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PubMed2003

Intertwin birth weight discordance as a potential adaptive measure to promote gestational age.

OBJECTIVE: To determine if discordant twins are delivered at a more advanced gestational age than concordant twins of the same total twin birth weight. STUDY DESIGN: We used the U.S. National Center for Health Statistics matched multiple birth data file containing all twin births in the United States from 1995 through 1997. Birth weight discordance was defined as > 25% difference between the heavier and lighter twin. We compared mean gestational age between concordant and discordant pairs at 250-g total birth weight intervals in the entire population and in the subgroups of primiparas and multiparas. RESULTS: The frequency of discordant pairs declined with increasing total twin birth weight, from 7.2% at 3,000-3,250 g, to 3% at 4,750-5,000 g (R2 = .94, P < .05), with no significant difference between primiparas and multiparas (all P values > .05). The mean gestational age of discordant pairs was significantly higher across the entire range of total birth weight intervals except for the uppermost interval (> 4,750 g). The effect of discordance on gestational age was modified by parity, with significant differences between concordant and discordant pairs among primiparas mainly at the lower birth weight strata (P < .05). CONCLUSION: In the total twin birth weight range of 3,000-5,000 g, birth weight discordant twins are delivered at a more advanced gestational age than concordant twins. Discordant growth may serve as an adaptive measure to promote maturity by reducing the inevitable uterine overdistension.

Adult↗
PubMed1992

Light and retinopathy of prematurity: does retinal location offer a clue?

Nursery illumination has been implicated in the pathogenesis of retinopathy of prematurity (ROP), although the results of recent studies are conflicting. The data base for this article is a prospective ROP study on 607 infants of birth weight less than or equal to 1700 g including 35 larger siblings from multiple births when 1 infant fulfilled the birth weight criteria. Retinopathy commences preferentially in the nasal retina of the most immature neonate and is less likely to develop, or its onset is delayed, in the superior and inferior regions. These findings cannot be fully accounted for by regional vascular and neuroanatomical variations. Radiometric and physiological evidence suggests that the very immature neonate, most at risk of developing severe ROP, receives the greatest retinal irradiance. Furthermore, ROP commences in the areas of the retina receiving the highest light dose, and its onset is either retarded or inhibited in the darker retinal regions. Further studies are required to determine whether early exposure to light is a factor in the development of ROP. If a causal relationship is proven, here at least is one modality that can easily and immediately be controlled.

Cohort Studies↗
PubMed2002

Fetal and neonatal mortality among twin gestations in the United States: the role of intrapair birth weight discordance.

OBJECTIVE: To examine the association of intrapair birth weight discordance with fetal and neonatal mortality. METHODS: We used the United States (1995-1997) Matched Multiple Birth File (n = 297,155). RESULTS: Among twin live births and stillborn fetuses, 29.9% had less than 5% birth weight discordance, 24.2% had 5-9%, 29.6% had 10-19%, 11.1% had 20-29%, 3.4% had 30-39%, and 1.8% had 40% or more. The stillborn fetus rate increased progressively with increasing birth weight discordance for smaller and larger twins of the same sex. Compared with the less than 5% birth weight discordance category, the adjusted odds ratios (OR) (95% confidence intervals [CIs]) for stillborn fetus associated with 5-9%, 10-19%, 20-29%, 30-39%, and 40% or more birth weight discordance, respectively, were 0.81 (95% CI 0.58, 1.11), 1.41 (95% CI 1.07, 1.84), 1.74 (95% CI 1.28, 2.35), 3.06 (95% CI 2.21, 4.24), and 4.29 (95% CI 3.05, 6.04) for smaller twins. The corresponding ORs (95% CIs) for larger twins were 0.78 (95% CI 0.57, 1.08), 1.26 (95% CI 0.96, 1.66), 1.77 (95% CI 1.27, 2.46), 3.38 (95% CI 2.33, 4.92), and 2.91 (95% CI 1.89, 4.47). Similar associations were observed among smaller but not larger twins of opposite sex. Among larger but not smaller twins of the same sex, increasing birth weight discordance was associated with overall neonatal deaths. This association was not apparent among smaller and larger twins of opposite sex. However, increasing birth weight discordance was associated with neonatal deaths related to congenital malformations among smaller and larger twins. CONCLUSION: The results provide evidence that increased twin birth weight discordance was associated with increased risk of intrauterine death and malformation-related neonatal deaths.

