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PubMed1994

Pregnancy outcomes in a randomised controlled trial of periconceptional multivitamin supplementation. Final report.

The effect of periconceptional multivitamin/trace element supplementation on pregnancy outcomes was evaluated in a randomised controlled trial. The final data-base included 5,502 females with confirmed pregnancy. A multivitamin including 0.8 mg folic acid or a trace element were supplemented for at least 28 days before conception and continuing for at least until the second missed menstrual period. Number of pregnancies, terminations of pregnancies, four types of fetal deaths, livebirths including low birth weight, preterm birth and sex ratio were analysed. Periconceptional multivitamin supplementation increased fertility (higher rates of cumulative conceptions and multiple births), had no significant effect on the rate of different groups of fetal deaths, low birth weight and preterm birth in singletons. This primary preventive method can reduce the occurrence and recurrence of neural-tube defects and had no other significant effect on pregnancy outcomes except multiple births.

Adult↗
PubMed2006

Births: final data for 2004.

OBJECTIVES: This report presents 2004 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's state of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 4.1 million births that occurred in 2004 are presented. Denominators for population-based rates are post-censal estimates derived from the U.S. 2000 census. RESULTS: In 2004, 4,112,052 births were registered in the United States, less than 1 percent more than the number in 2003. The crude birth rate declined slightly; the general fertility rate increased by less than 1 percent. Childbearing among teenagers and women aged 20-24 years declined to record lows. Rates for women aged 25-34 and 45-49 years were unchanged, whereas rates for women aged 35-44 years increased. All measures of unmarried childbearing rose in 2004. Smoking during pregnancy continued to decline. No improvement was seen in the timely initiation of prenatal care. The cesarean delivery rate jumped 6 percent to another all-time high, whereas the rate of vaginal birth after previous cesarean fell by 13 percent. Preterm and low birthweight rates continued their steady rise. The twinning rate increased, but the rate of triplet and higher order multiple births was down slightly.

Adolescent↗
PubMed2006

Planned vaginal births in women with multiple sclerosis: delivery and birth outcome.

OBJECTIVE: The objective of this study was to investigate the effect of maternal multiple sclerosis (MS) on delivery and birth outcome in births without planned caesarean section. METHODS: Data were collected from the compulsory Medical Birth Registry of Norway from 1988 to 2002. Intended vaginal births in this time period were 449 births given by MS mothers and 851,060 control births. RESULTS: The MS mothers had a higher rate of induction of labour, and there was a strong trend for slower progression of second stage of labour and increased use of forceps. The MS group had lower birth weight and length of the neonates. The frequency of birth defects and the neonatal mortality were not increased in the MS group. CONCLUSIONS: Maternal MS affects the birth process and the neonate prenatally, even when the births with planned caesarean section are excluded. MS-related neuronal dysfunction linked to the uterus, is postulated as the most likely mechanism.

Body Size↗
PubMed1996

The danger of overmatching in studies of the perinatal mortality and birthweight of infants born after assisted conception.

OBJECTIVE: To examine the impact of gestation length and plurality on short-term outcome of in vitro fertilization (IVF)-children. STUDY DESIGN: A register study using the Finnish Medical Birth Register for 1991-1993 (N = 194 383 newborns, of which 1335 were IVF-newborns). RESULTS: For IVF-newborns, a high proportion of multiple births (27%, odds ratio (OR) 19.67 compared with non-IVF births), low birth weight infants (30%, OR 7.94), and perinatal deaths (2.9%, OR 4.17) was found. The mothers' background did not explain the increased risks. After adjusting for gestation length and/or plurality, the odds ratios decreased significantly. CONCLUSION: Because of the high risk of plurality and premature births, matching the control group by gestation length and/or the number of multiples births may yield misleading results on the total health impact of IVF, and therefore it should be avoided.

Birth Weight↗
PubMed1998

Effects of the presence of rams during pregnancy on lambing performance in ewes.

