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Published on: February 2, 2017
Associations of gestational age with child health and neurodevelopment among twins: A nationwide Japanese
Kei Tamai1, Takashi Yorifuji2, Akihito Takeuchi1
1Department of Neonatology, Okayama Medical Center, National Hospital Organization, Okayama, Japan.
Insights
Gestational age impacts twin health. Early term twins (37-38 weeks) showed better child health and neurodevelopment compared to full term or preterm twins.
Area of Science:
- Perinatal Medicine
- Pediatric Health
- Developmental Neuroscience
Background:
- Multiple births are increasing, raising concerns about twin health outcomes.
- The relationship between gestational age and long-term morbidity in twins requires further investigation.
Purpose of the Study:
- To analyze the association between gestational age and child health and neurodevelopment in early childhood among twins.
- To identify optimal gestational age ranges for twin health outcomes.
Main Methods:
- A population-based longitudinal study included 479 twin pairs (947 children).
- Gestational age was assessed, and child health (hospitalization) and neurodevelopment (age-appropriate behaviors) were evaluated.
- Binomial log-linear regression and generalized estimating equations were used for analysis, controlling for covariates.
Main Results:
- Early term infants (37-38 weeks gestation) exhibited lower risks of poor health and neurodevelopment compared to full term (≥39 weeks) and preterm (<37 weeks) infants.
- Very preterm infants (<32 weeks) had a 2.2-fold increased risk of hospitalization compared to early term infants.
- Full term infants showed an 1.8-fold increased risk of hospitalization compared to early term infants.
Conclusions:
- A U-shaped association exists between gestational age and child health/neurodevelopment in twins.
- The early term gestational period (37-38 weeks) appears to be associated with the lowest risk of adverse outcomes in twins.
Background:
The prevalence of multiple births has recently increased. However, the association between gestational age and long-term morbidity among twins remains unclear.
Aims:
To examine the association of gestational age with child health and neurological development in early childhood among twins.
Study Design:
Population-based longitudinal study.
Subjects:
We included 947 children from 479 pairs of twins with information on gestational age.
Outcome Measures:
Hospitalization was used as an indicator of physical health, and responses to questions about age-appropriate behaviors were used as an indicator of neurobehavioral development. We conducted binomial log-linear regression analyses, controlling for both child and maternal variables in the model. We accounted for correlations within the pairs with generalized estimating equations.
Results:
The early term group (i.e., 37 to 38 weeks of gestation) had a lower risk of poor child health and unfavorable neurodevelopment compared with the full term group (≥39 weeks of gestation) and preterm group (<37 weeks of gestation). Compared with the early term group, the adjusted risk ratios for hospitalization for all causes during the period from 7 to 18 months of age was 2.2 (95% confidence interval: 1.3-3.8) for very preterm children (<32 weeks of gestation), 1.1 (0.8-1.6) for moderately and late preterm children (32 to 36 weeks of gestation), and 1.8 (1.0-3.2) for full term children.
Conclusion:
We observed a U-shaped association of gestational age with child health and neurodevelopment. The early term group had the lowest risk of poor outcomes among twins.
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