| Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries |
| Authors: |
Saverio Bellizzi, Howard Sobel, Ana Pilar Betran, and Marleen Temmerman |
| Source: |
Journal of Global Health, 8(1): 010404; DOI: 10.7189/jogh.08.010404 |
| Topic(s): |
Cesarean section
Neonatal mortality
Pregnancy outcomes
Twinning
|
| Country: |
More than one region
Multiple Regions
|
| Published: |
JUN 2018 |
| Abstract: |
Background Around the world, the incidence of multiple pregnancies
reaches its peak in the Central African countries and often represents
an increased risk of death for women and children because of higher
rates of obstetrical complications and poor management skills in those
countries. We sought to assess the association between twins and early
neonatal mortality compared with singleton pregnancies. We also
assessed the role of skilled birth attendant and mode of delivery on
early neonatal mortality in twin pregnancies.
Methods We conducted a secondary analysis of individual level data
from 60 nationally-representative Demographic and Health Surveys
including 521 867 singleton and 14 312 twin births. We investigated
the occurrence of deaths within the first week of life in twins compared
to singletons and the effect of place and attendance at birth; also, the
role of caesarean sections against vaginal births was examined, globally
and after countries stratification per caesarean sections rates. A
multi-level logistic regression was used accounting for homogeneity
within country, and homogeneity within twin pairs.
Results Early neonatal mortality among twins was significantly higher
when compared to singleton neonates (adjusted odds ratio (aOR) 7.6;
95% confidence interval (CI) = 7.0-8.3) in these 60 countries. Early
neonatal mortality was also higher among twins than singletons when
adjusting for birth weight in a subgroup analysis of those countries
with data on birth weight (n = 20; less than 20% of missing values)
(aOR = 2.8; 95% CI = 2.2-3.5). For countries with high rates (>15%) of
caesarean sections (CS), twins delivered vaginally in health facility had
a statistically significant (aOR = 4.8; 95% CI = 2.4-9.4) increased risk of
early neonatal mortality compared to twins delivered through caesarean
sections. Home twin births without SBA was associated with increased
mortality compared with delivering at home with SBA
(aOR = 1.3; 95% CI = 1.0-1.8) and with vaginal birth in health facility
(aOR = 1.7; 95% CI = 1.4-2.0).
Conclusions Institutional deliveries and increased access of caesarian
sections may be considered for twin pregnancies in low- and middleincome
countries to decrease early adverse neonatal outcomes. |
| Web: |
http://www.jogh.org/documents/issue201801/jogh-08-010404.pdf |