Ewes of the Préalpes-du-Sud breed (n = 112) were mated with fertile rams and were used to investigate the effect of the presence of vasectomized rams during pregnancy on reproductive outcomes. Ewes in the control group (n = 56) were isolated from rams during the whole period of pregnancy, whereas those in the experimental group (n = 56) were kept with vasectomized rams from day 10 post-mating until lambing. At day 10 post-mating, a series of blood samples was collected every 15 min for 8 h from five control ewes and five experimental ewes to determine their patterns of LH secretion. The introduction of the ram was associated with a rapid increase of pulsatile LH release. The lag between the introduction of the ram and the onset of the first episodic LH release was less than 15 min. The mean(+/- sem) number of LH pulses/4 h after the introduction of the ram (2.8 +/- 0.4) was significantly higher (P < 0.01) than that observed/4 h before the introduction of the ram (1.4 +/- 0.2). Although more ewes were pregnant in the control group (87.5%) than in the ram-exposed group (82.1%), the difference was not significant. The presence of rams did not affect gestation length (145.8 days), overall lamb mortality (3.5%) or birth weights of single (3.96 kg), twin (3.24 kg) or triplet (2.59 kg) lambs. The proportion of ewes with multiple births in the control group (69.4%) was significantly greater (P < 0.05) than that in the ram-exposed ewes (47.8%). The ewes in the control group had significantly more (P < 0.01) twin lambs born alive (72.3%) than the ewes in the ram-exposed group (50.0%). In conclusion, the presence of vasectomized rams during early pregnancy affected the incidence of multiple births but did not affect pregnancy rate or gestation length. The altered fertility of ewes exposed to vasectomized rams may reflect changes in embryonic loss during early pregnancy.

Animals↗
PubMed1994

Actigraphic home-monitoring of the sleep patterns of in vitro fertilization children and their matched controls.

The sleep patterns of 35 in vitro fertilization (IVF) children aged 19 to 57 months and their matched controls were evaluated by actigraphic home-monitoring for three consecutive nights. Actigraphic data were analysed by an automated scoring procedure developed in the authors' laboratory. There were no significant differences in activity levels between IVF multiple-birth subjects and their matched controls or between IVF singletons and their matched controls. In contrast, multiple-birth subjects had higher activity levels during sleep and lower sleep efficiency than singletons in both IVF and control groups. Sleep measures showed night-to-night stability in all groups.

Age Factors↗
PubMed2005

Trends in embryo transfer practices and multiple gestation for IVF procedures in the USA, 1996-2002.

BACKGROUND: Increasing use of IVF in the USA has been a major contributor to the rising national multiple birth rate. Many have advocated that reducing the number of embryos transferred is essential for addressing the IVF-associated multiple birth problem. METHODS: A population-based sample of 506 072 IVF transfers performed in the USA in 1996-2002 was used to investigate trends in embryo transfer practices and to determine whether any changes in practice patterns have impacted the multiple gestation risk associated with IVF. RESULTS: The proportion of procedures in which >or=3 embryos were transferred declined significantly for most patient groups between 1996 and 2002. However, declines for some groups were not sizeable (from 79 to 73% and from 76 to 71% for fresh, non-donor procedures among women aged 38-40 and 41-42 years respectively) and transferring >or=3 embryos remained the norm for all groups. As of 2002, single embryo transfer had not increased for most groups and remained uncommon. Some declines in overall multiple gestation rates were observed, although multiple gestation risk associated with 2 embryos transferred increased significantly for all groups. CONCLUSIONS: Despite changes in embryo transfer practices, multiple gestation risk remains high, in part due to increased multiple gestation rates associated with the transfer of two embryos.

Adult↗
PubMed1988

In-vitro fertilization pregnancies in Australia and New Zealand, 1979-1985. Australian In-Vitro Fertilization Collaborative Group.

We report here data on 1510 pregnancies that resulted from in-vitro fertilization in 12 in-vitro fertilization units in Australia and in one unit in New Zealand in the period 1979 to 1985. Live births occurred in 57.5% of all pregnancies (including preclinical abortions) and in 69.0% of clinical pregnancies. There was a high incidence of ectopic pregnancies (5.2% of clinical pregnancies) and spontaneous abortions (24.3% of intrauterine pregnancies). Of 902 viable pregnancies, 202 (22.4%) pregnancies resulted in multiple births. There were 700 infants who were born after singleton births and 438 infants who were born after multiple births. The over-all incidence of preterm delivery was 27.0%, with an incidence of 18.5% of singleton pregnancies. Low birth weight occurred in 34.8% of infants. The perinatal death rate was 47.5 deaths per 1000 births; still births accounted for three-quarters of these deaths. These findings can be used to counsel infertile couples about the risks of reproductive losses after treatment by in-vitro fertilization. National health surveys should include questions that relate to the prevalence of infertility to encourage studies of the prevention of infertility and to assess the requirements for clinical services.

