Multiple pregnancy in Dubai Hospital in 2012: Prevalence and maternal, perinatal and neonatal outcomes

Abstract

Introduction: Twin and higher-order multiple pregnancies are becoming increasingly common in obstetric practice and are associated with significant morbidity for both mothers and fetuses. A study of this type had not been carried out in the Dubai Health Authority area, or in the UAE. Therefore data from studies such as this can provide important insights for obstetricians in this region. Objectives: The aim of this study was to determine the prevalence of multiple pregnancy in a Dubai hospital in 2012 and to analyse the adverse maternal, perinatal and neonatal outcomes associated with these pregnancies. Methods: This is a retrospective study involving all multiple pregnancies delivered at Dubai Hospital, Dubai, between 1 January 2012 and 31 December 2012. All multiple pregnancies at or beyond 24 weeks of gestation delivered at Dubai Hospital during the study period were included. Data for patients with multiple pregnancy and their babies were obtained from the maternity register in Dubai Hospital's labour ward and antenatal files after obtaining ethics approval from the Dubai Health Authority's Medical Research Committee. We used Microsoft Excel 2013 (Microsoft Corporation, Redmond, WA, USA) to organise the data collected from patient medical records. Excel was also used for statistical analysis and presentation of data in tabular and graphical form. Results: In total, there were 106 multiple pregnancies over the period – 97 twin and nine triplet pregnancies – giving a multiple birth rate of 64.3/1000 live births. This is higher than any other documented multiple birth rate in the world. The mean maternal age was 30.5 ± 5.3 years (standard deviation). The most common morbidity in these multiple pregnancies was prematurity (72.6%), as expected, followed by maternal diabetes mellitus (22.6%). However, excluding premature delivery, almost 60% of mothers had no associated morbidities. Half of the multiple pregnancies were spontaneous conceptions, and half were the result of infertility treatments such as ovulation induction. Around one-third (30%) were conceived by in vitro fertilisation procedures, including intracytoplasmic sperm injection. As expected, triplets were delivered more prematurely than twins: the mean gestational age at delivery was 34.3 ± 3.7 weeks for twins and 31.0 ± 3.5 weeks for triplets. Around three-quarters (72.6%) of deliveries were by caesarean section, with the main indication (32.1%) being maternal request, 25.5% were delivered vaginally, 0.9% were delivered instrumentally and 0.9% were delivered vaginally (fi rst twin) and by caesarean section (second twin). Most of the newborns (58.4%) were of low birth weight. The vast majority (93.2%) had a 5-min Apgar score of ≥7, but the Neonatal Intensive Care Unit admission rate was around 38%, with triplets more likely to be admitted than twins (76.9% of all triplets vs. 33.3% of all twins). Overall, the results suggest a multiple pregnancy prevalence rate much higher than that of other developed countries, such as the USA, and even higher than that of Nigeria, which currently has the highest twin birth rate in the world. Conclusion: The increasing burden of multiple pregnancy in the United Arab Emirates may be attributable to the increasing availability and affordability of assisted reproductive technologies. Multiple pregnancy is associated with greater risks to both mothers and foetuses than singleton pregnancy, which warrants greater awareness of associated complications.