Abstract
BackgroundTwin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth.MethodsSecondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI.ResultsThe occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy.ConclusionTwin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.
Highlights
Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin
A regression model was built using acute adverse perinatal outcome and any adverse perinatal outcome as the main outcomes and all Results Among the 318,534 women initially enrolled in the WHOMCS, 312,867 women and 316,695 deliveries remained after the exclusion criteria were applied, 4756 (1.5%) of them with twin pregnancies corresponding to 8568 deliveries of neonates (Fig. 1)
Rates were significantly higher for twins compared to singletons, and for the second twin compared to the first twin (Fig. 3)
Summary
Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. The maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. Among the obstetric conditions known to increase the risk of perinatal mortality, twin pregnancy is a well-recognized factor [4,5,6] Twin pregnancy results from a complex interaction of genetic and environmental determinants (maternal age, parity, family history of multiple pregnancies, habits, social conditions) occurring in approximately 2–4% of livebirths and interestingly, rates are highest in some parts of Africa where care is often poorest [7,8,9,10]. Preterm birth and birth weight are significant determinants of morbidity and mortality into infancy and childhood [5]
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