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The risk of mortality or cerebral palsy in twins: a collaborative population-based study
Ann I Scher1, Bev Petterson, Eve Blair
1Neuroepidemiology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA. schera@mail.nih.gov
Insights
Twins face higher risks of fetal death, neonatal death, and cerebral palsy (CP) compared to singletons. However, small twins generally fare better than small singletons, and co-twin death is a significant predictor of CP in survivors.
Area of Science:
- Obstetrics and Gynecology
- Neonatalogy
- Pediatric Neurology
Background:
- Twin births have increased, with trends showing higher maternal age and more unlike-sex pairs.
- Understanding risks associated with twin gestation is crucial for improving perinatal outcomes.
Purpose of the Study:
- To identify demographic and clinical factors linked to fetal/neonatal death and cerebral palsy (CP) in twins.
- To compare twin outcomes with singleton births.
Main Methods:
- Analysis of vital statistics from US and Australian populations (1980-1989).
- Inclusion of 1,141,351 births, with 25,772 twin births.
- CP data included diagnoses made after one year of age.
Main Results:
- Twins showed significantly higher risks: 5-fold for fetal death, 7-fold for neonatal death, and 4-fold for CP versus singletons.
- Twins with birth weight <2500g had better mortality and CP rates than comparable singletons.
- Co-twin death was a strong predictor of CP in surviving twins, regardless of sex-pair or gestational age.
Conclusions:
- Overall, twins have increased mortality and CP risks, but small twins demonstrate better outcomes than small singletons.
- Co-twin death is a critical factor increasing CP risk in surviving twins.
- Further research into specific risk factors and interventions for twin pregnancies is warranted.
Abstract:
The purpose of the paper was to describe demographic and clinical factors associated with fetal or neonatal death or cerebral palsy (CP) in twins. Vital statistics from five populations in the United States and Australia, which included information on CP diagnosed after 1 y of age. Information on zygosity was not available. In 1,141,351 births, 25,772 of whom were twins, significant secular trends from 1980 to 1989 included increasing prevalence of twins, increasing proportion of unlike-sex twins, and increasing maternal age. Overall, twins were at an approximately 5-fold increased risk of fetal death, 7-fold increased risk of neonatal death, and 4-fold increased risk of CP compared with singletons. However, at birth weight <2500 g, twins generally did better than singletons, both with respect to mortality and to CP rates. Second-born twins and twins from same-sex pairs were at increased risk of early death but not of CP. Twins from growth-discordant pairs and twins whose co-twin died were at increased risk of both mortality and CP. The highest rates of CP were in surviving twins whose co-twin was still-born (4.7%), died shortly after birth (6.3%) or had CP (11.8%). In this large data set spanning a 10-y period, overall rates of death or cerebral palsy were higher in twins than singletons, although small twins generally did better than small singletons. Co-twin death was a strong predictor of CP in surviving twins. This risk was the same for same- and different-sex pairs, and observed both for preterm and term infants.