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Canelón SP, Butts S, Boland MR. Evaluation of Stillbirth Among Pregnant People With Sickle Cell Trait. JAMA Netw Open 2021; 4:e2134274. [PMID: 34817585 PMCID: PMC8613600 DOI: 10.1001/jamanetworkopen.2021.34274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/18/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Relative to what is known about pregnancy complications and sickle cell disease (SCD), little is known about the risk of pregnancy complications among those with sickle cell trait (SCT). There is a lack of clinical research among sickle cell carriers largely due to low sample sizes and disparities in research funding. Objective To evaluate whether there is an association between SCT and a stillbirth outcome. Design, Setting, and Participants This retrospective cohort study included data on deliveries occurring between January 1, 2010, and August 15, 2017, at 4 quaternary academic medical centers within the Penn Medicine health system in Pennsylvania. The population included a total of 2482 deliveries from 1904 patients with SCT but not SCD, and 215 deliveries from 164 patients with SCD. Data were analyzed from May 3, 2019, to September 16, 2021. Exposures The primary exposure of interest was SCT, identified using clinical diagnosis codes recorded in the electronic health record. Main Outcomes and Measures A multivariate logistic regression model was constructed to assess the risk of stillbirth using the following risk factors: SCD, numbers of pain crises and blood transfusions before delivery, delivery episode (as a proxy for parity), prior cesarean delivery, multiple gestation, patient age, marital status, race and ethnicity, ABO blood type, Rhesus (Rh) factor, and year of delivery. Results This cohort study included 50 560 patients (63 334 deliveries), most of whom were aged 25 to 34 years (29 387 of 50 560 [58.1%]; mean [SD] age, 29.5 [6.1] years), were single at the time of delivery (28 186 [55.8%]), were Black or African American (23 777 [47.0%]), had ABO blood type O (22 879 [45.2%]), and were Rhesus factor positive (44 000 [87.0%]). From this general population, 2068 patients (4.1%) with a sickle cell gene variation were identified: 1904 patients (92.1%) with SCT (2482 deliveries) and 164 patients (7.9%) with SCD (215 deliveries). In the fully adjusted model, SCT was associated with an increased risk of stillbirth (adjusted odds ratio [aOR], 8.94; 95% CI, 1.05-75.79; P = .045) while adjusting for the risk factors of SCD (aOR, 26.40; 95% CI, 2.48-280.90; P = .007) and multiple gestation (aOR, 4.68; 95% CI, 3.48-6.29; P < .001). Conclusions and Relevance The results of this large, retrospective cohort study indicate an increased risk of stillbirth among pregnant people with SCT. These findings underscore the need for additional risk assessment during pregnancy for sickle cell carriers.
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Affiliation(s)
- Silvia P. Canelón
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | - Samantha Butts
- Division of Reproductive Endocrinology and Infertility, Penn State College of Medicine and Penn State Health, Hershey, Pennsylvania
| | - Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia
- Center for Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Kalikkot Thekkeveedu R, Dankhara N, Desai J, Klar AL, Patel J. Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database. Matern Health Neonatol Perinatol 2021; 7:15. [PMID: 34711283 PMCID: PMC8554969 DOI: 10.1186/s40748-021-00135-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background The available data regarding morbidity and mortality associated with multiple gestation births is conflicting and contradicting. Objective To compare morbidity, mortality, and length of stay (LOS) outcomes between multiple gestation (twin, triplet and higher-order) and singleton births. Methods Data from the national multicenter Kids’ Inpatient Database of the Healthcare Cost and Utilization Project from the years 2000, 2003, 2006, 2009, 2012, and 2016 were analyzed using a complex survey design using Statistical Analysis System (SAS) 9.4 (SAS Institute, Cary NC). Neonates with ICD9 and ICD10 codes indicating singletons, twins or triplets, and higher-order multiples were included. Mortality was compared between these groups after excluding transfer outs to avoid duplicate inclusion. To analyze LOS, we included inborn neonates and excluded transfers; who died inpatient and any neonates who appear to have been discharged less than 33 weeks PMA. The LOS was compared by gestational age groups. Results A total of 22,853,125 neonates were analyzed for mortality after applying inclusion-exclusion criteria; 2.96% were twins, and 0.13% were triplets or more. A total of 22,690,082 neonates were analyzed for LOS. Mean GA, expressed as mean (SD), for singleton, twins and triplets, were 38.30 (2.21), 36.39 (4.21), and 32.72 (4.14), respectively. The adjusted odds for mortality were similar for twin births compared to singleton (aOR: 1.004, 95% CI:0.960–1.051, p = 0.8521). The adjusted odds of mortality for triplet or higher-order gestation births were higher (aOR: 1.33, 95% CI: 1.128–1.575, p = 0.0008) when compared to the singleton births. Median LOS (days) was significantly longer in multiple gestation compared to singleton births overall (singletons: 1.59 [1.13, 2.19] vs. twins 3.29 [2.17, 9.59] vs. triplets or higher-order multiples 19.15 [8.80, 36.38], p < .0001), and this difference remained significant within each GA category. Conclusion Multiple gestation births have higher mortality and longer LOS when compared to singleton births. This population data from multiple centers across the country could be useful in counseling parents when caring for multiple gestation pregnancies. Supplementary Information The online version contains supplementary material available at 10.1186/s40748-021-00135-5.
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Affiliation(s)
| | - Nilesh Dankhara
- Newborn Medicine, University of Mississippi Medical Center, 2500 N State St, W154, Jackson, MS, 39216, USA
| | - Jagdish Desai
- Newborn Medicine, University of Mississippi Medical Center, 2500 N State St, W154, Jackson, MS, 39216, USA
| | - Angelle L Klar
- Newborn Medicine, University of Mississippi Medical Center, 2500 N State St, W154, Jackson, MS, 39216, USA
| | - Jaimin Patel
- Newborn Medicine, University of Mississippi Medical Center, 2500 N State St, W154, Jackson, MS, 39216, USA
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Learning Disabilities in Reading and Writing and Type of Delivery in Twin Births. CHILDREN-BASEL 2021; 8:children8100834. [PMID: 34682099 PMCID: PMC8534999 DOI: 10.3390/children8100834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Abstract
The aim of this study was to analyse the relationship between the type of delivery (vaginal or caesarean), as a risk factor, and the likelihood of having learning disabilities in reading (reading accuracy) and writing (phonetic and visual orthography), controlling for the interaction and/or confounding effect of gestational, obstetric, and neonatal variables (maternal age at delivery, gestational age, foetal presentation, Apgar 1, and newborn weight) among six-year-old children born in twin births. In this retrospective cohort study, the exposed and non-exposed cohorts consisted of children born by caesarean section and vaginal delivery, respectively. A total of 124 children born in twin births were evaluated in year one of primary education. Intelligence was measured using the K-BIT test; reading and writing variables were evaluated using the Evalúa-1 battery of tests, and clinical records were used to measure gestational, obstetric, and neonatal variables. Binary logistic regressions applied to each dependent variable indicated that caesarean delivery is a possible independent risk factor for difficulties in reading accuracy and phonetic and visual orthography. Future research using larger samples of younger children is required to analyse the relationship between obstetric and neonatal variables and the different basic indicators of reading and writing.
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Feeding Twins with Human Milk and Factors Associated with Its Duration: A Qualitative and Quantitative Study in Southern Italy. Nutrients 2021; 13:nu13093099. [PMID: 34578976 PMCID: PMC8464927 DOI: 10.3390/nu13093099] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/23/2021] [Accepted: 08/28/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Over the past year, there has been a rise in twin births. The current scientific consensus recommended breast-feed milk for all newborns for at least 6 months. They stated that it is possible to meet the nutritional needs of two or more newborns with only one mother's milk. More information would be desirable about the factors that influence or lead to the initiation and interruption of breastfeeding. The quality of the evidence available from multiple studies has been inconclusive and therefore led to controversial interpretations and practices. AIMS The first aim of this study was to analyze the extent of the feeding of multiples with breast milk in the experience of our clinical unit in terms of incidence and duration. The second objective was to evaluate the correlation between maternal, perinatal and neonatal variables with breast milk feeding rates and duration. METHODS The study was conducted between 2015 and 2020, in a NICU in Southern Italy (San Giovanni Rotondo, Foggia). Sixty-one women who have given birth to multiples were enrolled into the study. Newborn data were retrospectively collected by informatic database and breastfeeding information were collected by a questionnaire. RESULTS In our centre, the percentage of twins out of the total number of births over the years has almost doubled from 1.28% in 2015 to 2.48% in 2020 and the 88% of twins are premature. 18.1% received breast milk for more than 6 months and 6.3% received it for more than 12 months. Infants of lower gestational age and weight, born to multiparous, more mature and medium-high schooling mothers received breast milk for a longer period. 35% of women explained that the interruption of breastfeeding was due to the insufficient milk production and 41% to the stress and difficulties in managing the twins. Qualitative analysis of maternal narrative revealed, for many of them, the awareness of the importance of breastfeeding and the efforts made to try to give breast milk, but also fears about the quantity of milk and satiety of their children. CONCLUSIONS It is important to identify the factors both favoring and obstructing maternal milk feeding of multiples and it would be desirable the activation of a network of training and support for mothers after discharge, with particular regard to the categories found to be less inclined.
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Bizzego A, Gabrieli G, Bornstein MH, Deater-Deckard K, Lansford JE, Bradley RH, Costa M, Esposito G. Predictors of Contemporary under-5 Child Mortality in Low- and Middle-Income Countries: A Machine Learning Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031315. [PMID: 33535688 PMCID: PMC7908191 DOI: 10.3390/ijerph18031315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
Child Mortality (CM) is a worldwide concern, annually affecting as many as 6.81% children in low- and middle-income countries (LMIC). We used data of the Multiple Indicators Cluster Survey (MICS) (N = 275,160) from 27 LMIC and a machine-learning approach to rank 37 distal causes of CM and identify the top 10 causes in terms of predictive potency. Based on the top 10 causes, we identified households with improved conditions. We retrospectively validated the results by investigating the association between variations of CM and variations of the percentage of households with improved conditions at country-level, between the 2005–2007 and the 2013–2017 administrations of the MICS. A unique contribution of our approach is to identify lesser-known distal causes which likely account for better-known proximal causes: notably, the identified distal causes and preventable and treatable through social, educational, and physical interventions. We demonstrate how machine learning can be used to obtain operational information from big dataset to guide interventions and policy makers.
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Affiliation(s)
- Andrea Bizzego
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy;
| | - Giulio Gabrieli
- School of Social Sciences, Nanyang Technological University, Singapore 639798, Singapore;
| | - Marc H. Bornstein
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892, USA;
- Institute for Fiscal Studies, London WC1E 7AE, UK
- UNICEF, New York, NY 10038, USA
| | | | | | - Robert H. Bradley
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ 85287, USA; (R.H.B.); (M.C.)
| | - Megan Costa
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ 85287, USA; (R.H.B.); (M.C.)
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy;
- School of Social Sciences, Nanyang Technological University, Singapore 639798, Singapore;
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
- Correspondence: or
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Adank MC, Broere-Brown ZA, Gonçalves R, Ikram MK, Jaddoe VWV, Steegers EAP, Schalekamp-Timmermans S. Maternal cardiovascular adaptation to twin pregnancy: a population-based prospective cohort study. BMC Pregnancy Childbirth 2020; 20:327. [PMID: 32471487 PMCID: PMC7257120 DOI: 10.1186/s12884-020-02994-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/06/2020] [Indexed: 11/20/2022] Open
Abstract
Background In women with singleton pregnancies, maternal adaptation is considered a stress test for later life cardiovascular disease. The aim of this study was to assess maternal adaptation in women with twin pregnancies compared to women carrying singletons during and after pregnancy. Methods This was a population based prospective cohort study of 91 women with twin pregnancies and 8107 women carrying singletons. The association of twin pregnancy and maternal adaptation was examined using regression analyses. In pregnancy, we measured soluble fms-like tyrosine kinase-1 (sFLT-1), placental growth (PGF) factor, systolic (SBP) and diastolic blood pressure (DBP), and the occurrence of pre-eclampsia (PE). After pregnancy, measurements were obtained on SBP and DBP, cardiac function, retinal calibres, intima media thickness and distensibility of the common carotid artery. Results sFLT-1 and PGF concentrations were higher in early (13.4 weeks) and mid-pregnancy (20.4 weeks) in women with twin pregnancies compared to women with singleton pregnancies. Women with twin pregnancies had a different DBP pattern in pregnancy. Women with twin pregnancies were more likely to have PE (odds ratio 3.63; 95% CI [1.76 to 7.48]). Six and ten years after pregnancy, no differences in maternal adaptation were observed. Conclusions Women with twin pregnancies show an altered adaptation during pregnancy compared to women with singleton pregnancies. This is associated with a substantially increased incidence of PE, but does not lead to persistent altered maternal adaptation years after pregnancy.