Adult↗
PubMed1992

Twins in the family.

The key role of the health visitor in supporting families with multiple births was highlighted in the recent OPCS study Three, four or more. JUDI LINNEY, president of the Twins and multiple births association (TAMBA), outlines the health visitor's role in these circumstances.

Community Health Nursing↗
PubMed2004

Parenting stress in first-time mothers of twins and triplets conceived after in vitro fertilization.

OBJECTIVE: To examine psychosocial and obstetric outcomes at 1 year postpartum in first-time mothers who conceived after IVF. DESIGN: Prospective cohort study. SETTING: University medical center in the United Kingdom. PATIENT(S): One hundred twenty-nine mothers with a single naturally conceived birth, 95 mothers with a single IVF birth, and 36 mothers with a twin or triplet IVF birth. MAIN OUTCOME MEASURE(S): General Health Questionnaire and Parenting Stress Index. RESULT(S): Twenty-two percent of mothers of multiples had Parenting Stress Index scores indicating severe parenting stress, compared with 5% of mothers of IVF singletons (odds ratio, 5.14 [95% confidence interval (CI), 1.55-16.99]) and 9% of mothers of naturally conceived singletons (odds ratio, 2.76 [95% CI, 1.03-7.4]). Mothers of multiple children conceived by IVF did not have poorer mental health but were less likely to be in paid employment at follow-up than were mothers of singletons conceived by IVF (odds ratio, 0.3 [95% CI, 0.13-0.67]) or naturally (odds ratio, 0.27 [95% CI, 0.12-0.59]). Multiple births were more premature, had lower birth weights, and had more medical complications. They were more likely to have been admitted to special care than were singletons conceived by IVF (odds ratio, 14.6 [95% CI, 5.1-42.0)] or those conceived naturally (odds ratio, 10.59 [95% CI, 3.67-30.57]) CONCLUSION(S): Clinicians should ensure that couples making decisions about embryo transfer have considered the potential psychosocial burden of a multiple birth.

Adult↗
PubMed2001

Twinning rate in a sample from a Brazilian hospital with a high standard of reproductive care.

CONTEXT: Epidemiological studies on twin births have been motivated mostly by the positive correlation between twinning rate and human fertility, prematurity, low birth weight, increased risk of infant death and long term risk for morbidity. OBJECTIVE: This paper intends to estimate the incidence of multiple births in a private hospital in Brazil with a high standard of reproductive care, and to evaluate the effects of maternal age, gestation order and assisted fertilization on twinning rate. DESIGN: Retrospective analysis. SETTING: First-class tertiary private hospital, São Paulo, Brazil. PARTICIPANTS: The multiple birth rate was investigated among 7,997 deliveries from 1995 to 1998, including 7,786 singletons, 193 twins, 17 triplets and one quadruplet. RESULTS: The rates per 1,000 dizygotic and monozygotic pairs and for triplets were estimated as 19.51, 4.50 and 2.13, respectively. The dizygotic and triplet rates were the highest observed in Brazil up to the present day. The twinning rate among primigravidae older than 30 years was very high (45.02 per 1,000) and was due to a disproportionately high frequency of dizygotic pairs. The triplet rate was also very high among the mothers of this age group (5.71 per 1,000). These facts are strong indicators that these women were the ones most frequently submitted to assisted reproductive techniques. The mean maternal age of the studied population was about six years higher than that estimated for mothers in the general population of southeastern Brazil. Primigravidae aged under 30 years as well as multigravidae showed similar twinning rates, which were almost 20 per 1,000. Among the deliveries of multigravidae older than 30 years, an unusually high frequency of monozygotic twins was observed (7.04 per 1,000), probably as a consequence of the residual effect of long-term use of oral contraceptives. CONCLUSIONS: The dizygotic twinning rate increased from 13.51 to 28.98 per 1,000 over the four years studied, with the twinning rate for primigravidae over 30 years old in 1998 being twice that observed in 1995. The mean maternal age was also high during this period, but the extremely high increase in twinning rate observed cannot be attributed solely to this variable. Assisted fertilization seems to be the most probable cause of this unusually high twinning rate.

