Causes and Consequences of Recent Increases in Preterm Birth Among Twins

Abstract

In Brief OBJECTIVE To examine the causes and consequences of the recent increase in preterm birth among twins. METHODS We studied all twin births among residents of the province of Nova Scotia, Canada, between 1988 and 1997. Rates of preterm birth, preterm labor induction, preterm cesarean, small-for-gestational age (SGA), respiratory distress syndrome (RDS), stillbirth, perinatal mortality, and infant mortality were compared between past and more recent years. Changes in perinatal mortality were examined using logistic regression to adjust for the effects of other determinants. RESULTS The study included 2516 twin births (73 stillbirths and 2443 live births). The rate of preterm birth increased from 42.3% in 1988–1992 to 48.2% of twin live births in 1993–1997 (14% increase, P = .04). Twin live births born after preterm labor induction increased from 3.5% in 1988–1989 to 8.6% in 1996–1997 (P for trend = .007). Of live births between 34 and 36 weeks' gestation, the proportion born SGA decreased from 17.5% in 1988–1992 to 9.2% in 1993–1997 (P = .005). Over the same period, rates of prophylactic maternal steroid therapy increased substantially and rates of RDS declined. Perinatal mortality rates among pregnancies reaching 34 weeks decreased from 12.9 per 1000 total births in 1988–1992 to 4.2 per 1000 total births in 1993–1997 (P = .05). CONCLUSION Increases in preterm labor induction appear to be responsible for the recent increase in preterm birth among twins. These changes have been accompanied by decreases in perinatal morbidity and mortality among twin pregnancies that reach 34 weeks' gestation. Increased preterm labor inductions in twin pregnancies appear to be responsible for recent increases in the number of preterm twin births, and for declines in perinatal morbidity and mortality.