Perinatal Outcomes of Multiple Births in Southwest Nigeria

Abstract

Compared to singletons, multiple births are associated with a substantially-higher risk of maternal and perinatal mortality worldwide. However, little evidence exists on the perinatal profile and risk of neurodevelopmental disabilities among the survivors, especially in developing countries. This cross-sectional study, therefore, set out to determine the adverse perinatal outcomes that are potential markers for neurodevelopmental disabilities in infants with multiple gestations in a developing country. In total, 4,573 mothers, and their 4,718 surviving offspring in an inner-city maternity hospital in Lagos, Nigeria, from May 2005 to December 2007, were recruited. Comparisons of maternal and infant outcomes between single and multiple births were performed using multivariable logistic regression and generalized estimation equation analyses. Odds ratio (OR) and the corresponding 95% confidence interval (CI) for each marker were estimated. Of the 4,573 deliveries, there were 4,416 (96.6%) singletons and 157 (3.4%) multiples, comprising 296 twins and six triplets together (6.4% of all live 4,718 infants). After adjusting for maternal age, ethnicity, occupation, parity, and antenatal care, multiple gestations were associated with increased risks of hypertensive disorders and caesarean delivery. Similarly, after adjusting for potential maternal confounders, multiple births were associated with low five-minute Apgar score (OR: 1.47, 95% CI 1.13-1.93), neonatal sepsis (OR: 2.16, 95% CI 1.28-3.65), severe hyperbilirubinaemia (OR: 1.60, 95% CI 1.00-2.56), and admission to a special-care baby unit (OR: 1.56, 95% CI 1.12-2.17) underpinned by preterm delivery before 34 weeks (OR: 1.91, 95% CI 1.14-3.19), birthweight of less than 2,500 g (OR: 6.45, 95% CI 4.80-8.66), and intrauterine growth restriction (OR: 9.04, 95% CI 6.62-12.34). Overall, the results suggest that, in resourcepoor settings, infants of multiple gestations are associated with a significantly-elevated risk of adverse perinatal outcomes. Since these perinatal outcomes are related to the increased risk of later neurodevelopmental disabilities, multiple-birth infants merit close developmental surveillance for timely intervention.

Mortality among twins and singletons in sub-Saharan Africa between 1995 and 2014: a pooled analysis of data from 90 Demographic and Health Surveys in 30 countries

“…Mortality rates of twins remain high after the perinatal period and twins have increased risk of other complications, such as neurodevelopmental disabilities and congenital malformations. 9,39 Therefore, it would be advisable to monitor these children in their first years of life. Particularly vulnerable are twins born after a short birth interval, from poor families, with an older mother, or when one child of a twin pair has died.…”

“…2-4 Under-5 and neonatal mortality rates are two to five times higher than among twins compared with the largest relative differences found in regions with the lowest mortality rates. [5][6][7][8][9][10] For example, in Finland, which has one of the lowest infant mortality rates in the world, infant mortality among multiple births is considerably higher than among singletons (11·1 vs 1·9 deaths per 1000 livebirths in the period 2010-15; Ahokas E, Population Statistics, Statistics Finland, personal communication). Twins suffer more from congenital malformations and could also therefore be more vulnerable after the first year of life.…”

“…Twins suffer more from congenital malformations and could also therefore be more vulnerable after the first year of life. 9 The fate of twins might be particularly precarious in sub-Saharan Africa where child mortality rates are the highest in the world, 11 where maternal and newborn care is weak, [11][12][13][14] and where the absolute number of children under 5 years, including twins, will increase by about 20% over the next decades. 15 High mortality rates among twins have been documented for many sub-Saharan sites or countries, with under-5 mortality rates ranging from over 200 to almost 400 deaths per 1000 livebirths.…”

Study Of Maternal And Fetal Outcome In Twin Gestation At Tertiary Care Teaching Hospital

“…The risk of adverse perinatal outcomes was the highest for multiples with low birth weight (OR: 6.45, 95% CI 4.80-8.66) and IUGR (OR: 9.04, 95% CI 6.62-12.34). 19 IJBAR (2012) 03(10) www.ssjournals.com…”

Management of Nonvertex Second Twin

“…Twin pregnancy is associated with increased perinatal morbidity and mortality, mainly because of the increased incidence of prematurity and growth restriction [3]. Although there is consensus regarding the safety of vaginal delivery for twins when both are vertex, controversy arises over intrapartum management when the second twin is nonvertex: which route is preferred among those with vertex-nonvertex twins?…”