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Affiliation(s)
- Maria C Adank
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands. .,Generation R Study Group, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
| | - Zoe A Broere-Brown
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Romy Gonçalves
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.,Department of Neurology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Vincent W V Jaddoe
- Generation R Study Group, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Sarah Schalekamp-Timmermans
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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7
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Kim ML, Hong K, Kim S, Lee MJ, Shim SS, Hur YM, Shin JS. Twin pregnancies with uterine fibroids are not at increased risk for obstetric complications: single center cohort study. BMC Pregnancy Childbirth 2020; 20:222. [PMID: 32295544 PMCID: PMC7161148 DOI: 10.1186/s12884-020-02908-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Twin pregnancies with uterine fibroid(s) (UFs) may not be at increased risk for obstetric complications compared to those without UFs. However, there was no reported comparison study with obstetric outcomes and complications of twin pregnancy after myomectomy. We aimed to compare the pregnancy outcomes in twin pregnancies with or without uterine fibroid(s), and also compared in patients with previous myomectomy history in Korean women. METHODS A cohort of twin pregnancies delivered in a single institution between January 2011 and March 2019 were retrospectively analyzed. UFs group was defined by the presence of UFs during pregnancy (≥1 fibroid, measuring ≥2 cm or multiple fibroids regardless of the size). Previous myomectomy group included patients with history of abdominal or laparoscopic or hysteroscopic myomectomy of ≥1 fibroid, measuring ≥2 cm or multiple fibroids whatever the size. Patients with monochorionic monoamniotic twins, myoma less than 2 cm in size, missed abortion or intrauterine fetal death (IUFD) of one fetus before 14 weeks, history of previous conization, and uterine anomalies were excluded. Pregnancy outcomes and obstetric complications were compared. RESULT A total 1388 patients were included in this study, 191 (13.8%) had UFs and 89 (6.4%) had a history of myomectomy. Maternal age was younger in non-UFs group and primiparity was more common in UFs group (p < 0.001, and p = 0.019). No significant differences were found in the gestational age at delivery (p = 0.657), delivery before 37 weeks (p = 0.662), delivery before 34 weeks (p = 0.340), and sum of birth weight of twin (p = 0.307). There were also no statistical differences in rates of obstetrical complications, such as preeclampsia, gestational diabetes mellitus, placenta previa, placenta abruption, cerclage, small for gestational age, IUFD, postpartum hemorrhage and peripartum transfusion or ICU care. These obstetrical outcomes and complications showed no statistical differences between UFs group and previous myomectomy group. CONCLUSION In patients with twin pregnancies, the presence of UFs or history of previous myomectomy did not relate to negative effects on pregnancy outcomes and obstetrical complications.
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Affiliation(s)
- Mi-La Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 135-081, Republic of Korea
| | - Kirim Hong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 135-081, Republic of Korea
| | - Sohyun Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 135-081, Republic of Korea
| | - Min Jin Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 135-081, Republic of Korea
| | - Sung Shin Shim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 135-081, Republic of Korea
| | - Yoon-Mi Hur
- College of General Education, Kookmin University, Seoul, Republic of Korea
| | - Joong Sik Shin
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 135-081, Republic of Korea.
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Jorgensen DR, Wu CM, Hariharan S. Epidemiology of end-stage renal failure among twins and diagnosis, management, and current outcomes of kidney transplantation between identical twins. Am J Transplant 2020; 20:761-768. [PMID: 31595679 DOI: 10.1111/ajt.15638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/03/2019] [Accepted: 09/22/2019] [Indexed: 01/25/2023]
Abstract
The aim of the study is to provide a comprehensive overview of identical twin kidney transplantation in the modern era. We provide epidemiologic trends in the US twin population from 1959 to 2000, current methods to identify zygosity, outcomes for identical twin transplants, and a comprehensive management strategy for identical twin kidney transplantation. By 2019, we project that 433 010 dizygotic and monozygotic twins will be alive and at risk for developing ESRF. Monozygosity between a donor-recipient pair can be confirmed by concordance in sex, blood type, and HLA antigen match with precision testing using 13/17 Short Tandem Repeat sequencing to a likelihood of nearly 100%. Among identical twin transplants from 2001 to 2017, excellent patient and kidney graft survival rates were noted. Approximately 50% of kidney transplant recipients of identical twins transplant did not receive maintenance immunosuppression, and no differences in graft survival were noted among patients with and without immunosuppression at 6 and 12 months (P = .8 and .7). Patients with glomerulonephritis as the cause of ESRF had lower graft survival (P = .06) suggesting that recurrent glomerulonephritis as a likely cause of graft loss among these recipients.
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Affiliation(s)
- Dana R Jorgensen
- Department of Medicine, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Christine M Wu
- Department of Medicine, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Sundaram Hariharan
- Department of Medicine, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
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Mallinson DC, Larson A, Berger LM, Grodsky E, Ehrenthal DB. Estimating the effect of Prenatal Care Coordination in Wisconsin: A sibling fixed effects analysis. Health Serv Res 2020; 55:82-93. [PMID: 31701531 PMCID: PMC6980950 DOI: 10.1111/1475-6773.13239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To estimate Prenatal Care Coordination's (PNCC) effect on birth outcomes for Wisconsin Medicaid-covered deliveries. DATA SOURCE A longitudinal cohort of linked Wisconsin birth records (2008-2012), Medicaid claims, and state-administered social services. STUDY DESIGN We defined PNCC treatment dichotomously (none vs. any) and by service level (none vs. assessment/care plan only vs. service uptake). Outcomes were birthweight (grams), low birthweight (<2500 g), gestational age (completed weeks), and preterm birth (<37 weeks). We estimated PNCC's effect on birth outcomes, adjusting for maternal characteristics, using inverse-probability of treatment weighted and sibling fixed effects regressions. DATA COLLECTION/EXTRACTION METHODS We identified 136 224 Medicaid-paid deliveries, of which 33 073 (24.3 percent) linked to any PNCC claim and 22 563 (16.6 percent) linked to claims for PNCC service uptake. PRINCIPAL FINDINGS Sibling fixed effects models-which best adjust for unobserved confounding and treatment selection-produced the largest estimates for all outcomes. For example, in these models, PNCC service uptake was associated with a 1.3 percentage point (14 percent) reduction and a 1.8 percentage point (17 percent) reduction in the probabilities of low birthweight and preterm birth, respectively (all P < .05). CONCLUSIONS PNCC's modest but significant improvement of birth outcomes should motivate stronger PNCC outreach and implementation of similar programs elsewhere.
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Affiliation(s)
- David C. Mallinson
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin
| | - Andrea Larson
- Department of Obstetrics and GynecologySchool of Medicine & Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin
| | | | - Eric Grodsky
- Department of SociologyCollege of Letters & ScienceUniversity of Wisconsin‐MadisonMadisonWisconsin
- Department of Educational Policy StudiesSchool of EducationUniversity of Wisconsin‐MadisonMadisonWisconsin
| | - Deborah B. Ehrenthal
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin
- Department of Obstetrics and GynecologySchool of Medicine & Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin
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Twin Births in Medicaid: Prevalence, Outcomes, Utilization, and Cost in Four States, 2014-2015. Matern Child Health J 2020; 24:546-551. [PMID: 31897931 DOI: 10.1007/s10995-019-02869-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Twin births have increased in prevalence. Twin births are more likely to have poorer outcomes than singleton births and are more costly. However, although Medicaid paid for approximately half of U.S. births in 2016, little is known specifically about the incidence of twin births and related costs for Medicaid beneficiaries. This paper seeks to expand the knowledge of twin births covered by Medicaid. METHODS We obtained data for singleton (N = 115,568) and twin (N = 3775) Medicaid-covered births in selected geographic areas of four states in 2014 and 2015. States provided linked birth certificates to Medicaid claims data for mothers and infants. We compared health care utilization and Medicaid costs for twins to singletons in the same geographic areas. RESULTS The prevalence of Medicaid twins in the selected areas of these four states was 3.2% of births, identical to the rate of twins nationwide. Two thirds of Medicaid twins were born preterm, and average gestational age was 34.8 weeks. Mothers of twins had higher rates of C-Sect. (73.6% vs. 32.0% for singletons) and of neonatal intensive care use (45.2% vs. 11.1%). The average length of delivery stay for twins was 12.3 days, vs. 4.1, and the rate of hospital readmissions was almost twice as high. The total cost for mother and infant over the prenatal, delivery, and post-natal period for a pair of twins was $48,479, over two and a half times as high as for singleton births ($18,032). However, when considering the average cost of a single twin vs. a singleton birth, the cost differential is less ($24,239 vs. $18,032, or a ratio of 1.34). CONCLUSIONS Medicaid twins are a fragile population with poorer outcomes and higher service use than singleton infants. Twins contribute substantially to the Medicaid cost of maternity and newborn care. A variety of strategies can be used to improve twin outcomes and reduce costs.
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Krispin E, Wertheimer A, Trigerman S, Ben-Haroush A, Meizner I, Wiznitzer A, Bardin R. Single or double needle insertion in twin's amniocentesis: Does the technique influence the risk of complications? Eur J Obstet Gynecol Reprod Biol X 2019; 3:100051. [PMID: 31403133 PMCID: PMC6687441 DOI: 10.1016/j.eurox.2019.100051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/30/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To compare complication rates following amniocentesis in twin gestations, according to sampling technique and number of needle insertions. STUDY DESIGN A retrospective cohort study of all women with twin gestations who underwent amniocentesis and delivered in a single university affiliated medical center during 2002-2016. Amniocentesis was performed either through one uterine entry with passage through the inter-twin membrane or through two different entries to the two amniotic sacs. Pregnancy outcome of women that underwent single needle insertion amniocentesis, was compared to this of double needle insertion. Primary outcome was neonatal complications within 4 weeks after amniocentesis (late abortion, chorioamnionitis, preterm premature rupture of membranes, or hospitalization due to related symptoms). Secondary outcomes were gestational week at delivery and labor characteristics. RESULTS The study group comprised 212 women. Of them, 73 (34.4%) underwent a single uterine insertion and 139 (65.6%) two separate needle insertions. Baseline characteristics did not differ between the groups. The amniocentesis complication rate was 13.7% in the single insertion group and 16.5% in the double insertion group (p = 0.587). Multivariate analysis found that a single insertion method had no statistically significant influence on complication rate, after making adjustments for potential confounders (OR = 1.085, 95% CI 0.4-2.9; p = 0.871). Other labor characteristics were similar between the groups. CONCLUSION Needle insertion technique in twin gestation amniocentesis was not associated with procedure related complications.