Adolescent↗
PubMed1997

[Twin pregnancy. Its incidence].

The authors evaluate changes in the incidence and proportion of the life births by plurality in Mothernal Hospital in Sofia between 1991-1995 and compare it with the incidence of multiple births in other countries in the world. The influence of some factors on the incidence of multiple pregnancy are discussed.

Bulgaria↗
PubMed2004

Associations between perinatal interventions and hospital stillbirth rates and neonatal mortality.

BACKGROUND: Previous studies suggest that high risk and low birthweight babies have better outcomes if born in hospitals with level III neonatal intensive care units. Relations between obstetric care, particularly intrapartum interventions and perinatal outcomes, are less well understood, however. OBJECTIVE: To investigate effects of obstetric, paediatric, and demographic factors on rates of hospital stillbirths and neonatal mortality. METHODS: Cross sectional data on all 65 maternity units in all Thames Regions, 1994-1996, covering 540 834 live births and stillbirths. Hospital level analyses investigated associations between staffing rates (consultant/junior paediatricians, consultant/junior obstetricians, midwives), facilities (consultant obstetrician/anaesthetist sessions, delivery beds, special care baby unit, neonatal intensive care unit cots, etc), interventions (vaginal births, caesarean sections, forceps, epidurals, inductions, general anaesthetic), parental data (parity, maternal age, social class, deprivation, multiple births), and birthweight standardised stillbirth rates and neonatal mortality. RESULTS: Unifactorial analyses showed consistent negative associations between measures of obstetric intervention and stillbirth rates. Some measures of staffing, facilities, and parental data also showed significant associations. Scores for interventional, organisational, and parental variables were derived for multifactorial analysis to overcome the statistical problems caused by high intercorrelations between variables. A higher intervention score and higher number of consultant obstetricians per 1000 births were both independently and significantly associated with lower stillbirth rates. Organisational and parental factors were not significant after adjustment. Only Townsend deprivation score was significantly associated with neonatal mortality (positive correlation). CONCLUSIONS: Birthweight adjusted stillbirth rates were significantly lower in units that took a more interventionalist approach and in those with higher levels of consultant obstetric staffing. There were no apparent associations between neonatal death rates and the hospital factors measured here.

Adolescent↗
PubMedDate not supplied

Perinatal outcome and developmental studies on children born after IVF.

Since the first birth after IVF, many scientific papers have been published on the technical aspects of the IVF procedure, but few studies have addressed the issue of the perinatal outcome of IVF pregnancies and of the children's development and well-being. A high rate of adverse outcome has been demonstrated in a large group of IVF pregnancies. Prematurity, low birth weight and perinatal mortality are higher than in the general population. The majority of these complications are related to multiple births, but they are also found in singleton pregnancies. An analysis of the multiple risk factors involved in these complications is needed. The infertile status of IVF patients clearly plays a role in the risk of adverse outcome. Age and parity may be important factors. The role of IVF itself has not been demonstrated convincingly. The effect of ovarian stimulation deserves further study. Most of the studies published on the follow-up of IVF children are reassuring, but it is clear that these studies are not sufficient to eliminate without doubt any adverse effects on the well-being of IVF children. All IVF pregnancies should be followed with great care, not because they are more precious than spontaneous pregnancies, but because they are exposed to an increased risk of complications. The main problem of IVF remains the high rate of multiple pregnancies, including twins.

Age Factors↗
PubMed2003

Birth weight discordancy and adverse perinatal outcomes among twin gestations in the United States: the effect of placental abruption.

