Gestational age at delivery of twins and perinatal outcomes: a cohort study in Aberdeen, Scotland.

Murray, S; Bhattacharya, Sohinee; Stock, Sarah; Pell, Jill P.; Norman, Jane E.

doi:10.12688/wellcomeopenres.15211.2

Cited by 10 publications

(12 citation statements)

References 21 publications

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“…In a Japanese population‐based study the best child health and neurodevelopmental outcome was achieved for children born at early term 9 . Others have concurred: the risks and benefits are in balance at 36 weeks, suggesting that uncomplicated MCDA twins should be delivered at 36 weeks and DCDA twins at 37 weeks; however, conflicting data also exist 7,21,22 …”

Section: Discussionmentioning

confidence: 99%

Perinatal outcome of dichorionic and monochorionic‐diamniotic Finnish twins: a historical cohort study

Rissanen

Gissler

Nupponen

et al. 2021

Acta Obstet Gynecol Scand

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Introduction Although the perinatal mortality of monochorionic twins has been reported to be higher, the role of chorionicity is debated and data from Finland are still lacking. To examine the effect of chorionicity on the main outcome measures, perinatal and neonatal mortality and neonatal morbidity of Finnish twins, a comprehensive population‐based historical cohort study was performed at Helsinki University Hospitals. Material and methods All 1034 dichorionic and monochorionic‐diamniotic twin pregnancies managed at Helsinki University Hospital area during 2006, 2010, 2014 and 2018 were collected from patient databases. Information on chorionicity was retrieved from ultrasound reports and all relevant clinical information from patient records. Differences in perinatal and neonatal mortality and neonatal morbidity were analyzed by performing group comparisons between the twins and chorionicity. The role of chorionicity was also assessed in logistic regression analyses. Results There were 1034 dichorionic‐diamniotic (DCDA, n = 789, 76.3%, 95% confidence interval [CI] 73.6–78.9) and monochorionic‐diamniotic (MCDA, n = 245, 23.7%, 95% CI 21.4–26.0) twin pregnancies during the studied years. Most (n = 580, 56.1%, 95% CI 52.8–59.2) twins were born at term, but 151 (61.6%, 95% CI 55.8–67.3) of MCDA twins were preterm and had lower birthweight and Apgar scores and higher risk of death of one twin. Perinatal and neonatal mortality did not differ between twins A and B, but the immediate outcome of twin B was worse, with lower arterial pH and Apgar scores and increased need of neonatal intensive care unit treatment. Conclusions Chorionicity contributes to the perinatal and neonatal outcome in favor of dichorionic twins. This disadvantage of MCDA twinning is likely explained by earlier gestational age at birth and inequal placental sharing. Irrespective of chorionicity, twin B faces more complications.

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Section: Discussionmentioning

confidence: 99%

Perinatal outcome of dichorionic and monochorionic‐diamniotic Finnish twins: a historical cohort study

Rissanen

Gissler

Nupponen

et al. 2021

Acta Obstet Gynecol Scand

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“…Nonetheless, this finding should be considered in light of established benefits of longer twin gestations. 31,32 Our study showed that boys are at particularly higher risk of death in the first 7 days of life compared with their female co-twins. We showed that the familial aggregation of birthweight should be properly considered when adjusting for this variable, by demonstrating the application of the 'within-between' method for the first time in twin pairs of the opposite sex.…”

Section: Discussionmentioning

confidence: 65%

“…2 Males are at higher risk than females for neonatal morbidity and mortality despite being heavier at birth. 3 This disadvantage is more evident for newborns with lower birthweight, as evidenced by a study in the USA which found that 22% [95% confidence interval (CI): [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] of boys and 15% (95% CI: 11-22) of girls who weighed less than 1500 g at birth died before hospital discharge. 4 Studying sex differences in early life mortality is challenging, not least because birthweight and gestational age, which are likely to be potential confounders or mediators, are familial and correlated with each other.…”

Section: Introductionmentioning

confidence: 99%

Birthweight, gestational age and familial confounding in sex differences in infant mortality: a matched co-twin control study of Brazilian male-female twin pairs identified by population data linkage

