Prevalence and outcomes of twin pregnancies in Botswana: a national birth outcomes surveillance study

Abstract

ObjectivesThis study aims to evaluate the prevalence and outcome of twin pregnancies in Botswana.SettingThe Tsepamo Study conducted birth outcomes surveillance at 8 government-run hospitals (~45% of all births in Botswana) from August 2014 to June 2018 and expanded to 18 hospitals (~70% of all births in Botswana) from July 2018 to March 2019.ParticipantsData were collected for all live-born and stillborn in-hospital deliveries with a gestational age (GA) greater than 24 weeks. This analysis included 117 593 singleton and 3718 twin infants (1859 sets (1.6%)) born to 119 477 women between August 2014 and March 2019 and excluded 73 higher order multiples (23 sets of triplets and 1 set of quadruplets).Outcomes measuredOur primary outcomes were preterm delivery (<37 weeks GA), very preterm delivery (<32 weeks GA) and stillbirth (APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score of 0, 0, 0).ResultsWomen with twin pregnancies had a similar median number of antenatal care visits (9 vs 10), but were more likely to deliver in a tertiary centre (54.8% vs 45.1%, p<0.001) and more likely to have a cesarean-section (54.6% vs 22.0%, p<0.001) than women with singletons. Compared with singletons, twin pregnancies had a higher risk of preterm delivery (<37 weeks GA) (47.6% vs 16.7%, adjusted risk ratio (aRR) 2.8, 95% CI 2.7 to 2.9) and very preterm delivery (<32 weeks) (11.8% vs 4.0%, aRR 3.0 95% CI 2.6 to 3.4). Among all twin pregnancies, 128 (6.9%) had at least one stillborn infant compared with 2845 (2.4%) stillbirths among singletons (aRR 2.8, 95% CI 2.3 to 3.3).ConclusionAdverse birth outcomes are common among twins in Botswana, and are often severe. Interventions that allow for earlier identification of twin gestation and improved antenatal management of twin pregnancies may improve infant and child survival.

Perinatal characteristics and neonatal outcomes of singletons and twins in Chinese very preterm infants: a cohort study

“…Our findings were similar to those from other studies showing that twins received more antenatal steroids and were more likely to be delivered by caesarean section, be conceived by ART and be born at a tertiary perinatal centre [ 1 , 5 , 7 – 10 ]. Although our study found that twins conceived by ART are substantially higher than singletons (39.5% for twins, 7.3% for singletons), the mortality of twins was slightly higher than that of singletons.…”

“…Over the past decade, the rate of very preterm twins has been increasing worldwide mainly due to the development of assisted reproductive technology (ART) and increased maternal childbearing age [ 1 – 7 ]. Data from the Australian and New Zealand Neonatal Network showed that the incidence of twins in extremely preterm infants increased from 21.6% in 1995–1999 to 25.6% in 2005–2009 [ 5 ].…”

Patterns of pregnancy loss among women living with and without HIV in Brazil, 2008–2018

“…Twin gestation and multigravida status were more frequently associated with pregnancy loss in the general population; such associations were previously noted. 33 , 34 , 35 …”

Abnormal umbilical cord insertion and birth weight discordancy in monochorionic diamniotic twins: A retrospective study

“…With the liberalization of the fertility policy and the widespread application of assisted reproductive technology, the incidence of twin pregnancies has gradually increased, which is considered to be 1 of the main factors that increase the incidence of maternal complications including hypertensive disorders, anemia, postpartum hemorrhage, and maternal death. [ 1 ] Twin pregnancies are universally considered to be “high risk.” Compared to singleton pregnancies, twins are also more likely to be born preterm and to have restricted growth in utero, thereby increasing their risk for intrauterine demise and neonatal mortality. [ 1 ] Higher risk of fetal death, preterm delivery and growth restriction in monochorionic diamniotic twins (MCDAs) is occured compared with dichorionic diamniotic twins (DCDAs).…”

“…[ 1 ] Twin pregnancies are universally considered to be “high risk.” Compared to singleton pregnancies, twins are also more likely to be born preterm and to have restricted growth in utero, thereby increasing their risk for intrauterine demise and neonatal mortality. [ 1 ] Higher risk of fetal death, preterm delivery and growth restriction in monochorionic diamniotic twins (MCDAs) is occured compared with dichorionic diamniotic twins (DCDAs). [ 2 ] Birth weight discordance (BWD) is 1 of the major determinants of perinatal outcomes in twins, with an associated increased risk of perinatal mortality and morbidity.…”