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Perinatal mortality in term and preterm twin and singleton births
Jennifer C Payne1, M Karen Campbell, Orlando DaSilva
1Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Health Canada, Ottawa, Ontario, Canada.
Summary
Preterm twins show lower perinatal mortality than singletons, but this advantage disappears when accounting for gestational age. This suggests a need for different definitions of term birth for twins and singletons.
Area of Science:
- Perinatal Medicine
- Obstetrics
- Neonatology
Background:
- Twins generally face higher perinatal mortality rates than singletons.
- Preterm twins paradoxically exhibit lower mortality than singletons of similar birth weight or gestational age.
Purpose of the Study:
- To investigate the reasons behind the "twin advantage" in preterm perinatal mortality.
- To determine if gestational age distribution or tertiary care center births explain this phenomenon.
Main Methods:
- Utilized a large dataset of Ontario births (1979-1985).
- Employed multivariable logistic regression, controlling for maternal age, hospital level, and gestational age.
- Standardized gestational age for comparative analysis between twins and singletons.
Main Results:
- The lower mortality rate for preterm twins persisted even after controlling for hospital level.
- When gestational age was standardized, twins with very preterm births (<2 SD below mean) showed higher risk than singletons.
- Tertiary perinatal center births did not significantly explain the observed twin advantage.
Conclusions:
- The "twin advantage" in preterm perinatal mortality is largely attributable to differences in gestational age distribution between twin and singleton populations.
- The findings support revising the definition of term birth to be distinct for twins and singletons.
- Hospital level of birth is not a primary factor in the twin mortality advantage.