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The impact of changes in preterm birth among twins on stillbirth and infant mortality in the United States

Journal of Perinatology volume 34, pages 823–829 (2014)Cite this article

Subjects

Abstract

Objective:

To examine trends for preterm births, stillbirths, neonatal and infant deaths in twin births by gestational age and birth weight categories, as well as trends in induction of labor and cesarean delivery during 1995–2006.

Study design:

A trend analysis was performed on data derived from the National Centers for Health Statistics’ Vital Statistics Data files (1995–2006). The primary outcomes examined were preterm birth, stillbirth, neonatal and infant mortality.

Result:

During the study period, rates of labor induction among twins decreased by 8% and rates of cesarean delivery increased by 35%. Concurrently, the preterm birth rate increased by 13% from 54% in 1995–96 to 61% in 2005–06. The overall stillbirth rate, and neonatal and infant death rates decreased during the same period by 21% (95% confidence interval (CI): 18–25%), 13% (95% CI: 9–16%) and 12% (95% CI: 8–15%), respectively. There were significant reductions in neonatal death rates related to respiratory distress syndrome (RDS; 48%, 95% CI: 41–54%) and congenital anomalies (25%, 95% CI: 16–33%) during the study period. Reductions in post-neonatal infant mortality were mainly in RDS (88%) and sudden infant death syndrome (26%). Mortality rates among infants born by either induction of labor or cesarean delivery fell during the study period and remained much lower than the overall infant mortality rate.

Conclusion:

The findings of this study suggest that during 1995–2006 there was an increase in preterm birth rates and a decrease in labor inductions with a sharp decline in stillbirth, neonatal and infant mortality rates.

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References

  1. Keith LG, Oleszczuk JJ, Keith DM . Multiple gestation: reflections on epidemiology, causes, and consequences. Int J Fertil Women' Med 2000; 45 (3): 206–214.

    CAS  Google Scholar 

  2. Ventura SJ, Martin JA, Curtin SC, Mathews TJ, Park MM . Births: final data for 1998. Natl Vital Stat Rep 2000; 48 (3): 1–100.

    PubMed  Google Scholar 

  3. Martin JA, Hamilton BE, Ventura SJ, Osterman MJ, Wilson EC, Mathews TJ . Births: Final Data for 2010. National Vital Statistics Reports, Vol 61, No. 1. National Center for Health Statistics: Hyattsville, MD, 2012.

    Google Scholar 

  4. Fell DB, Joseph KS . Temporal trends in the frequency of twins and higher-order multiple births in Canada and the United States. BMC Pregnancy Childbirth 2012; 12 (1): 103.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Joseph KS, Marcoux S, Ohlsson A, Liu S, Allen AC, Kramer MS et al. Changes in stillbirth and infant mortality associated with increases in preterm birth among twins. Pediatrics 2001; 108 (5): 1055–1061.

    Article  CAS  PubMed  Google Scholar 

  6. Joseph KS, Marcoux S, Ohlsson A, Kramer MS, Allen AC, Liu S et al. Preterm birth, stillbirth and infant mortality among triplet births in Canada, 1985-96. Paediatr Perinat Epidemiol 2002; 16 (2): 141–148.

    Article  CAS  PubMed  Google Scholar 

  7. Branum AM, Schoendorf KC . Changing patterns of low birthweight and preterm birth in the United States, 1981-98. Paediatr Perinat Epidemiol 2002; 16 (1): 8–15.

    Article  PubMed  Google Scholar 

  8. Luke B . The changing pattern of multiple births in the United States: maternal and infant characteristics, 1973 and 1990. Obstet Gynecol 1994; 84 (1): 101–106.

    CAS  PubMed  Google Scholar 

  9. Kogan MD, Alexander GR, Kotelchuck M, MacDorman MF, Buekens P, Martin JA et al. Trends in twin birth outcomes and prenatal care utilization in the United States, 1981-1997. JAMA: the journal of the American Medical Association 2000; 284 (3): 335–341.

    Article  CAS  PubMed  Google Scholar 

  10. Goldenberg RL, Culhane JF, Iams JD, Romero R . Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75–84.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Joseph KS, Demissie K, Kramer MS . Obstetric intervention, stillbirth, and preterm birth. Semin Perinatol 2002; 26 (4): 250–259.

    Article  CAS  PubMed  Google Scholar 

  12. Arabin B, Kyvernitakis I, Liao A, Zugaib M . Trends in cesarean delivery for twin births in the United States: 1995-2008. Obstet Gynecol 2012; 119 (3): 657–658 author reply 658-659.

    Article  PubMed  Google Scholar 

  13. Rogowski J . Cost-effectiveness of care for very low birth weight infants. Pediatrics 1998; 102 (1 Pt 1): 35–43.

    Article  CAS  PubMed  Google Scholar 

  14. Ananth CV, Joseph KS, Demissie K, Vintzileos AM . Trends in twin preterm birth subtypes in the United States, 1989 through 2000: impact on perinatal mortality. Am J Obstet Gynecol 2005; 193 (3 Pt 2): 1076–1082.