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Affiliation(s)
- E Krispin
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Wertheimer
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Trigerman
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Ben-Haroush
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Meizner
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Bardin
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Li M, Wang Y, Shi J. Do day-3 embryo grade predict day-5 blastocyst transfer outcomes in patients with good prognosis? Gynecol Endocrinol 2019; 35:36-39. [PMID: 30241445 DOI: 10.1080/09513590.2018.1484444] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The main aim was to investigate whether or not day-3 embryo grade could predict day-5 blastocyst transfer outcomes in patients with good prognosis. This study included 233 elective single blastocyst transfers (eSBT) by D5 selection with conventional morphology (CM) and 121 elective single blastocyst transfers (eSBT) by D5 selection with time-lapse monitoring system (TL) from October 2016 to October 2017. All the patients were submitted to controlled ovarian stimulation (COS) with long-term protocol and transferred for the first time. The main outcome measures were clinical pregnancy rates (CPR) and ongoing pregnancy (OPR). Our results suggested that CPR (58.04 versus 57.89 versus 55.56%; p = .957) and OPR (66.07 versus 65.79 versus 64.44%; p = .981) were comparable among day 3 grades I, grades II, and grades III groups. We also observed that the TL group showed a slightly better CPR and OPR than CM group (p > .05). Our findings suggested that good or poor embryos at day-3 were not predictive of the outcomes of good-quality blastocysts in a good-prognosis population. It needed to be emphasized that time-lapse monitoring might be useful for elective single blastocyst transfer.
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Affiliation(s)
- Mingzhao Li
- a The ART center , Northwest Women's and Children's Hospital , Xi'an , China
| | - Yingjin Wang
- b Medical Ultrasound Center , Northwest Women's and Children's Hospital , Xi'an , China
| | - Juanzi Shi
- a The ART center , Northwest Women's and Children's Hospital , Xi'an , China
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Arya S, Mulla ZD, Plavsic SK. Outcomes of Women Delivering at Very Advanced Maternal Age. J Womens Health (Larchmt) 2018; 27:1378-1384. [DOI: 10.1089/jwh.2018.7027] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sushila Arya
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Zuber D. Mulla
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Sanja Kupesic Plavsic
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
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Yazdekhasti A, Firouzfar A, Hajheidari P, Havaei A, Tavakol G, Karbasian F. Prevalence of multiple birth in Isfahan, Iran. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2018; 23:25. [PMID: 29692822 PMCID: PMC5894274 DOI: 10.4103/jrms.jrms_892_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 07/03/2017] [Accepted: 08/28/2017] [Indexed: 11/04/2022]
Abstract
Background According to increasing rate of using assisted reproductive technology (ART) which result in higher rates of multiple birth and natal difficulties, we aimed to determine the prevalence rate of multiple birth pregnancies. Materials and Methods A descriptive cross-sectional study evaluating birth files in 2009-2010 of main hospitals of Isfahan, Iran. Results Among 31640 files' studies, 614 cases of multiple birth pregnancies were investigated. The product of these pregnancies were 1286 (50.2% females) infants including 557 twins (17.6/1000), 56 triplets (1.8/1000), and one case of quadruple (0.03/1000). Infants weigh <2500 g were 84.9% of all. Mothers had a mean age of 27.9 ± 4.9 which 30.4% of them had a positive history of using ART. Conclusion The prevalence of multiple birth pregnancies is growing. The need for more mother and child care is important. Using ART world wide is leading more multiple birth which could be a cause for more complicated pregnancies.
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Affiliation(s)
- Ahmad Yazdekhasti
- Pediatrician, Amin Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Firouzfar
- Medical Student, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Hajheidari
- Medical Student, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Havaei
- School of Medicine, Tehran University of Medical Sciences, Isfahan, Iran
| | - Golchehreh Tavakol
- Medical Student, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Karbasian
- Pediatrician, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bolognani CV, Reis LBDSM, Dias A, Calderon IDMP. Robson 10-groups classification system to access C-section in two public hospitals of the Federal District/Brazil. PLoS One 2018; 13:e0192997. [PMID: 29462215 PMCID: PMC5819776 DOI: 10.1371/journal.pone.0192997] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 02/02/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The global increase in C-section rates is real. In Brazil, these indices correspond to 58.94% in the Midwest region and 52.77% in the Federal District. OBJECTIVE To evaluate the C-section rates and identify the groups with the greatest risk at two reference hospitals in the public network of Federal District/Brazil, using 10-Group Robson System. METHOD A cross-sectional study of 6579 births assisted at the Hospital A (HA) and the Hospital B (HB) during 2013. The C-section rates in each group and its respective contribution to the total hospital C-sections was compared between HA and HB. To this, was used the proportion difference test (similar to chi-square test), with RR and 95% CI, and the logistic regression analysis (OR; 95% CI) among the groups with higher C-section/total C-section. The significance limit of p < 0.05 was defined for all tests. RESULTS The C-section rates were 50.8% at the HA and 42.3% at the HB, with 1.20 RR (95%CI = 1.13-1.28) at the HA. The highest rates were observed in Robson groups G5, G1, and G2. At the HA, G1 had a 21.5% C-section rate, which was greater than at the HB (13.8%; p < 0.05); the cesarean rates for groups G2 and G5 were higher at the HB (respectively, 18.6 and 38.1%) than at the HA (14.8 and 32.5%, respectively; p < 0.05). CONCLUSION These results point out specific goals to be achieved in order to reduce abusive cesarean rates in both A and B hospitals, especially in the primigravida and in those with previous C-section.
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Affiliation(s)
- Cláudia Vicari Bolognani
- Medical School Coordination, Graduate School of Health Sciences/FEPECS/SES, Brasília, Federal District, Brazil
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School/UNESP, Botucatu, São Paulo, Brazil
| | | | - Adriano Dias
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School/UNESP, Botucatu, São Paulo, Brazil
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Woolcock JG, Grivell RM, Dodd JM, Cochrane Pregnancy and Childbirth Group. Regimens of ultrasound surveillance for twin pregnancies for improving outcomes. Cochrane Database Syst Rev 2017; 11:CD011371. [PMID: 29108135 PMCID: PMC6486298 DOI: 10.1002/14651858.cd011371.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Increased ultrasound surveillance of twin pregnancies has become accepted practice due to the higher risk of complications. There is no current consensus however as to the method and frequency of ultrasound monitoring that constitutes optimal care. OBJECTIVES To systematically review the effects of different types and frequency of ultrasound surveillance for women with a twin pregnancy on neonatal, fetal and maternal outcomes. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (all searched 11 August 2017), and reference lists of retrieved studies. SELECTION CRITERIA Randomised and quasi-randomised trials (including those published in abstract form) comparing the effects of described antenatal ultrasound surveillance regimens in twin pregnancies. Trials using a cluster-randomised design would have been eligible for inclusion in this review but none were identified. Trials using a cross-over design are not eligible for inclusion in this review.Different types and frequencies of ultrasound testing (for fetal surveillance and detection of specific problems) compared with each other and also compared with no testing. For example, an intervention might comprise a specific approach to ultrasound examination with dedicated components to detect twin-specific pathology. Different interventions could also include a specific type of surveillance at different intervals or different combinations at the same intervals.In this review we only found one study looking at fetal growth (biometry) and Doppler ultrasounds at 25, 30 and 35 weeks' gestation versus fetal growth alone. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and quality, and extracted data. We checked data for accuracy. MAIN RESULTS We included one trial of 526 women with a twin pregnancy of two viable twins, with no known morphological abnormality, in this review. The trial compared women receiving fetal growth and Doppler ultrasounds at 25, 30 and 35 weeks' gestation to fetal growth alone. We judged the included study to be at low risk of bias however the risk of performance and detection bias were unclear.The primary outcome was the perinatal mortality rate (after randomisation), for which there was no evidence of a clear difference between the fetal growth + Doppler and the fetal growth alone groups (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.32 to 2.41, low-quality evidence) with similar rates in both groups (seven events in the Dopper + fetal growth group and eight in the fetal growth alone group). No clear differences were seen between the two regimens for the other outcomes in this review: stillbirth (RR 0.67, 95% CI 0.11 to 3.99), neonatal death (RR 1.01, 95% CI 0.29 to 3.46, low-quality evidence), gestational age at birth (weeks) (mean difference 0.10, 95% CI -0.39 to 0.59, moderate-quality evidence), infant requiring ventilation (RR 0.86, 95% CI 0.59 to 1.25), admission to special care or intensive care units (RR 0.96, 95% CI 0.88 to 1.05), caesarean section (any) (RR 1.00, 95% CI 0.81 to 1.23, high-quality evidence), elective caesarean section (RR 1.06, 95% CI 0.77 to 1.47), emergency caesarean section (RR 0.93, 95% CI 0.66 to 1.32), induction of labour (RR 1.10, 95% CI 0.80 to 1.50, moderate-quality evidence) or antenatal hospital admission (RR 0.96, 95% CI 0.80 to 1.15, high-quality evidence). The number of preterm births before 28 weeks' gestation was not reported in the included study. For the mortality-related outcomes, event numbers were small.The included study did not report the majority of our maternal and infant secondary outcomes. Infant outcomes not reported included fetal acidosis, Apgar scores less than 7 at five minutes and preterm birth before 37 and 34 weeks' gestation. The maternal outcomes; length of antenatal hospital stay, timely diagnosis of significant complications, rate of preterm, prelabour rupture of membranes and women's level of satisfaction with their care were not reported. The study did not classify twin pregnancies according to their chorionicity. An awareness of the chorionicity may have improved applicability of this data set.We downgraded outcomes assessed using GRADE for imprecision of effect estimates. AUTHORS' CONCLUSIONS This review is based on one small study which was underpowered for detection of rare outcomes such as perinatal mortality, stillbirth and neonatal death.There is insufficient evidence from randomised controlled trials to inform best practice for fetal ultrasound surveillance regimens when caring for women with a twin pregnancy. More studies are needed to evaluate the effects of currently used ultrasound surveillance regimens in twin pregnancies. Future research could report on the important maternal and infant outcomes as listed in this review.
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Affiliation(s)
- Jane G Woolcock
- The University of Adelaide, Women's and Children's HospitalWomen's and Babies' Division, Discipline of Obstetrics and Gynaecology72 King William RoadAdelaideAustralia5006
| | - Rosalie M Grivell
- Flinders University and Flinders Medical CentreDepartment of Obstetrics and GynaecologyBedford ParkSouth AustraliaAustraliaSA 5042
| | - Jodie M Dodd
- The University of Adelaide, Women's and Children's HospitalSchool of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology72 King William RoadAdelaideSouth AustraliaAustralia5006
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Wu VCC, Chen TH, Yeh JK, Wu M, Lu CH, Chen SW, Wu KPH, Cheng CW, Chang CH, Hung KC, Chern MS, Lin FC, Wen MS. Clinical outcomes of peripartum cardiomyopathy: a 15-year nationwide population-based study in Asia. Medicine (Baltimore) 2017; 96:e8374. [PMID: 29069030 PMCID: PMC5671863 DOI: 10.1097/md.0000000000008374] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is the development of heart failure during late pregnancy to months postpartum with potential fatal outcome. However, the disease is not well-studied in Asia.We aimed to investigate the epidemiology and clinical outcomes of PPCM in Taiwan.Electronic medical records were retrieved from Taiwan National Health Insurance Research Database from 1997 to 2011. Patients with PPCM were separated into 3 groups based on the timing of diagnosis. Early: PPCM diagnosed first to ninth month of pregnancy. Traditional: PPCM diagnosed last month of pregnancy till fifth month post-delivery. Late: PPCM diagnosed sixth to twelfth month post-delivery. Primary outcomes defined as cardiac death, all-cause mortality, and major adverse cardiovascular events (MACE) within 1 year.A total of 3,506,081 deliveries during 1997 to 2011 were retrieved and 925 patients with PPCM were identified. Overall incidence of PPCM was 1:3,790 during the 15 years. Early, Traditional, and Late group each had 88, 742, and 95 patients. Cardiac death occurred in 31 patients, all-cause mortality in 72 patients, and MACE in 65 patients. Late group had 2- to 3-fold event rates in cardiac death, all-cause mortality, and MACE compared with Early and Traditional groups. Cumulative incidence showed significant differences for cardiac death (P = .0011), all-cause mortality (P = .0031), and MACE (P = .0014) among 3 groups. Multivariate Cox model showed Late group had significantly worse outcomes after adjusted for clinical variables compared with 2 other groups.Our study is the largest national cohort among Asian countries that showed timing of diagnosis of PPCM had different outcomes. Late diagnosis portended significantly increased morbidity and mortality, even after adjusted for clinical variables.