OBJECTIVE: We evaluated whether the relationship between birth weight discordancy of twins and stillbirth, neonatal deaths, and preterm births was modified by the presence of abruption. STUDY DESIGN: We used the 1995 to 1997 matched multiple birth file for United States twin births (n = 269287). Birth weight discordancy was defined as the ratio of the difference in birth weight of the heavier from the lighter twin to that of the heavier twin and was categorized as <5%, 5% to 9%, 10% to 14%, 15% to 19%, 20% to 29%, 30% to 39%, and >or=40%. We evaluated the risks of stillbirth (>or=20 weeks of gestation), neonatal deaths (within 28 days after birth), and preterm birth (< 32 weeks) in the presence and absence of abruption. Associations between birth weight discordancy and these perinatal outcomes were expressed as adjusted relative risks and were derived from multivariable logistic regression models, based on the method of generalized estimating equations. Risk of these outcomes were derived for each stratum of birth weight discordancy and abruption status, with the <5% birth weight discordancy, nonabruption status labeled as the reference group. All analyses were performed separately for same and different sex twins. RESULTS: A birth weight discordancy of >or=20% among same sex (adjusted relative risk, 1.2; 95% CI, 1.1, 1.4), and >or=40% among different sex twins (relative risk, 2.2; 95% CI, 1.7, 2.8) conferred increased risk for abruption. Among nonabruption births, a birth weight discordancy of >or=15% among same sex and >or=30% among different sex twins increased the risk of stillbirths, neonatal deaths, and preterm births. Among abruption births, however, the risks were increased even in the lowest birth weight discordancy category (<5%). The relative risks of stillbirths and neonatal deaths among abruption births were significantly higher for each birth weight discordancy group, both for same and different sex twins, compared with the reference group. The association between birth weight discordancy and preterm birth was not modified by either the presence or absence of abruption. CONCLUSION: Birth weight discordancy of >or=15% for same sex and >or=30% for different sex confer greatest risk of adverse perinatal outcomes in the absence of abruption. In the presence of placental abruption, these risks are further compounded. The results underscore the need for careful monitoring of twin pregnancies.

Abruptio Placentae↗
PubMed1997

Multifetal pregnancy reduction: a review of the world results for the period 1993-1996.

The objective of this work was to evaluate the outcome of multifetal pregnancy reduction and to provide an analysis of the ethical dilemmas associated with its application. The study design was based on data on over 1400 completed pregnancies that underwent multifetal pregnancy reduction as reported in the world literature during 1993-1996. The results were: A total of 1453 completed cases of multifetal pregnancy reduction are presented. The total survival rate was estimated to be 87.7%, resulting in a total pregnancy loss rate of 12.3%. The lowest survival rate is found to be in higher-order pregnancies of five or more fetuses (75.2%), whereas pregnancy loss rate seems to be similar for quadruplets, triplets and twins that underwent reduction (11.3%, 8.3% and 13.6%, respectively). A 33.3% of the total pregnancy loss rate occurred within four weeks from the procedure, whereas 66.7% occurred after the four weeks but at 24 weeks of gestation or earlier. The mean gestational age at delivery was estimated to be 33 weeks for pregnancies reduced to triplets, 35.8 weeks for those reduced to twins and 36.9 weeks for singletons, with 5% delivering at less than 28 weeks and 9.6% at 29-32 weeks. We conclude that multifetal pregnancy reduction has been established as an efficient and safe way to improve outcome of multifetal gestations, especially those with four or more fetuses and likely of triplets. As the experience from the procedure increases, it seems that reduction of triplets to twins can be offered to patients with satisfactory results. The reduction to singletons has not yet been established and is being performed only when medical indications exist. Prenatal genetic diagnosis should become an integral part of counselling on multiple pregnancy. Physicians should take whenever possible measures designed to prevent high multiple birth pregnancies. We also note that although multifetal pregnancy reduction improves significantly the outcome of multiple pregnancies, several ethical dilemmas arising from its application are still under dispute.

