Twin pregnancy and perinatal outcomes: Data from ‘Birth in Brazil Study’

Abstract

Background Twin pregnancies account for 0.5–2.0% of all gestations worldwide. They have a negative impact on perinatal health indicators, mainly owing to the increased risk for preterm birth. However, population-based data from low/middle income countries are limited. The current paper aims to understand the health risks of twins, compared to singletons, amongst late preterms and early terms. Methods Data is from “Birth in Brazil”, a national inquiry into childbirth care conducted in 2011/2012 in 266 maternity hospitals. We included women with a live birth or a stillborn, and excluded births of triplets or more, totalling 23,746 singletons and 554 twins. We used multiple logistic regressions and adjusted for potential confounders. Results Twins accounted for 1.2% of gestations and 2.3% of newborns. They had higher prevalence of low birth weight and intrauterine growth restriction, when compared to singletons, in all gestational age groups, except in the very premature ones (<34 weeks). Amongst late preterm’s, twins had higher odds of jaundice (OR 2.7, 95% CI 1.8–4.2) and antibiotic use (OR 1.8, 95% CI 1.1–3.2). Amongst early-terms, twins had higher odds of oxygen therapy (OR 2.7, 95% CI 1.3–5.9), admission to neonatal intensive care unit (OR 3.1, 95% CI 1.5–6.5), transient tachypnoea (OR 3.7, 95% CI 1.5–9.2), jaundice (OR 2.8, 95% CI 1.3–5.9) and antibiotic use (OR 2.2, 95% CI 1.14.9). In relation to birth order, the second-born infant had an elevated likelihood of jaundice, antibiotic use and oxygen therapy, than the first-born infant. Conclusion Although strongly mediated by gestational age, an independent risk remains for twins for most neonatal morbidities, when compared to singletons. These disadvantages seem to be more prominent in early-term newborns than in the late preterm ones.

Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document

“…This recent systematic review and meta-analysis demonstrated that hypoxia at birth, reported in 16 studies ( n = 9867 participants), substantially increased the possibility of having MIH (OR 2.76 [2.09, 3.64]; P < 0.0001) (Garot et al 2021 ). Hypoxia may be associated with birth-related medical problems noted above, or in addition to prolonged delivery (Ananth and Chauhan 2012 ; Esteves-Pereira et al 2021 ).…”

Relationship between molar incisor hypomineralization, intrapartium medication and illnesses in the first year of life

“…Dinoprostone produces a maturation of the cervix during childbirth, going from being a rigid structure to dilate and soften to allow the fetus to pass through the birth canal, thanks to collagenase, which breaks down the structure of collagen 27 . When administered vaginally, a small part is absorbed through the cervix or lymphatic system and most of the dose passes into the bloodstream 28 . In the package insert, we see that it causes an increase in skeletal abnormalities in rats and rabbits 27 .…”

High Maternal Serum Estradiol in First Trimester of Multiple Pregnancy Contributes to Small for Gestational Age via DNMT1-Mediated CDKN1C Upregulation

“…The frequency of multiple births with in vitro fertilization (IVF) ranges from 25 to 50% [3]. Multiple gestation pregnancies have an increased risk of LBW, especially when more than two fetuses are present [4][5][6]. It has been proposed that the reduced intrauterine growth of fetuses results from the constraints imposed by uterine size and a restricted ability of the placenta to support the nutrients required for fetuses during late gestation [5].…”

“…Multiple gestation pregnancies have an increased risk of LBW, especially when more than two fetuses are present [ 4 – 6 ]. It has been proposed that the reduced intrauterine growth of fetuses results from the constraints imposed by uterine size and a restricted ability of the placenta to support the nutrients required for fetuses during late gestation [ 5 ]. However, the procedure of fetal reduction in early gestation cannot eliminate all the detrimental effects of multiple gestations on the remaining fetuses.…”