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Factors associated with neonatal problems in twin gestations.
1Epidemiology and Health Services Evaluation Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Acta Geneticae Medicae Et Gemellologiae
|January 1, 1991
Summary
Lower birth weight in twins is the primary factor contributing to neonatal complications, outweighing risks from multiple gestations. Controlling for birth weight significantly reduces most identified risks for twins compared to singletons.
Area of Science:
- Neonatal outcomes
- Perinatal epidemiology
- Maternal-fetal medicine
Background:
- Multiple gestations, specifically twin births, are associated with unique neonatal challenges.
- Previous studies suggest increased risks for twins, but the specific contributing factors require further elucidation.
- Understanding these factors is crucial for improving neonatal care and outcomes.
Purpose of the Study:
- To compare neonatal outcomes between twin and singleton births.
- To identify specific risk factors for neonatal morbidity and mortality in twins.
- To assess the impact of birth weight and other confounding variables on twin neonatal outcomes.
Main Methods:
- Retrospective cohort study comparing 644 twins and 656 singletons born between 1984-1986.
- Analysis of neonatal outcomes including mortality, congenital malformations, and common neonatal morbidities.
- Statistical control for confounding factors such as maternal age, mode of delivery, and gestational age, with a primary focus on birth weight.
Main Results:
- Twins exhibited a nearly four-fold risk of antepartum death, which was eliminated after controlling for birth weight.
- No increased risk for intrapartum or early neonatal mortality was observed in twins.
- Congenital heart malformations showed a statistically significant increased relative risk in twins (RR=5.0) even after controlling for maternal age.
- Twins had significantly higher rates of hyaline membrane disease, hypoglycemia, hyperbilirubinemia, anemia, and septicemia.
- Controlling for birth weight effectively removed most excess risks, except for hypoglycemia.
Conclusions:
- Lower birth weight, intrinsically linked to twin gestations, is the most significant factor contributing to neonatal problems in twin births.
- While some risks like congenital heart malformations persist, birth weight adjustment is a powerful tool for understanding and mitigating twin-related neonatal morbidity.
- Targeting interventions to improve birth weight in twin pregnancies is critical for enhancing neonatal outcomes.