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Affiliation(s)
- Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City
| | - Tien-Hsing Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Keelung
| | - Jih-Kai Yeh
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City
| | - Michael Wu
- Divison of Cardiology, Weill Cornell Medical Center, New York, NY
| | - Cheng-Hui Lu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City
| | - Katie Pei-Hsuan Wu
- Department of Rehabilitation, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City
| | - Chun-Wen Cheng
- Department of Infectious Diseases, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City
| | - Chih-Hsiang Chang
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City
| | - Kuo-Chun Hung
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City
| | - Ming-Shyan Chern
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City
| | - Fen-Chiung Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City
| | - Ming-Shien Wen
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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McLennan AS, Gyamfi-Bannerman C, Ananth CV, Wright JD, Siddiq Z, D'Alton ME, Friedman AM. The role of maternal age in twin pregnancy outcomes. Am J Obstet Gynecol 2017; 217:80.e1-80.e8. [PMID: 28286050 PMCID: PMC5571734 DOI: 10.1016/j.ajog.2017.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/25/2017] [Accepted: 03/02/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are limited data on how maternal age is related to twin pregnancy outcomes. OBJECTIVE The purpose of this study was to assess the relationship between maternal age and risk for preterm birth, fetal death, and neonatal death in the setting of twin pregnancy. STUDY DESIGN This population-based study of US birth, fetal death, and period-linked birth-infant death files from 2007-2013 evaluated neonatal outcomes for twin pregnancies. Maternal age was categorized as 15-17, 18-24, 25-29, 30-34, 35-39, and ≥40 years of age. Twin live births and fetal death delivered at 20-42 weeks were included. Primary outcomes included preterm birth (<34 weeks and <37 weeks), fetal death, and neonatal death at <28 days of life. Analyses of preterm birth at <34 and <37 weeks were adjusted for demographic and medical factors, with maternal age modeled with the use of restricted spline transformations. RESULTS A total of 955,882 twin live births from 2007-2013 were included in the analysis. Preterm birth rates at <34 and <37 weeks gestation were highest for women 15-17 years of age, decreased across subsequent maternal age categories, nadired for women 35-39 years old, and then increased slightly for women ≥40 years old. Risk for fetal death generally decreased across maternal age categories. Risk for fetal death was 39.9 per 1000 live births for women 15-17 years old, 24.2 for women 18-24 years old, 17.8 for women 25-29 years old, 16.4 for women 30-34 years old, 17.2 for women 35-39 years old, and 15.8 for women ≥40 years old. Risk for neonatal death at <28 days was highest for neonates born to women 15-17 years old (10.0 per 1,000 live births), decreased to 7.3 for women 18-24 years old and 5.5 for women 25-29 years old and ranged from 4.3-4.6 for all subsequent maternal age categories. In adjusted models, risk for preterm birth at <34-<37 weeks gestation was not elevated for women in their mid-to-late 30s; however, risk was elevated for women <20 years old and increased progressively with age for women in their 40s. CONCLUSION Although twin pregnancy is associated with increased risk for most adverse perinatal outcomes, this analysis did not find advanced maternal age to be an additional risk factor for fetal death and infant death. Preterm birth risk was relatively low for women in their late 30s. Risks for adverse outcomes were higher among younger women; further research is indicated to improve outcomes for this demographic group. It may be reasonable to counsel women in their 30s that their age is not a major additional risk factor for adverse obstetric outcomes in the setting of twin pregnancy.
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Affiliation(s)
- Amelia S McLennan
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY
| | - Jason D Wright
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Zainab Siddiq
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY.
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Whitford HM, Wallis SK, Dowswell T, West HM, Renfrew MJ, Cochrane Pregnancy and Childbirth Group. Breastfeeding education and support for women with twins or higher order multiples. Cochrane Database Syst Rev 2017; 2:CD012003. [PMID: 28244065 PMCID: PMC6464508 DOI: 10.1002/14651858.cd012003.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND There are rising rates of multiple births worldwide with associated higher rates of complications and more hospital care, often due to prematurity. While there is strong evidence about the risks of not breastfeeding, rates of breastfeeding in women who have given birth to more than one infant are lower than with singleton births. Breastfeeding more than one infant can be more challenging because of difficulties associated with the birth or prematurity. The extra demands on the mother of frequent suckling, coordinating the needs of more than one infant or admission to the neonatal intensive care unit can lead to delayed initiation or early cessation. Additional options such as breast milk expression, the use of donor milk or different methods of supplementary feeding may be considered. Support and education about breastfeeding has been found to improve the duration of any breastfeeding for healthy term infants and their mothers, however evidence is lacking about interventions that are effective to support women with twins or higher order multiples. OBJECTIVES To assess effectiveness of breastfeeding education and support for women with twins or higher order multiples. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2016), ClinicalTrials.gov (30 June 2016), the WHO International Clinical Trials Registry Platform (ICTRP) (1 July 2016), the excluded studies list from the equivalent Cochrane review of singletons, and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised trials comparing extra education or support for women with twins or higher order multiples were included. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We planned to assess the quality of evidence using the GRADE approach, but were unable to analyse any data. MAIN RESULTS We found 10 trials (23 reports) of education and support for breastfeeding that included women with twins or higher order multiples. The quality of evidence was mixed, and the risk of bias was mostly high or unclear. It is difficult to blind women or staff to group allocation for this intervention, so in all studies there was high risk of performance and high or unclear risk of detection bias. Trials recruited 5787 women (this included 512 women interviewed as part of a cluster randomised trial); of these, data were available from two studies for 42 women with twins or higher order multiples. None of the interventions were specifically designed for women with more than one infant, and the outcomes for multiples were not reported separately for each infant. Due to the scarcity of evidence and the format in which data were reported, a narrative description of the data is presented, no analyses are presented in this review, and we were unable to GRADE the evidence.The two trials with data for women with multiple births compared home nurse visits versus usual care (15 women), and telephone peer counselling versus usual care (27 women). The number of women who initiated breastfeeding was reported (all 15 women in one study, 25 out of 27 women in one study). Stopping any breastfeeding before four to six weeks postpartum, stopping exclusive breastfeeding before four to six weeks postpartum, stopping any breastfeeding before six months postpartum andstopping exclusive breastfeeding before six months postpartum were not explicitly reported, and there were insufficient data to draw any meaningful conclusions from survival data. Stopping breast milk expression before four to six weeks postpartum, andstopping breast milk expression before six months postpartum were not reported. Measures ofmaternal satisfaction were reported in one study of 15 women, but there were insufficient data to draw any conclusions; no other secondary outcomes were reported for women with multiple births in either study. No adverse events were reported. AUTHORS' CONCLUSIONS We found no evidence from randomised controlled trials about the effectiveness of breastfeeding education and support for women with twins or higher order multiples, or the most effective way to provide education and support . There was no evidence about the best way to deliver the intervention, the timing of care, or the best person to deliver the care. There is a need for well-designed, adequately powered studies of interventions designed for women with twins or higher order multiples to find out what types of education and support are effective in helping these mothers to breastfeed their babies.
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Affiliation(s)
- Heather M Whitford
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeScotlandUKDD1 4HJ
| | - Selina K Wallis
- Liverpool School of Tropical MedicineCapacity Research UnitLiverpoolUK
| | - Therese Dowswell
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Helen M West
- The University of LiverpoolInstitute of Psychology, Health and SocietyLiverpoolUK
| | - Mary J Renfrew
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeScotlandUKDD1 4HJ
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Berkovitz A, Biron-Shental T, Pasternak Y, Sharony R, Hershko-Klement A, Wiser A. Predictors of twin pregnancy after ovarian stimulation and intrauterine insemination in women with unexplained infertility. HUM FERTIL 2017; 20:200-203. [PMID: 28112003 DOI: 10.1080/14647273.2017.1279351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Multi-foetal gestation is a well-known, adverse outcome of infertility treatment. Maternal and obstetrical complications are more frequent in multiple pregnancies compared to singletons. The aim of this study was to determine parameters that affect the risk for multiple pregnancies after ovarian stimulation (OS) with intrauterine insemination (IUI). We retrospectively evaluated all cases of OS with IUI cycles that ended with successful clinical pregnancy. A total of 259 pregnancies were analysed (175 singletons, 63 twins and 21 triplets). Significant parameters predicting multiple pregnancies were gravidity and number of follicles at least 15 mm in diameter on day of hCG. A previous pregnancy increased the risk for multiple gestation by a factor of 1.86 (95% CI 1.03-3.37, p = 0.04). Each follicle ≥15 mm increased the odds ratio for multiple gestation by 1.3 (95% CI 1.03-1.65, p = 0.027). In conclusion, women with more than one previous pregnancy and three or more than three follicles ≥15 mm at hCG are at risk for multi-foetal pregnancy after OS and IUI.
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Affiliation(s)
- Arie Berkovitz
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Sava , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Tal Biron-Shental
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Sava , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Yael Pasternak
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Sava , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Reuven Sharony
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Sava , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Anat Hershko-Klement
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Sava , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Amir Wiser
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Sava , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Alrahmani L, Abdelsattar ZM, Adekola H, Puscheck E, Gonik B, Awonuga AO. Risk-profiles and outcomes of multi-foetal pregnancies in adolescent mothers. J OBSTET GYNAECOL 2016; 36:1056-1060. [PMID: 27624001 DOI: 10.1080/01443615.2016.1196477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this retrospective review of 468 mothers with a multi-foetal pregnancy in Detroit, we describe the risk-profiles and the obstetrical, maternal and foetal outcomes of multi-foetal pregnancy in 59 (13%) adolescents. Overall, most mothers were African American, did not have private insurance and all were unmarried. For most mothers, this was their first pregnancy (59.3%) and their first delivery (69.5%). Almost 50% presented to triage at least once during their pregnancy. Anaemia (78%) and hypertensive disorders (18.6%) were common in this age group. The majority of adolescents delivered preterm as 81.4% were <37 weeks and 49% were <34 weeks. Furthermore, the majority of infants (79%) had low birth weights (median: 1975 g, range: 365-3405 g). This contemporary report emphasises the need for multidisciplinary prenatal management and specialist supervision, as multi-foetal pregnancies in adolescents pose real risks and impact obstetrical, maternal and neonatal outcomes.
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Affiliation(s)
- Layan Alrahmani
- a Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Zaid M Abdelsattar
- b Center for Healthcare Outcomes and Policy , University of Michigan , Ann Arbor , MI , USA
| | - Henry Adekola
- a Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Elizabeth Puscheck
- a Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Bernard Gonik
- a Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Awoniyi O Awonuga
- a Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
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Zhang B, Cao Z, Zhang Y, Yao C, Xiong C, Zhang Y, Wang Y, Zhou A. Birthweight percentiles for twin birth neonates by gestational age in China. Sci Rep 2016; 6:31290. [PMID: 27506479 PMCID: PMC4978964 DOI: 10.1038/srep31290] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/15/2016] [Indexed: 11/09/2022] Open
Abstract
Localized birthweight references for gestational ages serve as an essential tool in accurate evaluation of atypical birth outcomes. Such references for twin births are currently not available in China. The aim of this study was to construct up-to-data sex specific birth weight references by gestational ages for twin births in China. We conducted a population-based analysis on the data of 22,507 eligible living twin infants with births dated between 8/01/2006 and 8/31/2015 from all 95 hospitals within the Wuhan area. Gestational ages in complete weeks were determined using a combination of last-menstrual-period based (LMP) estimation and ultrasound examination. Smoothed percentile curves were created by the Lambda Mu Sigma (LMS) method. Reference of the 3(rd), 10(th), 25(th), 50(th), 75(th), 90(th), 97(th) percentiles birth weight by sex and gestational age were made using 11,861 male and 10,646 female twin newborns with gestational age 26-42 weeks. Separate birthweight percentiles curves for male and female twins were constructed. In summary, our study firstly presents percentile curves of birthweight by gestational age for Chinese twin neonates. Further research is required for the validation and implementation of twin birthweight curves into clinical practice.