    PubMed  Google Scholar 

  15. National Center for Health Statistics (US). 1990, and 1995-2000 Linked Birth/Infant Death Data Sets [electronic resource]. US Dept. of Health and Human Services Public Health Service Centers for Disease Control and Prevention National Center for Health Statistics: Hyattsville, MD, 1989.

  16. Lydon-Rochelle MT, Holt VL, Nelson JC, Cardenas V, Gardella C, Easterling TR et al. Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington State linked birth records. Paediatr Perinat Epidemiol 2005; 19 (6): 460–471.

    Article  PubMed  Google Scholar 

  17. Lydon-Rochelle MT, Cardenas V, Nelson JL, Tomashek KM, Mueller BA, Easterling TR . Validity of maternal and perinatal risk factors reported on fetal death certificates. Am J Public Health 2005; 95 (11): 1948–1951.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lain SJ, Hadfield RM, Raynes-Greenow CH, Ford JB, Mealing NM, Algert CS et al. Quality of data in perinatal population health databases: a systematic review. Med Care 2012; 50 (4): e7–20.

    Article  PubMed  Google Scholar 

  19. Ventura SJ, Martin JA, Curtin SC, Mathews TJ . Births: final data for 1997. Natl Vital Stat Rep 1999; 47 (18): 1–96.

    PubMed  Google Scholar 

  20. Oakley L, Doyle P . Predicting the impact of in vitro fertilisation and other forms of assisted conception on perinatal and infant mortality in England and Wales: examining the role of multiplicity. BJOG 2006; 113 (6): 738–741.

    Article  CAS  PubMed  Google Scholar 

  21. Reynolds MA, Schieve LA, Martin JA, Jeng G, Macaluso M . Trends in multiple births conceived using assisted reproductive technology, United States, 1997-2000. Pediatrics 2003; 111 (5 Pt 2): 1159–1162.

    PubMed  Google Scholar 

  22. Anderson RN, Minino AM, Hoyert DL, Rosenberg HM . Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates. Natl Vital Stat Rep 2001; 49 (2): 1–32.

    PubMed  Google Scholar 

  23. Martin JA, Hamilton BE, Osterman MJ . Three decades of twin births in the United States, 1980-2009. NCHS Data Brief 2012; (80): 1–8.

  24. Lee HC, Gould JB, Boscardin WJ, El-Sayed YY, Blumenfeld YJ . Trends in cesarean delivery for twin births in the United States: 1995-2008. Obstet Gynecol 2011; 118 (5): 1095–1101.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sunderam S, Kissin DM, Flowers L, Anderson JE, Folger SG, Jamieson DJ et al. Assisted reproductive technology surveillance—United States, 2009. MMWR Surveill Summ 2012; 61 (7): 1–23.

    PubMed  Google Scholar 

  26. Louis JM, Ehrenberg HM, Collin MF, Mercer BM . Perinatal intervention and neonatal outcomes near the limit of viability. Am J Obstet Gynecol 2004; 191 (4): 1398–1402.

    Article  PubMed  Google Scholar 

  27. Hartley RS, Hitti J . Increasing rates of preterm twin births coincide with improving twin pair survival. J Perinat Med 2010; 38 (3): 297–303.

    Article  PubMed  Google Scholar 

  28. Stillbirth Collaborative Research Network Writing G. Causes of death among stillbirths. JAMA 2011; 306 (22): 2459–2468.

    Article  Google Scholar 

  29. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560. Medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121 (4): 908–910.

    Article  Google Scholar 

  30. Rayburn WF, Zhang J . Rising rates of labor induction: present concerns and future strategies. Obstet Gynecol 2002; 100 (1): 164–167.

    PubMed  Google Scholar 

  31. Barrett JF, Hannah ME, Hutton EK, Willan AR, Allen AC, Armson BA et al. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med 2013; 369 (14): 1295–1305.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Genest DR, Williams MA, Greene MF . Estimating the time of death in stillborn fetuses: I. Histologic evaluation of fetal organs; an autopsy study of 150 stillborns. Obstet Gynecol 1992; 80 (4): 575–584.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank V Chiu, HS Takhar, T Im and DJ Pinion for their technical support. This study was supported by Kaiser Permanente Direct Community Benefit Funds. Dr D Getahun was funded by grants from the National Institute of Child Health and Human Development of the National Institute of Health (1R01 HD071986–01A1) and from the National Institute of Environmental Health Sciences of the National Institute of Health (1R01ES023116–01).

DISCLAIMER

The opinions expressed are solely the responsibility of the authors and do not necessarily reflect the official views of the Kaiser Permanente Community Benefit Funds, the National Institute of Child Health and Human Development, and the National Institute of Environmental Health Sciences of the National Institute of Health.

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Authors and Affiliations

  1. Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group, Pasadena, CA, USA

    D Getahun

  2. Department of Obstetrics and Gynecology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    D Getahun

  3. Department of Epidemiology, Rutgers-School of Public Health, Piscataway, NJ, USA

    K Demissie, S W Marcella & G G Rhoads

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  1. D Getahun
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Correspondence to D Getahun.

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Getahun, D., Demissie, K., Marcella, S. et al. The impact of changes in preterm birth among twins on stillbirth and infant mortality in the United States. J Perinatol 34, 823–829 (2014). https://doi.org/10.1038/jp.2014.119

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