Adult↗
PubMed1990

Twinning in southern Israel. Seasonal variation and effects of ethnicity, maternal age and parity.

Seasonality of births in southern Israel was examined in two populations, Jews and Bedouins, with distinctly different life-styles. The study included 1,444 twin births that occurred between the years 1970 and 1986. The peak month for the birth of monozygotic twins was September in both populations, while the maximum number of deliveries occurred in January for the Bedouins and August for the Jews. Of Jewish dizygotic twin births, higher rates were found from July to December. In addition, the peak months of singleton births in women aged 35 years and older and in women of high parity did not coincide with the peak months of multiple births. Maternal age and parity have been shown to greatly influence twin birth rates. The autumnal peak we found, which was independent of ethnic origin and its associated cultural and sociologic differences, was also independent of maternal age and parity and was consistent with findings in other populations in the northern hemisphere. That finding suggests that a seasonal factor, as yet undefined, affects the rates of multiple births.

Ethnicity↗
PubMed1989

The Yoruba contribution to our understanding of the twinning process.

The Yoruba people of Nigeria possess a twinning rate more than fourfold that of Caucasian populations. As such, they provide extraordinary possibilities for the study of multiple birth. Percy Nylander clarified many of the factors that contribute to this high incidence of twinning. His analyses of Nigerian placentation and zygosity have shown the increased rate of multiple pregnancy to be a result of higher proportions of dizygotic twins and trizygotic triplets as compared to Caucasian populations. Whereas a well-established genetic influence upon dizygotic twinning exists throughout the rest of the world, there may be an environmental factor in Nigeria responsible for the increased incidence of multiple births. Nylander's study of the Yoruba also has provided important contributions to the studies of perinatal mortality in multiple gestation. In totality, much of Nylander's work can be applied to further the understanding of ethnic and racial differences in human twin placentation and zygosity.

Birth Rate↗
PubMed1999

Obstetric and perinatal outcome of pregnancies after intrauterine insemination.

The main aim of this study was to evaluate the obstetric and perinatal outcome of pregnancies after intrauterine insemination (IUI) with the partner's spermatozoa combined with ovarian stimulation. Information concerning the antenatal care and obstetric and perinatal outcome of IUI pregnancies (n = 111), spontaneous (n = 333) and in-vitro fertilization (IVF) (n = 333) was obtained from the Finnish Medical Birth Register (MBR). The multiple birth rate in the IUI group was 17% (19/111). Significantly less antenatal care was required by the IUI group than the IVF group. The frequency of Caesarean section was 25% for IUI singletons and 58% for IUI multiples, similar to the other groups. The mean (SD) gestational age for IUI singletons at birth was 39.5 (1.8) weeks, with a mean birth weight of 3285 (575) g, compared with 3448 (600) g in non-assisted singletons (P < 0.05). For IUI multiples the mean gestational age at birth was 36.0 (2.8) weeks and the mean birth weight was 2449 (678) g. The incidence of preterm birth, low birth weight or low Apgar scores and the need for neonatal care were similar in all groups. One case of major malformation and two perinatal deaths were recorded in the IUI group. In conclusion, IUI treatment did not appear to increase obstetric or perinatal risks compared with matched spontaneous or IVF pregnancies. Most problems were associated with patient characteristics and multiple pregnancy. Reduction of the high incidence of multiple pregnancies after assisted reproductive technology is essential to improve its outcome.

Adult↗
PubMed1995

Coffee intake and other factors in relation to multiple deliveries: a study in Greece.