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Affiliation(s)
- Bin Zhang
- Wuhan Medical &Healthcare Center for Women and Children, Wuhan, China
| | - Zhongqiang Cao
- Wuhan Medical &Healthcare Center for Women and Children, Wuhan, China
| | - Yiming Zhang
- Wuhan Medical &Healthcare Center for Women and Children, Wuhan, China
| | - Cong Yao
- Wuhan Medical &Healthcare Center for Women and Children, Wuhan, China
| | - Chao Xiong
- Wuhan Medical &Healthcare Center for Women and Children, Wuhan, China
| | - Yaqi Zhang
- Wuhan Medical &Healthcare Center for Women and Children, Wuhan, China
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science &Technology, Wuhan, China
| | - Aifen Zhou
- Wuhan Medical &Healthcare Center for Women and Children, Wuhan, China
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Heino A, Gissler M, Hindori-Mohangoo AD, Blondel B, Klungsøyr K, Verdenik I, Mierzejewska E, Velebil P, Sól Ólafsdóttir H, Macfarlane A, Zeitlin J, Euro-Peristat Scientific Committee. Variations in Multiple Birth Rates and Impact on Perinatal Outcomes in Europe. PLoS One 2016; 11:e0149252. [PMID: 26930069 PMCID: PMC4773186 DOI: 10.1371/journal.pone.0149252] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/11/2016] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR) exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse perinatal outcomes at a population level. METHODS We used national aggregate birth data on multiple pregnancies, maternal age, gestational age (GA), stillbirth and neonatal death collected in the Euro-Peristat project (29 countries in 2010, N = 5 074 643 births). We also used European Society of Human Reproduction and Embryology (ESHRE) data on assisted conception and single embryo transfer (SET). The impact of MBR on outcomes was studied using meta-analysis techniques with random-effects models to derive pooled risk ratios (pRR) overall and for four groups of country defined by their MBR. We computed population attributable risks (PAR) for these groups. RESULTS In 2010, the average MBR was 16.8 per 1000 women giving birth, ranging from 9.1 (Romania) to 26.5 (Cyprus). Compared to singletons, multiples had a nine-fold increased risk (pRR 9.4, 95% Cl 9.1-9.8) of preterm birth (<37 weeks GA), an almost 12-fold increased risk (pRR 11.7, 95% CI 11.0-12.4) of very preterm birth (<32 weeks GA). Pooled RR were 2.4 (95% Cl 1.5-3.6) for fetal mortality at or after 28 weeks GA and 7.0 (95% Cl 6.1-8.0) for neonatal mortality. PAR of neonatal death and very preterm birth were higher in countries with high MBR compared to low MBR (17.1% (95% CI 13.8-20.2) versus 9.8% (95% Cl 9.6-11.0) for neonatal death and 29.6% (96% CI 28.5-30.6) versus 17.5% (95% CI 15.7-18.3) for very preterm births, respectively). CONCLUSIONS Wide variations in MBR and their impact on population outcomes imply that efforts by countries to reduce MBR could improve perinatal outcomes, enabling better long-term child health.
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Affiliation(s)
- Anna Heino
- THL National Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland
| | - Ashna D. Hindori-Mohangoo
- TNO, Netherlands Organisation for Applied Scientific Research, Department Child Health, Leiden, The Netherlands
- Anton de Kom University of Suriname, Faculty of Medical Sciences, Department Public Health, Paramaribo, Suriname
| | - Béatrice Blondel
- INSERM, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen and Medical Birth Registry of Norway, Norwegian Institute of Public Health, 5018, Bergen, Norway
| | - Ivan Verdenik
- Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Ewa Mierzejewska
- Department of Epidemiology, National Research Institute of Mother and Child, Warsaw, Poland
| | - Petr Velebil
- Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Helga Sól Ólafsdóttir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
| | - Alison Macfarlane
- Centre for Maternal and Child Health Research, School of Health Sciences, City University London, London, Great Britain
| | - Jennifer Zeitlin
- INSERM, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France
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Connolly KA, Eddleman KA. Amniocentesis: A contemporary review. World J Obstet Gynecol 2016; 5:58-65. [DOI: 10.5317/wjog.v5.i1.58] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/27/2015] [Accepted: 12/15/2015] [Indexed: 02/05/2023] Open
Abstract
Amniocentesis is an essential tool in obstetrics. Invasive testing remains the only modality for diagnostic genetic testing and the only way to provide comprehensive testing for chromosomal abnormalities. Despite increasing use of cell free fetal deoxyribonucleic acid (DNA) testing, amniocentesis should still be offered to all women who desire more complete and accurate genetic testing. Counseling patients on the limitations of screening tests is of the upmost importance and amniocentesis should continue to be recommended to confirm positive results from cell free fetal DNA testing or in the case of failed cell free fetal DNA test. As cell free fetal DNA screening has not adequately been studied in multiple gestations, its use is not recommended in this population and invasive testing should be offered. Amniocentesis is also very useful in providing additional information in settings other than genetic testing the second and third trimester. If intraamniotic infection is suspected, but the clinical findings are not enough to guide management, amniocentesis can provide testing that can both immediately clarify the picture (interleukin-6, gram stain, glucose levels) and finally confirm the presence of infection (culture). It can also be used to detect the presence of intrauterine viral infections. Additionally, amniocentesis may be used to test for markers of fetal lung maturity. The American Congress of Obstetricians and Gynecologists recommends that amniocentesis for this indication not be used in cases where late preterm delivery is indicated. It may be useful in guiding decision-making, however, when late preterm delivery is indicated, but when exact timing is unclear. Regardless of the indication, amniocentesis appears to be a relatively low risk procedure with minimal risk to the patient. Additional randomized controlled trials are not likely, as they are not feasible to due extremely high number of participants that would be needed to detect a difference in loss rates. Based on current literature, however, the risk of pregnancy loss from second trimester amniocentesis is low in both singleton and twin gestations. We counsel patients that technique has changed since the original studies in the 1970s and feel comfortable quoting a loss rate of 1/500-1/1000 based on contemporary data.
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Okby R, Shoham-Vardi I, Sergienko R, Sheiner E. Twin pregnancy: is it a risk factor for long-term cardiovascular disease? J Matern Fetal Neonatal Med 2015; 29:1626-30. [PMID: 26429152 DOI: 10.3109/14767058.2015.1057491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate whether twin pregnancy increases the risk for long-term maternal cardiovascular disease (CVD). STUDY DESIGN A retrospective population-based cohort study compared the incidence of long-term CVD in a cohort of women with and without a previous twin delivery. SETTING Deliveries occurred between the years 1988 and 2012. PATIENTS Patients who had a twin birth between years 1988 and 2012 were included in the study, patient that had a singleton delivery included in the control group. MAIN OUTCOME MEASURES CVD was divided into four categories according to severity and type. Kaplan-Meier survival curve was used to estimate cumulative incidence of cardiovascular hospitalizations. Cox proportional hazards model was used to estimate the adjusted hazard ratios (HR) for CVD. RESULTS During the study period, there were 100 387 women that met the inclusion criteria, 4.6% (n = 4647) delivered twins at least once during the period. The incidence of CVD was 1% in women who had a twin delivery and 1.12% in women who had a singleton delivery. There was no difference in the cumulative incidence of cardiovascular hospitalizations among women who had twin deliveries as compared with singletons. When performing a Cox proportional hazard model, a history of twin delivery did not increase the risk for long-term maternal cardiovascular hospitalizations (adjusted HR = 1.0, 95% CI = 0.8-1.1, p = 0.698). CONCLUSIONS Twin pregnancy is not associated with an increased risk for long-term maternal CVD.
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Affiliation(s)
- Rania Okby
- a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel and
| | - Ilana Shoham-Vardi
- b Department of Public Health , Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Ruslan Sergienko
- b Department of Public Health , Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Eyal Sheiner
- a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel and
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Kosto A, Okby R, Levy M, Sergienko R, Sheiner E. The effect of maternal anemia on maternal and neonatal outcomes in twin pregnancies. J Matern Fetal Neonatal Med 2015; 29:2297-300. [PMID: 26371889 DOI: 10.3109/14767058.2015.1084616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study is to investigate the effect of second trimester anemia on maternal and perinatal outcomes in twin pregnancies. METHODS A retrospective population-based study was conducted, comparing maternal and neonatal outcomes in women carrying twins, with second trimester anemia (defined as hemoglobin < 10 g/dl) to those without anemia (defined as hemoglobin > or equal to 10 g/dl). Deliveries occurred in a tertiary medical center in 2013. RESULTS During the study period, there were 307 twin deliveries. Hemoglobin levels were available for 247 (80.4%) twins; 66 (26.7%) of these had anemia (<10 g/dl) during the second trimester. Women with second trimester anemia had a higher parity (p=0.03), and needed more blood transfusions than those with hemoglobin level > or equal to 10 g/dl (OR = 1.6; 95% CI 1.11-2.43, p < 0.001). No significant differences were noted between the groups regarding other obstetrical outcomes or regarding perinatal outcomes. CONCLUSION Second trimester anemia in women carrying twins is associated with a high parity and increases the risk for blood transfusions. However, in our population, maternal anemia in twin gestations does not increase the risk for adverse perinatal outcome.
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Affiliation(s)
- Amit Kosto
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel and
| | - Rania Okby
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel and
| | - Maya Levy
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel and
| | - Ruslan Sergienko
- b Department of Public Health , Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Eyal Sheiner
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel and
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Richards J, Graham R, Embleton ND, Campbell C, Rankin J. Mothers' perspectives on the perinatal loss of a co-twin: a qualitative study. BMC Pregnancy Childbirth 2015; 15:143. [PMID: 26134115 PMCID: PMC4488109 DOI: 10.1186/s12884-015-0579-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a growing body of literature exploring the emotional impact of perinatal loss upon parents but only limited research focussing specifically on the views and experiences of parents who have experienced a loss from a twin or higher order pregnancy. We undertook a qualitative study to provide an in-depth understanding of the experiences of mothers who have had a loss from a twin pregnancy and subsequently continued visiting hospital whilst their surviving twin was cared for. METHODS A qualitative study involving semi-structured interviews. Mothers were recruited from a Neonatal Intensive Care Unit and Fetal Medicine department. Fourteen interviews were carried out with mothers who had experienced a loss in pregnancy or the neonatal period and had a surviving twin on the neonatal unit. Data were analysed using a generative thematic approach. RESULTS The analysis identified three key themes in the accounts mothers gave of their experiences: the status of 'special'; the importance of trust; and control and empowerment. Where the surviving co-twin remained in hospital for many weeks, mothers described the emotional support of health professionals as crucial to their wellbeing. Few mothers sought formal bereavement support, instead they kept their grief 'on hold' in order to support their surviving baby. Due to the trauma of their loss, mothers reflected that they had been unable to make informed decisions, in particular in relation to the funeral of their deceased baby. CONCLUSIONS Our study highlighted that there are a specific set of issues for mothers who have lost a baby from a twin pregnancy. Relatively small changes to practice however, made a significant difference to wellbeing during their time in hospital with a surviving twin. Findings from this research will provide insight into the needs of bereaved mothers, will inform healthcare planning and the development of care packages.
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Affiliation(s)
- Judy Richards
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, England, NE2 4AE, UK.
| | - Ruth Graham
- School of Geography, Politics and Sociology, Newcastle University, Newcastle upon Tyne, England, NE1 7RU, UK.
| | - Nicholas D Embleton
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, England, NE2 4AE, UK.
- Newcastle Hospitals NHS Foundation Trust, Newcastle Neonatal Service, Newcastle upon Tyne, England, NE2 4AE, UK.
| | - Claire Campbell
- Newcastle Hospitals NHS Foundation Trust, Newcastle Neonatal Service, Newcastle upon Tyne, England, NE2 4AE, UK.
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, England, NE2 4AE, UK.
