Abstract
IntroductionPerinatal outcomes for singleton pregnancies are poorer, on average, for Aboriginal people than non-Aboriginal people, but little is known about Aboriginal multifetal pregnancies. Yet multifetal pregnancies and births are often more complicated and have poorer outcomes than singleton pregnancies. We describe the pregnancies, births and perinatal outcomes for Aboriginal twins born in Western Australia (WA) and New South Wales (NSW) with comparisons to Aboriginal singletons in both states and to non-Aboriginal births in NSW.Materials and methodsWhole-population birth records and birth and death registrations were linked for all births during 2000–2013 (WA) and 2002–2008 (NSW). Hospital records and the WA Register of Developmental Anomalies - Cerebral Palsy were linked for all WA births and hospital records for a subset of NSW births. Descriptive statistics are reported for maternal and child demographics, maternal health, pregnancy complications, births and perinatal outcomes.ResultsThirty-four thousand one hundred twenty-seven WA Aboriginal, 32,352 NSW Aboriginal and 601,233 NSW non-Aboriginal births were included. Pregnancy complications were more common among mothers of Aboriginal twins than Aboriginal singletons (e.g. 17% of mothers of WA twins had hypertension/pre-eclampsia/eclampsia vs 8% of mothers of singletons) but similar to mothers of NSW non-Aboriginal twins. Most Aboriginal twins were born in a principal referral, women’s or large public hospital. The hospitals were often far from the mother’s home (e.g. 31% of mothers of WA Aboriginal twins gave birth at hospitals located more than 3 h by road from their home). Outcomes were worse for Aboriginal liveborn twins than Aboriginal singletons and non-Aboriginal twins (e.g. 58% of NSW Aboriginal twins were preterm compared to 9% of Aboriginal singletons and 49% non-Aboriginal twins).ConclusionsMothers of Aboriginal twins faced significant challenges during the pregnancy, birth and the postnatal period in hospital and, in addition to accessible specialist medical care, these mothers may need extra practical and psychosocial support throughout their journey.
Highlights
Perinatal outcomes for singleton pregnancies are poorer, on average, for Aboriginal people than non-Aboriginal people, but little is known about Aboriginal multifetal pregnancies
Studies in non-Aboriginal populations report that serious complications are more common in multifetal pregnancies than singletons, including anaemia, pre-eclampsia and possibly gestational diabetes, and complications such as twin-to-twin transfusion syndrome are unique to multiple pregnancies with monochorionicity [6, 7]
This paper aims to fill the gap in knowledge of Aboriginal twins by describing the pregnancies, births and perinatal outcomes for all Aboriginal twins born in Western Australia (WA) from 2000 to 2013 and New South Wales (NSW) from 2002 to 2008 using linked administrative data, alongside data on Aboriginal singletons in both states and non-Aboriginal births in NSW
Summary
Perinatal outcomes for singleton pregnancies are poorer, on average, for Aboriginal people than non-Aboriginal people, but little is known about Aboriginal multifetal pregnancies. The Coalition of Aboriginal and Torres Strait Islander Peak Organisations and Australian state and federal governments recently set a new Closing the Gap outcome – “Children are born healthy and strong” – with a target of 91% of Aboriginal liveborn singletons having a healthy birth weight by 2031 [5]. This new Closing the Gap target excludes multiple births. Guidelines recommend heightened monitoring of multifetal pregnancies and access to specialist medical care during birth [11, 12]
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