We conducted a case-control study of factors that may be related to the prevalence of multiple births with at least one liveborn. Over a period of 15 months during 1991-1992 in Athens, Greece, we identified 380 women who had a multiple birth that was delivered in one of the six larger maternity hospitals in the area. We selected as controls 380 livebirth singleton pregnancies delivered at the same hospitals immediately following a multiple pregnancy. All mothers were interviewed in the maternity wards or at home, and zygosity was ascertained through the similarity method. The odds ratio for ovulation-inducing drugs was not elevated for monozygotic twins, but it was 9-fold for dizygotic twins and 90-fold for triplets or quadruplets. We excluded drug-induced pregnancies, twins of indeterminable zygosity, and all triplets from further analyses. We found no remarkable association between any of the study variables and the occurrence of monozygotic twins, with the exception of an increasing trend with age. For dizygotic twins, we found weak associations in the expected directions with maternal age (positive) and height (positive) as well as with parity and number of induced abortions (positive). A history of oral contraceptive use was inversely, but weakly, associated with dizygotic twinning. Each cup of coffee per day was associated with an increment in the odds ratio of 1.23-fold. (95% confidence interval = 1.05-1.43). Restriction of the analysis to dizygotic twins of different gender increased the point estimate of the odds ratio to 1.31 for each cup of coffee consumed daily.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Frequency of twin births in developed countries.

Twinning rates in developed countries have recently registered an increase. At the end of the 1970s, the change in mother's age structure has partially contributed to the growth in the proportion of multiple births. In fact, the evolution of twinning rates is related to the calendar of maternity since, comparatively to younger mothers, older women more frequently have twins. Moreover, the growing frequency of multiple births also depends on fertility treatments, which are largely used in the developed countries. National data from the civil birth registration systems are taken into account in order to describe, in a comparative study, the main trends of twinning rates in the 20th century.

Birth Rate↗
PubMed1984

Factors responsible for post parturient metritis in dairy cattle.

Factors associated with retained placenta and post parturient metritis in Israeli-Friesian dairy cattle are examined. The overall incidence rate, in a total of 2017 calvings on seven farms, was 16.1 per cent for retained placenta and 37.3 per cent for primary metritis. Risk factors associated with retained placenta include rising parity, short gestations, induction of parturition, multiple births, summer calvings, left displacement of the abomasum and ketosis. Risk factors associated with metritis include declining parity, long gestations, induction of parturition, stillbirth, multiple births, low milk yield before drying off, left displacement of the abomasum, ketosis and winter calvings. A proposed aetiology of metritis is presented and the various possible factors involved are discussed.

Animals↗
PubMed1999

Annual summary of vital statistics--1998.

Most vital statistics indicators of the health of Americans were stable or showed modest improvements between 1997 and 1998. The preliminary birth rate in 1998 was 14.6 births per 1000 population, up slightly from the record low reported for 1997 (14.5). The fertility rate, births per 1000 women aged 15 to 44 years, increased 1% to 65.6 in 1998, compared with 65.0 in 1997. The 1998 increases, although modest, were the first since 1990, halting the steady decline in the number of births and birth and fertility rates in the 1990s. Fertility rates for total white, non-Hispanic white, and Native American women each increased from 1% to 2% in 1998. The fertility rate for black women declined 19% from 1990 to 1996, but has changed little since 1996. The rate for Hispanic women, which dropped 2%, was lower than in any year for which national data have been available. Birth rates for women 30 years or older continued to increase. The proportion of births to unmarried women remained about the same at one third. The birth rate for teen mothers declined again for the seventh consecutive year, and the use of timely prenatal care (82.8%) improved for the ninth consecutive year, especially for black (73.3%) and Hispanic (74.3%) mothers. The number and rate of multiple births continued their dramatic rise; the number of triplet and higher-order multiple births jumped 16% between 1996 and 1997, accounting, in part, for the slight increase in the percentage of low birth weight (LBW) births. LBW continued to increase from 1997 to 1998 to 7.6%. The infant mortality rate (IMR) was unchanged from 1997 to 1998 (7.2 per 1000 live births). The ratio of the IMR among black infants to that for white infants (2.4) remained the same in 1998 as in 1997. Racial differences in infant mortality remain a major public health concern. In 1997, 65% of all infant deaths occurred to the 7.5% of infants born LBW. Among all of the states, Maine, Massachusetts, and New Hampshire had the lowest IMRs. State-by-state differences in IMR reflect racial composition, the percentage LBW, and birth weight-specific neonatal mortality rate for each state. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth increased slightly to 76.7 years for all gender and race groups combined. Death rates in the United States continue to decline, including a drop in mortality from human immunodeficiency virus. The age-adjusted death rate for suicide declined 6% in 1998; homicide declined 14%. Death rates for children from all major causes declined again in 1998. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.

Adolescent↗