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Luke B, Brown MB, Wantman E, Stern JE, Baker VL, Widra E, Coddington CC, Gibbons WE, Van Voorhis BJ, Ball GD. Application of a validated prediction model for in vitro fertilization: comparison of live birth rates and multiple birth rates with 1 embryo transferred over 2 cycles vs 2 embryos in 1 cycle. Am J Obstet Gynecol 2015; 212:676.e1-7. [PMID: 25683965 PMCID: PMC4416976 DOI: 10.1016/j.ajog.2015.02.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/21/2015] [Accepted: 02/09/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to use a validated prediction model to examine whether single embryo transfer (SET) over 2 cycles results in live birth rates (LBR) comparable with 2 embryos transferred (DET) in 1 cycle and reduces the probability of a multiple birth (ie, multiple birth rate [MBR]). STUDY DESIGN Prediction models of LBR and MBR for a woman considering assisted reproductive technology developed from linked cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System for 2006-2012 were used to compare SET over 2 cycles with DET in 1 cycle. The prediction model was based on a woman's age, body mass index (BMI), gravidity, previous full-term births, infertility diagnoses, embryo state, number of embryos transferred, and number of cycles. RESULTS To demonstrate the effect of the number of embryos transferred (1 or 2), the LBRs and MBRs were estimated for women with a single infertility diagnosis (male factor, ovulation disorders, diminished ovarian reserve, and unexplained); nulligravid; BMI of 20, 25, 30, and 35 kg/m2; and ages 25, 35, and 40 years old by cycle (first or second). The cumulative LBR over 2 cycles with SET was similar to or better than the LBR with DET in a single cycle (for example, for women with the diagnosis of ovulation disorders: 35 years old; BMI, 30 kg/m2; 54.4% vs 46.5%; and for women who are 40 years old: BMI, 30 kg/m(2); 31.3% vs 28.9%). The MBR with DET in 1 cycle was 32.8% for women 35 years old and 20.9% for women 40 years old; with SET, the cumulative MBR was 2.7% and 1.6%, respectively. CONCLUSION The application of this validated predictive model demonstrated that the cumulative LBR is as good as or better with SET over 2 cycles than with DET in 1 cycle, while greatly reducing the probability of a multiple birth.
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Affiliation(s)
- Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, MI.
| | - Morton B Brown
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | | | - Judy E Stern
- Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Valerie L Baker
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, CA
| | - Eric Widra
- Shady Grove Fertility Center, Washington, DC
| | | | - William E Gibbons
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Bradley J Van Voorhis
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA
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Vanishing twin syndrome: is it associated with adverse perinatal outcome? Fertil Steril 2015; 103:1209-14. [DOI: 10.1016/j.fertnstert.2015.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/08/2015] [Accepted: 02/09/2015] [Indexed: 11/17/2022]
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Lee CM, Yang SH, Lee SP, Hwang BC, Kim SY. Clinical factors affecting the timing of delivery in twin pregnancies. Obstet Gynecol Sci 2014; 57:436-41. [PMID: 25469330 PMCID: PMC4245335 DOI: 10.5468/ogs.2014.57.6.436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/05/2014] [Accepted: 07/12/2014] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To investigate clinical factors affecting the timing of delivery in twin pregnancies in order to minimize perinatal complications. METHODS A retrospective study involved 163 twin pregnancies delivered from January 2006 to September 2011 at Gachon University Gil Medical Center. These cases were divided into three groups based on the delivery timing: less than 32 weeks' gestation (group A), between 32 and 35+6 weeks' gestation (group B), and over 36 weeks' gestation (group C). Clinical factors including maternal age, parity, presence of premature uterine contraction, presence of premature rupture of membrane, white blood cell, high sensitive C-reactive protein level, cervical dilatation, maternal complication, chorionicity, twin specific complication, and perinatal complication were analyzed for each group. RESULTS In group B, the timing of delivery was postponed for 14 days or more from the time of admission, and there were fewer numbers of babies with low Apgar score at birth compared with other groups. The frequency of uterine contraction (P<0.001), presence of premature rupture of membranes (P=0.017), dilatation of cervix (P<0.001), increased white blood cell and high sensitive C-reactive protein levels (P=0.002, P<0.001) were important clinical factors during decision making process of delivery timing in twin pregnancies. Twin specific fetal conditions, such as twin-twin transfusion syndrome and discordant growth (over 25% or more) were shown more frequently in group A. However, there were no significant statistical differences among three groups (P=0.06, P=0.14). CONCLUSION Proper management for preventing premature contraction and inflammation can be essential in twin pregnancies until 32 weeks' gestation, and may decrease maternal and perinatal complications.
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Affiliation(s)
- Chae Min Lee
- Department of Obstetrics and Gynecology, Gachon University Gil Hospital, Gachon University Graduate School of Medicine, Incheon, Korea
| | - Sun Hye Yang
- Department of Obstetrics and Gynecology, Gachon University Gil Hospital, Gachon University Graduate School of Medicine, Incheon, Korea
| | - Sun Pyo Lee
- Department of Obstetrics and Gynecology, Gachon University Gil Hospital, Gachon University Graduate School of Medicine, Incheon, Korea
| | - Byung Chul Hwang
- Department of Obstetrics and Gynecology, Gachon University Gil Hospital, Gachon University Graduate School of Medicine, Incheon, Korea
| | - Suk Young Kim
- Department of Obstetrics and Gynecology, Gachon University Gil Hospital, Gachon University Graduate School of Medicine, Incheon, Korea
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Okby R, Weintraub AY, Sergienko R, Eyal S. Gestational diabetes mellitus in twin pregnancies is not associated with adverse perinatal outcomes. Arch Gynecol Obstet 2014; 290:649-54. [DOI: 10.1007/s00404-014-3272-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 04/25/2014] [Indexed: 10/25/2022]
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Shankaran S, Lin A, Maller-Kesselman J, Zhang H, O’Shea TM, Bada HS, Kaiser JR, Lifton RP, Bauer CR, Ment LR. Maternal race, demography, and health care disparities impact risk for intraventricular hemorrhage in preterm neonates. J Pediatr 2014; 164:1005-1011.e3. [PMID: 24589078 PMCID: PMC4095864 DOI: 10.1016/j.jpeds.2014.01.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/19/2013] [Accepted: 01/17/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine whether risk factors associated with grade 2-4 intraventricular hemorrhage (IVH) differs between infants of African ancestry and white infants. STUDY DESIGN Inborn, appropriate for gestational age infants with birth weight 500-1250 g and exposure to at least 1 dose of antenatal steroids were enrolled in 24 neonatal intensive care units. Cases had grade 2-4 IVH and controls matched for site, race, and birth weight range had 2 normal ultrasounds read centrally. Multivariate logistic regression modeling identified factors associated with IVH across African ancestry and white race. RESULTS Subjects included 579 African ancestry or white race infants with grade 2-4 IVH and 532 controls. Mothers of African ancestry children were less educated, and white case mothers were more likely to have more than 1 prenatal visit and multiple gestation (P ≤ .01 for all). Increasing gestational age (P = .01), preeclampsia (P < .001), complete antenatal steroid exposure (P = .02), cesarean delivery (P < .001), and white race (P = .01) were associated with decreased risk for IVH. Chorioamnionitis (P = .01), 5-minute Apgar score <3 (P < .004), surfactant use (P < .001), and high-frequency ventilation (P < .001) were associated with increased risk for IVH. Among African ancestry infants, having more than 1 prenatal visit was associated with decreased risk (P = .02). Among white infants, multiple gestation was associated with increased risk (P < .001), and higher maternal education was associated with decreased risk (P < .05). CONCLUSION The risk for IVH differs between infants of African ancestry and white infants, possibly attributable to both race and health care disparities.
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Affiliation(s)
- Seetha Shankaran
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI.
| | - Aiping Lin
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | | | - Heping Zhang
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT
| | - T. Michael O’Shea
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC
| | - Henrietta S. Bada
- Department of Pediatrics, University of Kentucky College of Medicine
| | - Jeffrey R. Kaiser
- Departments of Pediatrics and Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Richard P. Lifton
- Department of Genetics and the Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT
| | - Charles R. Bauer
- Department of Pediatrics, University of Miami Miller School of Medicine
| | - Laura R. Ment
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT,Department of Neurology, Yale University School of Medicine, New Haven, CT
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Association of Maternal Age to Development and Progression of Retinopathy of Prematurity in Infants of Gestational Age under 33 Weeks. J Ophthalmol 2014; 2014:187929. [PMID: 24876945 PMCID: PMC4021680 DOI: 10.1155/2014/187929] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 04/13/2014] [Indexed: 12/20/2022] Open
Abstract
Aim. To find predictive and indicative markers of risk for development of retinopathy of prematurity (ROP) and its progression to the stage requiring laser treatment, in premature infants whose gestational age (GA) was under 33 weeks. Methods. We retrospectively reviewed medical records of 197 premature infants born in 2005-2010 whose GA < 33 weeks and underwent eye screening at Keio University Hospital. The association between candidate risk factors and development or progression of ROP was assessed. Results. Among the 182 eligible infants (median GA, 29.1 weeks; median birth weight (BW), 1028 g), 84 (46%) developed any stage of ROP, of which 45 (25%) required laser treatment. Multivariate analysis using a stepwise method showed that GA (P = 0.002; 95% confidence interval (CI), 0.508-0.858), BW (P < 0.001; 95% CI, 0.994-0.998), and lower maternal age (P = 0.032; 95% CI, 0.819-0.991) were the risk factors for ROP development and GA (P < 0.001; 95% CI, 0.387-0.609) and lower maternal age (P = 0.012; 95% CI, 0.795-0.973) were for laser treatment. The odds ratio of requiring laser treatment was 3.3 when the maternal age was <33 years. Conclusion. ROP was more likely to be developed and progressed in infants born from younger mother and low GA.
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Abstract
PURPOSE OF REVIEW Peripartum cardiomyopathy (PPCM) is a disorder in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the late stages of pregnancy and the early postpartum period. Incidences vary geographically; it is common in some countries and rare in others. The acute form of PPCM is a clinical syndrome with reduced cardiac output, tissue hypoperfusion, and increase in the pulmonary capillary wedge pressure. Monitoring of the patient with the acute form of PPCM should be initiated as soon as possible. The syndrome carries a high morbidity and mortality and diagnosis is often delayed. This review focuses on new data and aspects in terms of diagnosis, causes of disease, pharmacological therapy, and management of delivery in patients with PPCM. RECENT FINDINGS New investigations reveal that PPCM is likely due to multiple factors. It develops based on oxidative stress leading to cleavage of deleterious 16-kDa prolactin, which can be blocked with bromocriptine. New data show furthermore that it is partly a two-hit vascular disease due to imbalances in angiogenic signaling worsening the severity of the disease. SUMMARY Different mechanisms have been investigated and give rise to promising therapeutic approach, which will be developed based on the new findings.
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Suciu LM, Puscasiu L, Szabo B, Cucerea M, Ognean ML, Oprea I, Bell EF. Mortality and morbidity of very preterm infants in Romania: how are we doing? Pediatr Int 2014; 56:200-6. [PMID: 24015920 DOI: 10.1111/ped.12219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 07/31/2013] [Accepted: 08/26/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Birth before 28 weeks of gestation is associated with high mortality and morbidity. The purpose of this study was to examine characteristics associated with in-hospital mortality and morbidity among extremely low-birthweight neonates admitted to three tertiary care centers in Romania. METHODS The study was conducted in three Romanian hospitals with level-III neonatal intensive care units. We studied singleton live births at the established Romanian limit of viability (i.e., 25-28 weeks' gestational age) born between January 2007 and December 2010 (n = 227). Infants born in non-level-III facilities transferred to these three centers were included in our study (n = 39). Descriptive and multivariate statistical analyses were used to describe the population and examine outcomes and risk factors. RESULTS During the study period, 62 neonates (27.3%) were delivered at 25 weeks, 56 (24.7%) were delivered at 26 weeks, 56 (24.7%) at 27 weeks, and 53 (23.3%) at 28 weeks. Overall in-hospital mortality was 65% (from 85% at 25 weeks to 35% at 28 weeks). The rates for major morbidities were necrotizing enterocolitis 8.8%, bronchopulmonary dysplasia 12.5%, and retinopathy of prematurity (stage higher than 2) 26.2%. CONCLUSIONS During 2007-2010, in-hospital survival of infants admitted to three neonatal intensive care units in Romania was 35% and ranged from 14% at 25 weeks to 64% at 28 weeks.
