The Risk of Birth Defects in Multiple Births: A Population-Based Study

Tang, Yi‐Wei; Ma, Changxing; Cui, Wei; Chang, V. Y. H.; Ariet, Mario; Morse, Steven B.; Resnick, Michael B.; Roth, Jeffrey

doi:10.1007/s10995-005-0031-5

Cited by 61 publications

(57 citation statements)

References 22 publications

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“…1,24 This finding is in line with previous reports of increased risk of congenital malformations in multiple gestation infants in comparison with singletons. 14,15,30 Our study is among the largest population-based cohorts to examine the recent trends of mortality and morbidity for extremely preterm multiples. Conflicting reports with regard to outcomes could reflect differences in study designs and population characteristics.…”

Section: Discussionmentioning

confidence: 99%

Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns

et al. 2015

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To examine the risk of mortality and major morbidities in extremely preterm multiple gestation infants compared with singletons over time.METHODS: This is a retrospective study of 15 402 infants born #27 weeks' gestation, admitted to NICUs in the Australian and New Zealand Neonatal Network from 1995 to 2009. Mortality and major morbidities were compared between singletons and multiples across three 5-year epochs.RESULTS: Extreme preterm multiples were more likely to have lower birth weight; higher maternal age; and higher rates of assisted conception, antenatal steroid use, and cesarean delivery compared with singletons. The mortality rate was significantly higher in multiples compared with singletons even as there was a trend of decreasing gestational-age stratified mortality in multiples over the time period investigated. The rates of major morbidities or composite adverse outcomes were not different between multiples and singletons across all epochs. The adjusted odds ratio (AOR) for mortality in multiples was significantly higher in multiples compared with singletons (AOR 1.20, 95% confidence interval [CI] 1.08-1.34). There were no differences in the adjusted odds for poor outcomes in multiples compared with singletons in the most recent epoch: mortality (AOR 1.00, 95% CI 0.84-1.19), major morbidity (0.95, 95% CI 0.81-1.10), and composite adverse outcome (0.96, 95% CI 0.83-1.11).CONCLUSIONS: Over the 15-year period, the odds for mortality in extremely preterm NICU infants of multiple gestation was significantly higher compared with singletons. The adjusted odds of poor outcomes in multiples were not significantly different from that of singletons in the most recent epoch. WHAT'S KNOWN ON THIS SUBJECT:Studies on the risk of mortality and morbidities of extremely preterm infants of multiple gestation births have shown inconsistent results. Perinatal antecedents, admission status and severity of illness after birth can adversely affect outcomes of the extremely premature infants.WHAT THIS STUDY ADDS: Preterm multiple gestation infants have increased risk of mortality but similar risk of major morbidities compared with singletons. Outcomes improved over time and all adverse outcomes, including mortality, were comparable between multiples and singletons in the most recent 5-year epoch.

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Section: Discussionmentioning

confidence: 99%

Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns

et al. 2015

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“…Many studies have shown that multiple births carry a high risk of birth defects (Doyle et al, 1990;Mastroiacovo et al, 1999;Li et al, 2003;Tang et al, 2006;Glinianaia et al, 2008). A recent report from England showed that the rate of congenital anomalies in twins was 405.8 per 10,000 and in singletons was 238.2 per 10,000 (relative risk, 1.7; 95% CI, 1.5-2.0) (Glinianaia et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

“…Much attention has been paid to the association of multiple births with birth defects (Doyle et al, 1990;Mastroiacovo et al, 1999;Li et al, 2003;Tang et al, 2006;Glinianaia et al, 2008), but limited research on this topic has been done using study populations from China.…”

Section: Introductionmentioning

confidence: 99%

Risk of birth defects increased in multiple births

Zhang

Qiu

Huang

2010

Birth Defects Research

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“…Although the APR also collects data from clinical trials and retrospective studies, the primary APR cohort is limited to prospectively registered women. Only singleton births are included in the current analysis; multiple births such as twin and triplet births are excluded because of the increased risk of adverse outcomes associated with such pregnancies 8, 9, 10. We also compare in utero ZDV exposure at any time during pregnancy to in utero non‐ZDV exposure, because drug exposure at any time during pregnancy may be relevant for birth outcomes.…”

Section: Methodsmentioning

confidence: 99%

Association between in utero zidovudine exposure and nondefect adverse birth outcomes: analysis of prospectively collected data from the Antiretroviral Pregnancy Registry

Vannappagari

Koram

Albano

et al. 2015

BJOG

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ObjectiveTo examine the association between nondefect adverse birth outcomes and in utero exposure to zidovudine (ZDV)‐containing regimens versus non‐ZDV antiretroviral (ARV) regimens.DesignAnalysis of prospectively‐collected data.SettingGlobal.Population HIV‐infected pregnant women prenatally exposed to antiretrovirals.MethodsEstimation of prevalence of and risk for nondefect adverse birth outcomes among HIV‐infected women.Main outcome measuresPrevalence of and risk for nondefect adverse birth outcomes.ResultsAmong 12 780 singleton birth outcomes with in utero ZDV exposure, 96.1% were live births; 3.9% were spontaneous abortions, induced abortions or stillbirths. Among live births, 16.4% were low birthweight (LBW); 12.3% were premature. Among 1904 outcomes with in utero exposure to non‐ZDV ARV regimens, 85.8% were live births; 14.2% were spontaneous abortions, induced abortions or stillbirths. Among live births, 14.1% were LBW; 12.4% were premature. Relative risk comparing exposure to ZDV‐containing ARV regimens to non‐ZDV ARV regimens for spontaneous abortions was 0.18 (95% confidence interval [95% CI] 0.14–0.22); induced abortions 0.28 (95% CI 0.22–0.36); stillbirths 0.76 (95% CI 0.51–1.12); premature births 1.00 (95% CI 0.87–1.15) and LBW 1.17 (95% CI 1.02–1.33).ConclusionPrevalence of nondefect adverse birth outcomes is lower among outcomes with in utero ZDV exposure versus in utero non‐ZDV ARV exposure. The risks for spontaneous and induced abortions were no different for ZDV‐containing regimens versus non‐ZDV ARV regimens. For premature births and stillbirths, there was no significant difference in risk between the two regimens. The risk of LBW was statistically significantly higher among ZDV‐containing regimens versus non‐ZDV ARV regimens.Tweetable abstract ZDV‐containing regimens do not increase the risk for nondefect adverse birth outcomes.

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The Risk of Birth Defects in Multiple Births: A Population-Based Study

Abstract: Multiple births have increased risks of birth defects compared to singletons.

Cited by 61 publications

References 22 publications

Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns

Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns

Risk of birth defects increased in multiple births

Association between in utero zidovudine exposure and nondefect adverse birth outcomes: analysis of prospectively collected data from the Antiretroviral Pregnancy Registry

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