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DOI: 10.1055/s-0033-1341572
Neonatal Morbidity by Week of Gestational Age for Twins Compared to Singletons: A Population-Based Cohort Study
Publikationsverlauf
10. Dezember 2012
07. Februar 2013
Publikationsdatum:
01. April 2013 (online)
![](https://www.thieme-connect.de/media/ajp/201402/lookinside/thumbnails/10.1055-s-0033-1341572-1.jpg)
Abstract
Objective Quantify neonatal morbidity by week of gestation for twins compared with singletons.
Study Design We performed a population-based retrospective cohort study of all Ohio births from 2006 to 2007. Composite neonatal morbidity consisting of Apgar score < 7 at 5 minutes, assisted ventilation > 6 hours, neonatal transport, or seizures was compared between singletons and twins from 34 to 41 weeks.
Results Neonatal morbidity was the lowest in twins delivered at 37 completed weeks and 2 weeks later for singletons at 39 weeks. Twin morbidity rapidly increased after 37 weeks and reached 15.8% at 41 weeks versus the singleton morbidity rate of 3.4% at 41 weeks. Twins delivered at 39 weeks and beyond were more than twice as likely to incur neonatal morbidity compared with singletons.
Conclusion The lowest rate of neonatal morbidity occurs at 37 weeks for twins versus 39 weeks for singleton births. The increased risk after 37 weeks for twins accelerates at a faster rate compared with that for singletons born past 39 weeks.
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References
- 1 Practice Bulletin ACOG; American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Obstetrics; Society for Maternal-Fetal Medicine; ACOG Joint Editorial Committee. ACOG Practice Bulletin #56: Multiple gestation: complicated twin, triplet, and high-order multifetal pregnancy. Obstet Gynecol 2004; 104: 869-883
- 2 Luke B. Reducing fetal deaths in multiple births: optimal birthweights and gestational ages for infants of twin and triplet births. Acta Genet Med Gemellol (Roma) 1996; 45: 333-348
- 3 Malone FD, D'Alton ME. Multiple gestation. In: Creasy RK, Resnik R, Iams JD, , eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 6th ed. Philadelphia, PA: Saunders/Elsevier; 2009: 461
- 4 Lee YM, Cleary-Goldman J, D'Alton ME. Multiple gestations and late preterm (near-term) deliveries. Semin Perinatol 2006; 30: 103-112
- 5 Lewis DF, Fontenot MT, Robichaux AG, Stedman CM, Jaekle RK, Evans AT. Respiratory morbidity in well-dated twins approaching term. What are the risks of elective delivery?. J Reprod Med 2002; 47: 841-844
- 6 Breathnach FM, McAuliffe FM, Geary M , et al; Perinatal Ireland Research Consortium. Optimum timing for planned delivery of uncomplicated monochorionic and dichorionic twin pregnancies. Obstet Gynecol 2012; 119: 50-59
- 7 Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004; 159: 702-706
- 8 Ananth CV. Perinatal epidemiologic research with vital statistics data: validity is the essential quality. Am J Obstet Gynecol 2005; 193: 5-6
- 9 Reichman NE, Schwartz-Soicher O. Accuracy of birth certificate data by risk factors and outcomes: analysis of data from New Jersey. Am J Obstet Gynecol 2007; 197: e1-e8
- 10 Reichman NE, Hade EM. Validation of birth certificate data. A study of women in New Jersey's HealthStart program. Ann Epidemiol 2001; 11: 186-193
- 11 Emery III ES, Eaton A, Grether JK, Nelson KB. Assessment of gestational age using birth certificate data compared with medical record data. Paediatr Perinat Epidemiol 1997; 11: 313-321
- 12 Lydon-Rochelle MT, Holt VL, Cárdenas V , et al. The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. Am J Obstet Gynecol 2005; 193: 125-134
- 13 Bailit JL. Ohio Perinatal Quality Collaborative. Rates of labor induction without medical indication are overestimated when derived from birth certificate data. Am J Obstet Gynecol 2010; 203: e1-e3
- 14 Piper JM, Mitchel Jr EF, Snowden M, Hall C, Adams M, Taylor P. Validation of 1989 Tennessee birth certificates using maternal and newborn hospital records. Am J Epidemiol 1993; 137: 758-768
- 15 Lain SJ, Algert CS, Nassar N, Bowen JR, Roberts CL. Incidence of severe adverse neonatal outcomes: use of a composite indicator in a population cohort. Matern Child Health J 2012; 16: 600-608
- 16 Thorngren-Jerneck K, Herbst A. Low 5-minute Apgar score: a population-based register study of 1 million term births. Obstet Gynecol 2001; 98: 65-70
- 17 Ehrenstein V. Association of Apgar scores with death and neurologic disability. Clin Epidemiol 2009; 1: 45-53
- 18 ACOG Practice Bulletin No. 102: Management of stillbirth. Obstet Gynecol 2009; 113: 748-761
- 19 Garite TJ, Clark RH, Elliott JP, Thorp JA. Twins and triplets: the effect of plurality and growth on neonatal outcome compared with singleton infants. Am J Obstet Gynecol 2004; 191: 700-707
- 20 Refuerzo JS, Momirova V, Peaceman AM , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Neonatal outcomes in twin pregnancies delivered moderately preterm, late preterm, and term. Am J Perinatol 2010; 27: 537-542
- 21 Bakr AF, Karkour T. What is the optimal gestational age for twin delivery. BMC Pregnancy Childbirth 2006; 6: 3
- 22 Spong CY, Mercer BM, D'alton M, Kilpatrick S, Blackwell S, Saade G. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118 (2 Pt 1) 323-333