Calais-Ferreira

Barreto

Mendonça

et al. 2021

International Journal of Epidemiology

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Background In infancy, males are at higher risk of dying than females. Birthweight and gestational age are potential confounders or mediators but are also familial and correlated, posing epidemiological challenges that can be addressed by studying male-female twin pairs. Methods We studied 28 558 male-female twin pairs born in Brazil between 2012 and 2016, by linking their birth and death records. Using a co-twin control study matched for gestational age and familial factors, we applied logistic regression with random effects (to account for paired data) to study the association between male sex and infant death, adjusting for: birthweight, within- and between-pair effects of birthweight, birth order and gestational age, including interactions. The main outcome was infant mortality (0–365 days) stratified by neonatal (early and late) and postneonatal deaths. Results Males were 100 g heavier and more at risk of infant death than their female co-twins before [odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.11–1.49, P = 0.001] and after (OR = 1.60, 95% CI: 1.39–1.83, P <0.001) adjusting for birthweight and birth order. When adjusting for birthweight within-pair difference and mean separately, the OR attenuated to 1.40 (95% CI: 1.21–1.61, P <0.001), with evidence of familial confounding (likelihood ratio test, P <0.001). We found evidence of interaction (P = 0.001) between male sex and gestational age for early neonatal death. Conclusions After matching for gestational age and familial factors by design and controlling for birthweight and birth order, males remain at greater risk of infant death than their female co-twins. Birthweight’s role as a confounder can be partially explained by familial factors.

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“…Th is lack of diff erences was probably secondary to the low multiple pregnancy rate. Previous studies have reported two-fold and threefold increases in perinatal deaths among those born prior to 37 or 33 weeks of gestation underlining the importance multiple pregnancies and the major consequence, prematurity [2,8].…”

Section: One Of the Sources Of Perinatal Complications (Especiallymentioning

confidence: 98%

“…Such perinatal complications could be a direct consequence of the higher rate of multiple pregnancies. Twin pregnancies have a threefold greater perinatal death rate overall compared to singleton pregnancies [8,9].…”

Section: Introductionmentioning

confidence: 99%

Obstetrical and Perinatal Complications after Assisted Reproduction: what matters is age, not the procedure

Barrenetxea¹

2020

RIJOG

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Background: Worldwide, an increasing number of children (1 out of 10 in some countries) are born to pregnancies achieved by applying assisted reproductive technology (ART). It has been assumed that these pregnancies have a higher prevalence of both obstetric and neonatal complications compared to gestations achieved after natural reproduction (NR). Objective: The purpose of this study was to evaluate and compare maternal obstetrical and perinatal complications between pregnancies achieved after ART and NP, in a setting in which a strict policy of single embryo transfer is followed. Study design: This is an observational comparative study to assess obstetrical and perinatal outcomes involving 583 patients who achieved an ongoing pregnancy after ART, by using either autologous (AO) (363 women) or donated oocytes (DO) (220 women) at a University associated Assisted Reproduction Center, between January, 2016 and December, 2018. Age of women at delivery, gestational length, type of delivery, birthweight of newborns and perinatal complications were registered and compared to 273 deliveries of pregnant women after NP clinically followed at our center. Results: Due to strict single embryo transfer policy the rate of multiple pregnancies after ART (1,38%) was comparable to that of gestations after NR (1,10%) (OR: 1,25; 95% CI 0,33-4,76). In our series, the percentage of women aged 35 or older (AMA) and 40 and older (VAMA), was similar between women in the NR group (59,34% and 17,22%) and those of the ART with autologous oocytes (AO) group (57,85% and 13,77%) (p=0,759 and p=0,234). Age of women was signi icantly higher in women pregnant after ART-DO procedures. The rate of preterm deliveries was 6,59%, 3,58% and 12,27% for NR, ART-AO and ART-DO respectively. Birthweight of neonates after ART-AO was signi icantly higher than after NR (p=0,000) and after ART-DO (p=0,000).

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Gestational age at delivery of twins and perinatal outcomes: a cohort study in Aberdeen, Scotland.

Cited by 10 publications

References 21 publications

Perinatal outcome of dichorionic and monochorionic‐diamniotic Finnish twins: a historical cohort study

Perinatal outcome of dichorionic and monochorionic‐diamniotic Finnish twins: a historical cohort study

Birthweight, gestational age and familial confounding in sex differences in infant mortality: a matched co-twin control study of Brazilian male-female twin pairs identified by population data linkage

Obstetrical and Perinatal Complications after Assisted Reproduction: what matters is age, not the procedure

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