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Affiliation(s)
- Laura Mihaela Suciu
- Department of Pediatrics, University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures
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Sliwa K, Hilfiker-Kleiner D, Mebazaa A, Petrie MC, Maggioni AP, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, Roos-Hesslink JW, Shah AJ, Seferovic PM, Elkayam U, van Spaendonck-Zwarts K, Bachelier-Walenta K, Mouquet F, Kraigher-Krainer E, Hall R, Ponikowski P, McMurray JJV, Pieske B. EURObservational Research Programme: a worldwide registry on peripartum cardiomyopathy (PPCM) in conjunction with the Heart Failure Association of the European Society of Cardiology Working Group on PPCM. Eur J Heart Fail 2014; 16:583-91. [DOI: 10.1002/ejhf.68] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/05/2013] [Accepted: 12/13/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa; University of Cape Town; South Africa
| | | | - Alexandre Mebazaa
- Hôpital Lariboisière; Université Paris Diderot, Inserm 942; Paris France
| | | | - Aldo P. Maggioni
- EURObservational Research Programme (EORP); European Society of Cardiology; Sophie Antipolis France
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine (GiM); Charité - Universitätsmedizin; Berlin Germany
| | - Maria Schaufelberger
- Department of Medicine; Sahlgrenska University Hospital Ostra; Gothenburg Sweden
| | - Luigi Tavazzi
- Maria Cecilia Hospital; GVM Care & Research, E.S. Health Science Foundation; Cotignola Italy
| | | | | | - Ajay J. Shah
- King's College London BHF Centre of Excellence; London UK
| | | | - Uri Elkayam
- University of Southern California; Los Angeles CA USA
| | | | - Katrin Bachelier-Walenta
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin; Universitätsklinikum des Saarlandes; Homburg Saar Germany
| | - Frederic Mouquet
- Service de Cardiologie, Pôle Cardio-vasculaire et Pulmonaire; Hôpital Cardiologique; CHRU Lille France
| | - Elisabeth Kraigher-Krainer
- Department of Cardiology; Medical University Graz & Ludwig-Boltzmann Institute for Translational Heart Failure Research; Graz Austria
| | - Roger Hall
- Norfolk and Norwich University Hospitals; UK
| | - Piotr Ponikowski
- Department of Cardiology; Military Hospital, Center for Heart Diseases; Wroclaw Poland
| | | | - Burkert Pieske
- Department of Cardiology; Medical University Graz; Austria
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Giancotti A, Muto B, Diambrosio V, Bevilacqua E, Pasquali G, Squarcella A, La Torre R. Ultrasound management and clinical outcome of twin pregnancies. J OBSTET GYNAECOL 2013; 33:675-7. [DOI: 10.3109/01443615.2013.813915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lutz KF, Burnson C, Hane A, Samuelson A, Maleck S, Poehlmann J. Parenting Stress, Social Support, and Mother-Child Interactions in Families of Multiple and Singleton Preterm Toddlers. FAMILY RELATIONS 2012; 61:642-656. [PMID: 23125472 PMCID: PMC3483797 DOI: 10.1111/j.1741-3729.2012.00726.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The study investigated family support as a buffer of stress in 153 mothers and preterm toddlers. Data were collected regarding maternal depressive symptoms, parenting stress, and family support; infant health; and videotaped mother-child interactions. Although more parenting stress related to less optimal child play, only information support functioned as a protective factor. Information support predicted positive play under high, but not low, maternal stress. Mothers of multiples reported more parenting stress than mothers of singletons.
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Late preterm birth: a review of medical and neuropsychological childhood outcomes. Neuropsychol Rev 2012; 22:438-50. [PMID: 22869055 DOI: 10.1007/s11065-012-9210-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 06/29/2012] [Indexed: 12/12/2022]
Abstract
Late preterm (LP) birth (34 0/7 - 36 6/7 weeks' gestation) accounts for nearly three-fourths of all preterm births, making this population a sizeable public health concern. The immature fetal development associated with LP delivery increases the risk of mortality and short-term medical complications. Which combination of maternal, fetal, or neonatal risk factors may be most critical has only recently begun to be addressed, and whether LP birth's disruptive impact on brain development will exert adverse effects on neuropsychological functioning in childhood and adolescence has been understudied. Early data have shown a graded response, with LP children often functioning better than very preterm children but worse than term children, and with subtle intellectual and neuropsychological deficits in LP children compared with healthy children born at term gestational age. Further characterization of the neuropsychological profile is required and would be best accomplished through prospective longitudinal studies. Moreover, since moderate and LP births result in disparate medical and psychological outcomes, the common methodology of combining these participants into a single research cohort to assess risk and outcome should be reconsidered. The rapidly growing LP outcomes literature reinforces a critical principle: fetal development occurs along a dynamic maturational continuum from conception to birth, with each successive gestational day likely to improve overall outcome.
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Abstract
Twin births contribute disproportionately to the overall burden of perinatal morbidity and mortality in developed countries. Twins constitute 2%-4% of all births, and the rate of twining has increased by 76% between 1980 and 2009. The rate of preterm birth (<37 weeks) among twins is about 60%. Of all twin preterm births in the United States, roughly half are indicated, a third are due to spontaneous onset of labor, and about 10% are due to preterm premature rupture of membranes. Mortality related to preterm birth is influenced by antecedent factors and is highest when preterm delivery is the consequence of preterm premature rupture of membranes, followed by those as a result of spontaneous preterm labor and lowest among indicated preterm births. There also appears to have been a recent decline in serious neonatal morbidity (one or more of 5-minute Apgar score <4, neonatal seizures or assisted ventilation for ≥ 30 minutes) among twin gestations. Compared with twins conceived naturally, those born of assisted reproduction methods are more likely to deliver at <37 weeks. Although perinatal mortality rates have declined among twin births, the effect of preterm delivery on trends in mortality and morbidity and other long-term consequences remain issues for major concern. With the rapid increase in the liberal use of assisted reproduction methods combined with women electing to postpone their pregnancies and increased likelihood of spontaneous twins with advancing maternal age, this review underscores the need to develop priorities to understand the peripartum and long-term consequences facing twin births.
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Affiliation(s)
- Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY 10032, USA.
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Huy C, Loerbroks A, Hornemann A, Röhrig S, Schneider S. Prevalence, Trend and Determining Factors of Gestational Diabetes in Germany. Geburtshilfe Frauenheilkd 2012; 72:311-315. [PMID: 25284837 DOI: 10.1055/s-0031-1298390] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 02/02/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022] Open
Abstract
Purpose: The true prevalence of gestational diabetes in Germany is unknown. Thus, the study's purposes were to estimate the prevalence of gestational diabetes as well as to describe the temporal prevalence trend and to identify determinants. Material and Methods: We calculated prevalence estimates based on two datasets: the register-based German perinatal statistic (n = 650 232) and the maternal self-reports from the German children and youth health survey (KiGGS; n = 15 429). Differences between prevalence estimates were analysed using χ2 and trend tests, and determinants were identified using logistic regression. Results: According to the perinatal statistic, gestational diabetes was present in 3.7 % of pregnant women in Germany in 2010. The prevalence across the years 2001 to 2006 was estimated at 1.9 % which differed significantly from the prevalence estimate derived from the KiGGS dataset for the same period of time (5.3 %; 95 % confidence interval: 4.6-6.1 %). Both datasets show an increasing trend of gestational diabetes (p < 0.001). The risk for gestational diabetes was mainly associated with age, BMI and social class of pregnant women as well as with multiple pregnancies. Conclusion: The lack of significant screening studies among representative samples hampers a sound estimation of the true prevalence of gestational diabetes in Germany. The increasing trend in gestational diabetes might continue due to the projected increase of important risk factors (e.g., maternal age, obesity). Our analyses support the current consensus recommendations regarding standardised gestational diabetes screening.
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Affiliation(s)
- C Huy
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim
| | - A Loerbroks
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim
| | - A Hornemann
- Clinic for Gynaecology and Obstetrics, Universitätsmedizin Mannheim, Mannheim
| | - S Röhrig
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim
| | - S Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim
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Ananth CV, Smulian JC, Srinivas N, Getahun D, Salihu HM. Risk of Infant Mortality Among Twins in Relation to Placental Abruption: Contributions of Preterm Birth and Restricted Fetal Growth. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.8.5.524] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractWhile preterm birth and restricted fetal growth are strongly associated with infant mortality, the extent to which these associations are modified by placental abruption remains unknown. A retrospective cohort study was carried out to examine the risk of infant mortality among twins in relation to abruption, and explore the independent contributions of preterm birth and restricted fetal growth to these associations. The study was restricted to women who had delivered twins at 22 weeks' gestation or more and fetuses weighing 500 grams or more in the United States (1989–2000). Risks of preterm birth (less than 37 weeks' gestation), fetal growth restriction and infant mortality, in relation to placental abruption, were evaluated. All analyses were adjusted for potential sociodemographic confounding factors. The association between restricted twin fetal growth and abruption was the strongest among the most severely growth-restricted babies (i.e., less than 1 centile), with the strength of association diminishing with increasing birthweight centiles. The risk of preterm birth among pregnancies with and without abruption were 80.1% and 51.9%, respectively (relative risk [RR] 1.5, 95% confidence interval [CI] 1.4–1.6). The risk of small-for-gestational-age (SGA; birthweight of less than the 10th centile for gestational age) among abruption and nonabruption births was 11.7% and 9.2%, respectively (RR 1.3, 95% CI 1.2–1.4). Compared with twins of the appropriate growth delivered at term, the relative risks for infant mortality in the presence of abruption were 9.9 (95% CI 5.4–18.2) for term-SGA, 25.0 (95% CI 22.3–28.1) for preterm-non-SGA, and 36.2 (95% CI 28.4–46.1) for preterm-SGA births. The association between infant mortality and abruption among twins appears largely mediated through preterm birth, and to a lesser extent, through SGA. The association between fetal growth and abruption is strongest among the severely growth-restricted babies, suggesting that the origins of placental abruption may develop in early pregnancy.
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Swanson PB, Kane RT, Pearsall-Jones JG, Swanson CF, Croft ML. How Couples Cope With the Death of a Twin or Higher Order Multiple. Twin Res Hum Genet 2012; 12:392-402. [DOI: 10.1375/twin.12.4.392] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractFifty-two Australian couples who had experienced the death of at least one member of a multiple birth (twin or higher order), with at least one survivor of that birth, were interviewed about their experiences at the time of the death, and since. This study compared parents' coping after the twins' deaths using the Beck Depression Inventory II, Perinatal Grief Scale, and unstructured interviews with some structured queries. Parents provided information on the influence of family, community and medical staff. According to retrospective reports, mothers experienced significantly more depression and grief than fathers at the time of loss. Both parents found the death of their twins grievous, but fathers, unlike mothers, were not encouraged to express their emotions. Although parents generally agreed about what helped them cope, fathers believed that they should be able to cope regardless of their grief. The strength of parents' spiritual beliefs had increased significantly since their loss, and there was some evidence that depressed and grieving mothers turned to spiritual support. Parents whose children died earlier reported levels of depression similar to those reported by parents whose children died later. To date, this is the largest study of grief in couples who have experienced the death of a twin and who have a surviving twin or higher order multiple.
