The changing epidemiology of multiple births in the United States

Russell, Rebecca; Petrini, Joann; Damus, Karla; Mattison, Donald R.; Schwarz, Richard H.

doi:10.1016/s0029-7844(02)02316-5

Cited by 147 publications

(70 citation statements)

References 5 publications

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“…Finally, the incidence of multiple gestation pregnancies in white mothers was almost double that in African ancestry mothers in our study and that finding may have influenced the analysis. However, preterm multiple births have been reported to be more frequent in the white population than in African ancestry women [45, 46] and may be attributable to differences in the use of assisted reproduction technology. [47–49] The analysis of our data omitting all neonates from IVF-induced pregnancies confirmed our primary findings.…”

Section: Discussionmentioning

confidence: 99%

Maternal Race, Demography, and Health Care Disparities Impact Risk for Intraventricular Hemorrhage in Preterm Neonates

Shankaran¹,

Ai²,

Maller-Kesselman³

et al. 2014

The Journal of Pediatrics

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Objective To determine whether risk factors associated with Grade (Gr) 2–4 intraventricular hemorrhage (IVH) differs between African ancestry and white subjects. Study design Inborn, appropriate for gestational age (GA) infants with birth weights (BW) 500–1250 grams and exposed to >1 dose of antenatal steroids were enrolled in 24 neonatal intensive care units. Cases had Gr 2–4 IVH and controls matched for site, race and BW 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 Gr 2–4 IVH and 532 controls. Mothers of African ancestry children were less educated, and white case mothers were more likely to have > 1 prenatal visit and have a multiple gestation (P ≤.01 for all). Increasing GA (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), Apgar< 3 at 5 min (P < .004), surfactant (P < .001) and high frequency ventilation (P < .001) were associated with increased risk for IVH. Among African ancestry infants, having >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 with decreased IVH risk (P < .05). Conclusion Risk for IVH differs between African ancestry and white infants and may be attributable to both race and health care disparities.

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Section: Discussionmentioning

confidence: 99%

Maternal Race, Demography, and Health Care Disparities Impact Risk for Intraventricular Hemorrhage in Preterm Neonates

Shankaran¹,

Ai²,

Maller-Kesselman³

et al. 2014

The Journal of Pediatrics

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“…(7) Women age 35 or older are more likely to become pregnant with twins, as both increasing parity and fertility treatment increase the risk for multiple gestation. (8, 9)…”

Section: Introductionmentioning

confidence: 99%

The role of maternal age in twin pregnancy outcomes

McLennan

Gyamfi-Bannerman

Ananth

et al. 2017

American Journal of Obstetrics and Gynecology

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Background There is limited data on how maternal age is related to twin pregnancy outcomes. Objective 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 to 17, 18 to 24, 25 to 29, 30 to 34, 35 to 39, and ≥40 years of age. Twin live births and fetal death delivered at 20 to 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 using restricted spline transformations. Results A total of 955,882 twin live births between 2007 and 2013 were included in the analysis. Preterm birth rates at <34 weeks and <37 weeks were highest for women 15 to 17 years of age, decreased across subsequent maternal age categories, nadired for women age 35– 39 and then increased slightly for women 40 or over. Risk for fetal death generally decreased across maternal age categories. Risk for fetal death was 39.9 per 1,000 live births for women age 15 to 17, 24.2 for women age 18 to 24, 17.8 for women age 25 to 29, 16.4 for women age 30 to 34, 17.2 for women age 35 to 39 and, and 15.8 for women 40 or older. Risk for neonatal death <28 days was highest for neonates born to women age 15 to 17 (10.0 per 1,000 live births), decreased to 7.3 for women 18 to 24 and 5.5 for women 25 to 29, and ranged from 4.3 to 4.6 for all subsequent maternal age categories. In adjusted models, risk for preterm birth at <34 to <37 weeks was not elevated for women in their mid-to-late-thirties; however, risk was elevated for women <20 and increased progressively with age for women in their forties. Conclusion While 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 thirties. Risks for adverse outcomes were higher among younger women and further research is indicated to improve outcomes for this demographic group. It may be reasonable to counsel women in their thirties that their age is not a major additional risk factor for adverse obstetric outcomes in the setting of twin pregnancy.

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“…On a national basis, IVF infants account for 0.8% of all singletons, but 43.4% of twins and 32.5% of all triplet and higher-order multiples [9]. Although infants of multiple births comprise only 3% of all live births, they account for 13% of all preterm births (<37 weeks), 15% of all early preterm births (<32 weeks), 21% of all low birthweight infants (LBW, <2,500 g), and 25% of all very low birthweight infants (VLBW, <1,500 g) [11-16]. The average birthweight and gestational age is 3,296 g at 38.7 weeks for singletons, compared to 2,336 g at 35.3 weeks for twins, 1,660 g at 31.9 weeks for triplets, and 1,291 g at 29.5 weeks for quadruplets, and 1,002 g at 26.6 weeks for quintuplets [15].…”

Section: Introductionmentioning

confidence: 99%

“…The average birthweight and gestational age is 3,296 g at 38.7 weeks for singletons, compared to 2,336 g at 35.3 weeks for twins, 1,660 g at 31.9 weeks for triplets, and 1,291 g at 29.5 weeks for quadruplets, and 1,002 g at 26.6 weeks for quintuplets [15]. The two most important factors affecting perinatal mortality are gestational age and relative birthweight [16, 17]; with each additional fetus both of these factors are compromised [18, 19]. As a consequence, the risk of dying before their first birthday is nearly seven times greater for twins and almost twenty times greater for triplets and quadruplets, and the survivors are at continued higher risk of perinatally-related mental and physical handicaps [20-24].…”

Section: Introductionmentioning

confidence: 99%

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

Luke

Brown

Wantman³

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective To use a validated prediction model to examine whether single embryo transfer (SET) over two cycles results in live birth rates (LBR) comparable to two embryos transferred (DET) in one cycle, while reducing the probability of a multiple birth (i.e., multiple birth rate, MBR). Study Design Prediction models of LBR and MBR for a woman considering ART developed from linked cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) for 2006-2012 was used to compare SET over two cycles with DET in one cycle. The prediction model is based on a woman’s age, body mass index (BMI), gravidity, prior full-term births, infertility diagnoses, embryo state, number of embryos transferred, and number of cycles. Results To demonstrate the effect of 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; and ages 25, 35, and 40 by cycle (1st or 2nd). The cumulative LBR over two 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, age 35, BMI 30: 54.4% versus 46.5%; for women age 40, BMI 30: 31.3% versus 28.9%. The MBR with DET in one cycle was 32.8% for women age 35 and 20.9% for women age 40; with SET the cumulative MBR was 2.7% and 1.6%, respectively. Conclusions Applying this validated predictive model demonstrated that the cumulative LBR is as good as or better with SET over two cycles than with DET in one cycle, while greatly reducing the probability of a multiple birth.

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The changing epidemiology of multiple births in the United States

Cited by 147 publications

References 5 publications

Maternal Race, Demography, and Health Care Disparities Impact Risk for Intraventricular Hemorrhage in Preterm Neonates

Maternal Race, Demography, and Health Care Disparities Impact Risk for Intraventricular Hemorrhage in Preterm Neonates

The role of maternal age in twin pregnancy outcomes

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

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