of injuries. Cochrane Database Syst Rev 2011; 2 (02) CD003600
    PubMedGoogle Scholar
  • 31 Ananth CV, Vintzileos AM, Shen-Schwarz S, Smulian JC, Lai YL. Standards of birth weight in twin gestations stratified by placental chorionicity. Obstet Gynecol 1998; 91 (06) 917-924
    PubMedGoogle Scholar
  • 32 Luke B. Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: with an emphasis on U.S. population-based studies. Am J Obstet Gynecol 2017; 217 (03) 270-281
    CrossrefPubMedGoogle Scholar
  • 33 Cohen B, Bernson D, Sappenfield W. , et al; States Monitoring Assisted Reproductive Technology Collaborative. Accuracy of assisted reproductive technology information on birth certificates: Florida and Massachusetts, 2004-06. Paediatr Perinat Epidemiol 2014; 28 (03) 181-190
    CrossrefPubMedGoogle Scholar
  • 34 Viteri OA, Blackwell SC, Chauhan SP. , et al. Antenatal corticosteroids for the prevention of respiratory distress syndrome in premature twins. Obstet Gynecol 2016; 128 (03) 583-591
    CrossrefPubMedGoogle Scholar