Twins vs singletons-Long-term health outcomes
Tamar Wainstock1, Israel Yoles2, Ruslan Sergienko1
1Department of Public Health, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Insights
Offspring from twin pregnancies face higher risks for certain health issues, particularly due to preterm birth. However, when born at similar gestational ages, twins show reduced morbidity risks compared to singletons.
Area of Science:
- Obstetrics and Gynecology
- Pediatrics
- Public Health
Background:
- Multiple gestations, particularly twin pregnancies, are associated with increased risks for various pregnancy complications.
- Understanding the long-term health implications for offspring born from twin pregnancies is crucial for pediatric and obstetric care.
Purpose of the Study:
- To investigate whether offspring born after twin pregnancies are at an increased risk for long-term health complications compared to singleton offspring.
- To analyze the incidence and types of hospital-based morbidities in twins versus singletons up to 18 years of age.
Main Methods:
- A retrospective cohort study included over 369,000 offspring born between 1991-2021, followed until age 18.
- Hospital diagnoses were categorized into cardiac, respiratory, infectious, neurological, malignancy, and metabolic morbidities.
- Cox proportional hazard models were used to compare hospitalization risks between twins and singletons, adjusting for maternal factors.
Main Results:
- Twins (3.2%) were more likely to be born preterm, via Cesarean, and after infertility treatments compared to singletons (96.8%).
- Incidence of hospitalizations for cardiac, respiratory, infectious, and malignancy groups was significantly higher in twins.
- Multivariable analyses confirmed a higher risk for most morbidities in twins (adjusted hazard ratios 1.09-1.75).
Conclusions:
- Twins exhibit an elevated risk for most morbidities, primarily attributed to their higher rates of preterm birth.
- When gestational age at delivery is similar, the risk for most morbidities is lower among twins compared to singletons.
Introduction:
Multiple gestations are a risk factor for most pregnancy complications. The current study aimed to study whether offspring born after twin pregnancies are at increased risk for long-term health complications.
Material And Methods:
A retrospective cohort study was conducted in a large medical center, including all offspring born between the years 1991-2021, which were followed-up until 18 years of age. Hospital-based diagnoses of the offspring were categorized into main groups of morbidities: cardiac, respiratory, infectious, neurological, malignancy, and metabolic. Incidence of hospitalization with diagnoses from each main group was compared between twins and singletons, as well as time to first hospitalization. Cox proportional hazard models were used to study the association between twins vs singletons and hospitalizations by grouped morbidities, while adjusting for maternal age, ethnicity and gender, besides maternal recurrence in the cohort.
Results:
A total of 369 478 offspring were included in the analysis; of these 11 986 (3.2%) were twins and 357 492 (96.8%) were singletons. Twins were more likely to be delivered preterm (odds ratio = 17.65, 95% CI: 16.74-18.60), by cesarean delivery and following infertility treatments. Incidence of hospitalizations with all morbidity groups was slightly, some significantly, higher among twins, including cardiac: 1.9% vs 1.5%, respiratory; 8.4% vs 7.1%, neurological: 7.7% vs 7.4%, infectious: 26.0% vs 24.1%, and malignancies: 0.7% vs 0.4%. The risk remained higher in the multivariable analyses (adjusted hazard ratios ranging between 1.09-1.75). When stratifying by gestational age at delivery, the risk for most morbidities was lower among twins vs singletons born in similar gestational ages.
Conclusions:
Twins as compared to singletons are at increased risk for most morbidities due to their risk of being born earlier.
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