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The risks confronting twins: a national perspective

W F Powers1, J L Kiely

  • 1Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.

American Journal of Obstetrics and Gynecology
|February 1, 1994
PubMed
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Twins, though infrequent, significantly increase risks for adverse pregnancy outcomes and infant death. Early identification and interventions for twin pregnancies are crucial public health priorities.

Area of Science:

  • Perinatal epidemiology
  • Maternal-fetal medicine
  • Public health

Background:

  • Multiple gestations, specifically twin births, represent a growing proportion of pregnancies.
  • Twins are known to have higher risks for adverse perinatal outcomes compared to singletons.
  • Understanding the population-level impact of twin births on adverse outcomes is critical for resource allocation and intervention planning.

Purpose of the Study:

  • To quantify the relative risks and population-attributable risks of adverse pregnancy outcomes in twins versus singletons.
  • To examine the association between birth weight in twins and neonatal, postneonatal, and infant mortality compared to singletons.

Main Methods:

  • Population-based analysis utilizing U.S. Linked Birth/Infant Death Data Sets.

Related Experiment Videos

  • Inclusion of live births and infant deaths from the 1985 to 1986 birth cohorts.
  • Comparative risk assessment using singletons as the referent group.

    • Main Results:

    • Twins exhibited significantly higher relative risks for very low birth weight (9.97), low birth weight (8.61), and neonatal (7.06), postneonatal (2.75), and infant death (5.43) compared to singletons.
    • Despite comprising only 2.09% of live births, twins accounted for a disproportionately large share of adverse outcomes: 15.8% for very low birth weight, 13.7% for low birth weight, and 11.2% for neonatal death.
    • Population-attributable risks for infant death associated with being a twin were 8.4%, highlighting their substantial impact on overall infant mortality.

    Conclusions:

    • Twins contribute disproportionately to adverse pregnancy outcomes and infant mortality, despite their lower prevalence.
    • Early identification of twin pregnancies allows for targeted interventions.
    • Prioritizing the development and testing of interventions to prevent preterm birth in twin pregnancies is a national public health imperative.