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Newman RB, Unal ER. Multiple gestations: timing of indicated late preterm and early-term births in uncomplicated dichorionic, monochorionic, and monoamniotic twins. Semin Perinatol 2011; 35:277-85. [PMID: 21962627 DOI: 10.1053/j.semperi.2011.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this work we review the indications for late preterm and early-term birth in uncomplicated dichorionic, monochorionic, and monoamniotic twin gestations. Uncomplicated dichorionic twins have optimal outcomes when delivered at 38 weeks' gestation. Monochorionic twins, however, are at greater risk for unexpected stillbirth, and a management plan of late preterm delivery (34-37 weeks) after informed consent is reasonable. Monoamniotic twins are at even greater risk for sudden intrauterine fetal demise, and it is recommended that these expectant mothers be managed by inpatient hospitalization with fetal testing 1-3 times per day and delivery between 32 and 34 weeks' gestation. Recommendations are also provided for the circumstance of single intrauterine fetal demise in a twin gestation.
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Affiliation(s)
- Roger B Newman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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Gezer A, Rashidova M, Güralp O, Oçer F. Perinatal mortality and morbidity in twin pregnancies: the relation between chorionicity and gestational age at birth. Arch Gynecol Obstet 2011; 285:353-60. [PMID: 21766175 DOI: 10.1007/s00404-011-1973-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 06/23/2011] [Indexed: 11/25/2022]
Abstract
AIM To investigate perinatal mortality and morbidity rates of twin pregnancies and to determine the underlying factors responsible for the increase in these rates. METHODS Records of 300 twin pregnancies which have been followed in our clinic between 1996 and 2005 were reviewed retrospectively. Perinatal mortality and morbidity rates, zygocity, chorionicity, gestational age at delivery, route of conception, birth weight, route of delivery, fetal gender and cesarean rates were investigated. RESULTS A total of 16,549 deliveries have been reviewed and 2.9% (n = 484) of these were detected to be twin deliveries. Perinatal mortality, adjusted perinatal mortality, fetal loss, neonatal mortality and perinatal morbidity rates were 7.5, 6.9, 3, 5.8 and 15.4%, respectively. The principal causes of perinatal mortality were prematurity, fetal demise and congenital abnormalities. The main cause of morbidity was respiratory distress syndrome (RDS). In neonatal period 28% of newborns needed neonatal intensive care unit (NICU) and 12.1% received positive pressured ventilation (PPV). Perinatal mortality and morbidity rates were found to be independent from zygocity, instead they were closely linked with chorionicity. Perinatal mortality and morbidity were higher if maternal age was under 18 and over 35, and were not effected by intrauterine growth retardation (IUGR), discordance between twins or RDS prophylaxis. CONCLUSION Twin pregnancies have higher perinatal mortality and morbidity rates and potential obstetrical complications compared to singleton pregnancies, therefore should be monitored more intensely, appropriate precautions should be taken against obstetrical complications, especially before 31-32 weeks of gestation, deliveries should be performed in referral centers with competent NICUs.
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Affiliation(s)
- Altay Gezer
- Cerrahpasa School of Medicine, Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey.
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Ehsanipoor RM, Arora N, Lagrew DC, Wing DA, Chung JH. Twin versus singleton pregnancies complicated by preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2011; 25:658-61. [PMID: 21736498 DOI: 10.3109/14767058.2011.584924] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare latency period, infectious morbidity, neonatal morbidity and neonatal mortality in twin versus singleton pregnancies complicated by preterm premature rupture of membranes (PPROM) remote from term. METHODS A retrospective, matched cohort study comparing 41 twin and 82 singleton pregnancies complicated by PPROM between 24-0/7 and 31-6/7 weeks' gestation. The data were obtained by reviewing maternal and neonatal charts. RESULTS The median latency periods were 3.6 days (interquartile range 1.5-13.9 days) for twins and 6.2 days (interquartile range 2.9-11.8 days) for singletons (p = 0.86). Twins were less likely to be complicated by clinical chorioamnionitis when compared with singletons (4/41 [9.8%] vs. 19/82 [23.2%], relative risk [RR] 0.42, 95% confidence interval [CI] 0.18-0.96). Histological evidence of chorioamnionitis was also lower in twins compared with singletons (14/39 [35.9%] vs. 46/68 [67.7%], RR 0.56, 95% CI, 0.34-0.92). These differences persisted after adjusting for race, insurance status, latency period and route of delivery. Neonatal morbidity and mortality rates were similar between the two groups. CONCLUSIONS There was not a statistically significant difference in the latency periods for twin and singleton pregnancies complicated by PPROM. Clinical chorioamnionitis and histological evidence of infection were significantly less common in twins compared with singletons.
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Affiliation(s)
- Robert M Ehsanipoor
- Department of Obstetrics and Gynecology, University of California, Irvine, Orange, CA, USA.
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Talwar P, Sharma RK, Sandeep K, Sareen S, Duggal BS. Embryo reduction: our experience. Med J Armed Forces India 2011; 67:241-4. [PMID: 27365814 PMCID: PMC4920827 DOI: 10.1016/s0377-1237(11)60050-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 03/31/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The transvaginal ultrasound-guided embryo reduction technique is a feasible option for the prevention and management of the medical and obstetric risks associated with high-order multiple pregnancy resulting from assisted reproductive treatment. METHOD Multifoetal pregnancy reduction was carried out in 51 in vitro fertilisation pregnancies (IVF) and one intrauterine quintuplet pregnancy resulting from intrauterine insemination (IUI) using transvaginal approach under ultrasonographic guidance. RESULTS Of the 52 embryo reduction procedures, 48 (92%) were performed between the seventh and eighth weeks of gestation, three between eighth and ninth weeks and one in the 10th week of gestation. Forty-nine patients (94%) underwent reduction from triplets to twins, two from quadruplet to twins, and one from quintuplet to twin pregnancy. The average time required for the embryo reduction was 5.0 ± 0.5 minutes per sac in early gestation (6th-9th weeks), increasing to 8.5 minutes per sac for later procedures, due to technical difficulties brought about by increased embryo size and mobility. All embryo reduction procedures were successfully performed in a single session. CONCLUSION Transvaginal ultrasound guided embryo reduction technique performed between seventh and eighth-weeks of gestation is an effective and safe procedure for embryo reduction.
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Affiliation(s)
- Pankaj Talwar
- Classified Specialists (Obst and Gynae), ART Centre, AH (R & R), New Delhi – 10
| | - RK Sharma
- Consultant (Obst and Gynae), CH (SC), Pune
| | - K Sandeep
- Classified Specialists (Obst and Gynae), ART Centre, AH (R & R), New Delhi – 10
| | - Shashi Sareen
- RFWMO (Retd) (HQ Region), O/o DGAFMS, M Block, New Delhi
| | - BS Duggal
- Senior Advisor (Obst and Gynae), AH (R & R), New Delhi – 10
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Hannoun A, Usta IM, Awwad J, Moukalled D, Yahya F, Jurdi A, Nassar AH. Effect of parity on maternal and neonatal outcomes in twin gestations. Acta Obstet Gynecol Scand 2011; 91:117-121. [PMID: 21615358 DOI: 10.1111/j.1600-0412.2011.01192.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare maternal and neonatal outcomes of twin gestations in nulliparous and multiparous women. DESIGN Retrospective analysis of maternal and neonatal records. SETTING American University of Beirut Medical Center, a referral university-affiliated hospital. POPULATION Pregnant women who delivered twin gestations beyond 24 weeks from 1990 to 2004. METHODS The data collected were analyzed using Student's paired t-test or χ(2) test. Logistic regression analysis was used to study the effect of multiple variables on preterm delivery. MAIN OUTCOME MEASURE Preterm birth rate. RESULTS Nulliparas (n=333) were more likely to be younger (28.1±5.4 vs. 30.0±5.2 years; p<0.001) and the pregnancy a product of assisted reproductive technology (23.1 vs. 4.5%; p<0.001) compared with multiparas (n=508). They were at significantly increased risk of preterm delivery (54.4 vs. 45.1%; p=0.009) at lower gestational age (35.6±3.2 vs. 36.2±3.0 weeks; p=0.004). They had longer first and second stages of labor and a higher cesarean delivery rate (61.3 vs. 44.9%; p<0.001). Except for a higher intensive care nursery admission rate and longer nursery stay for twins of nulliparas, all neonatal morbidities were comparable. On multiple logistic regression analysis, multiparity (relative risk 0.70, 95% confidence interval 0.51-0.97) and growth restriction (relative risk 0.16, 95% confidence interval 0.12-0.22) were protective, while discordance (relative risk 2.24, 95% confidence interval 1.40-3.60) was a predictor of preterm delivery. CONCLUSIONS Nulliparous women with twin gestations are at significantly higher risk for preterm delivery and cesarean delivery compared with multiparous women. Although this was not translated into higher perinatal mortality, these women should be monitored closely and counseled regarding these risks and their attendant morbidity.
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Affiliation(s)
- Antoine Hannoun
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Tobe RG, Mori R, Shinozuka N, Kubo T, Itabashi K. A nationwide investigation on gestational age specific birthweight and mortality among Japanese twins. Paediatr Perinat Epidemiol 2011; 25:228-35. [PMID: 21470262 DOI: 10.1111/j.1365-3016.2011.01191.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gestational age specific birthweight has been used as an important indicator to identify the health status of neonates and to provide appropriate neonatal care services to those at high risk. To identify the gestational age specific birthweight of twins born in secondary and tertiary hospitals in Japan and to explore factors affecting mortality, we used a nationwide obstetric database in Japan. Liveborn twins from 2001 to 2005 in the database, which was established with the national Perinatal Health Care Project, were enrolled (n=22,240). Obstetric data from the medical records were collected and analysed. Approximately 60% of liveborn twins were delivered between weeks 33 and 38, most frequently at 36 and 37 weeks. The mean birthweight of liveborn twins was 2084 g and the mean gestational age was 34.9 weeks. Intrauterine growth differed by parity, mode of delivery, birth order, chorionicity and sex. Using logistic regression, lower gestational age, small for gestational age, monochorionic twins and vaginal delivery tended to have higher risks of mortality.
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Affiliation(s)
- Ruoyan Gai Tobe
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Japan
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Wadhawan R, Oh W, Vohr BR, Wrage L, Das A, Bell EF, Laptook AR, Shankaran S, Stoll BJ, Walsh MC, Higgins RD, Eunice Kennedy Shriver National Institute of Child Health & Human Development Neonatal Research Network. Neurodevelopmental outcomes of triplets or higher-order extremely low birth weight infants. Pediatrics 2011; 127:e654-60. [PMID: 21357334 PMCID: PMC3304548 DOI: 10.1542/peds.2010-2646] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Extremely low birth weight twins have a higher rate of death or neurodevelopmental impairment than singletons. Higher-order extremely low birth weight multiple births may have an even higher rate of death or neurodevelopmental impairment. METHODS Extremely low birth weight (birth weight 401-1000 g) multiple births born in participating centers of the Neonatal Research Network between 1996 and 2005 were assessed for death or neurodevelopmental impairment at 18 to 22 months' corrected age. Neurodevelopmental impairment was defined by the presence of 1 or more of the following: moderate to severe cerebral palsy; mental developmental index score or psychomotor developmental index score less than 70; severe bilateral deafness; or blindness. Infants who died within 12 hours of birth were excluded. Maternal and infant demographic and clinical variables were compared among singleton, twin, and triplet or higher-order infants. Logistic regression analysis was performed to establish the association between singletons, twins, and triplet or higher-order multiples and death or neurodevelopmental impairment, controlling for confounding variables that may affect death or neurodevelopmental impairment. RESULTS Our cohort consisted of 8296 singleton, 2164 twin, and 521 triplet or higher-order infants. The risk of death or neurodevelopmental impairment was increased in triplets or higher-order multiples when compared with singletons (adjusted odds ratio: 1.7 [95% confidence interval: 1.29-2.24]), and there was a trend toward an increased risk when compared with twins (adjusted odds ratio: 1.27 [95% confidence: 0.95-1.71]). CONCLUSIONS Triplet or higher-order births are associated with an increased risk of death or neurodevelopmental impairment at 18 to 22 months' corrected age when compared with extremely low birth weight singleton infants, and there was a trend toward an increased risk when compared with twins.
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Affiliation(s)
- Rajan Wadhawan
- West Coast Neonatology, All Children's Hospital, 601 Fifth Street South, OCC 5th Floor, St Petersburg, FL 33701, USA.
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