Abortion, Spontaneous↗
PubMed1993

[A study of birth weight of the Republic of Central Africa].

It is known that the rate of low birth weight in African developing countries is very high. A birth weight analysis based on their delivery charts is made in this paper for the babies born from 1988 to 1990 at two maternity hospitals, Castor and Boy-Rabe, in Bangui, the capital of the Republic of Central Africa. The total number of births amounted to 27,188 for Castor and 7,667 for Boy-Rabe, excluding multiple births. As a result, it was found that the youngest mother's age was twelve and the oldest fifty three, with the average age at the first delivery seventeen, followed by the another delivery every two years. Mean birth weight (MBW) values were significantly higher in Castor (males 3,134 +/- 527.5, females 3,018 +/- 511.6 grams) than in Boy-Rabe (males 3,017 +/- 542.6, females 2,909 +/- 507.1 grams). The total rate of low birth weight (LBW) under 2,500 grams was 10.9 percent. That of Castor maternity was 9.8 percent, while it was 14.7 percent for Boy-Rabe, which is significantly higher than the former. In addition, the rate of LBW is the highest in the first delivery for mothers younger than 16, while it is the lowest in the sixth delivery of the group of mothers group aged 25-29. Looking at the seasonal variation of LBW, we noticed that it became higher in July and August every year, the busiest period for farming, with harvesting followed by planting. These findings suggest that low birth weight infants are due to the age of delivery being younger than sixteen and also to the mother's heavy labor.

Adolescent↗
PubMed2001

Association of birth weight and current body size to blood pressure in female twins.

It has been proposed that low birth weight is associated with high levels of blood pressure in later life. The aim of this study was to assess the relationship of blood pressure to birth weight and current body size during growth and adulthood. A total of 711 female multiple births, with one group of 244 in their growth phase mean age 12.0 (2.3)(SD) years and the other of 467 adults (mean age 35.2 (12.6) years), had height, weight and both systolic (SBP) and diastolic (DBP) blood pressures measured, and self-reported their birth weight. Regression analyses were performed to assess the cross-sectional and within-pair associations of blood pressure to birth weight, with and without adjustments for current body size. Within-pair analysis was based on 296 twin pairs. Cross-sectionally, a reduction in birth weight of 1 kg was associated with 2 to 3 mm Hg higher age-adjusted SBP, which was of marginal significance and explained about 2% of the population variance. Adjustment for body mass index did not significantly change this association. Within-pair analyses found no association between birth weight and SBP or DBP,even after adjusting for current body size. After age, current body size was the strongest predictor of systolic BP. The weak association of blood pressure to birth weight cross-sectionally is of interest, but any within-pair effect of birth weight on blood pressure must be minimal compared with the effect of current body size.

Birth Weight↗
PubMed2005

Newborn hearing screening in the NICU: profile of failed auditory brainstem response/passed otoacoustic emission.

OBJECTIVE: Incidence of a specific pattern of auditory responses, absent auditory brainstem responses (ABRs) and present otoacoustic emissions (OAEs), in newborn hearing screening in a regional perinatal center neonatal intensive care unit (NICU) is described. This profile, labeled auditory neuropathy or auditory dyssynchrony (AN/AD), is a dysfunction in neural/brainstem transmission that occurs in individuals whose outer hairs cells are functioning normally. Although the AN/AD profile has been associated with various risk factors, incidence and prediction are unknown. METHOD: Analysis of electrophysiologic measures and medical record reviews of the first 22 months of the universal newborn hearing-screening program was conducted. Association of the AN/AD profile was evaluated with the following factors: gender, gestational age, ototoxic drug regimen, low birth weight, hyperbilirubinemia, hydrocephalus, low Apgar score, anoxia, respiratory distress syndrome, pulmonary hypertension, intraventricular hemorrhage, multiple birth, seizure activity, and family history. RESULTS: One hundred fifteen (24.1%) of the 477 infants failed the ABR in 1 or both ears and passed OAEs bilaterally. Comparisons of infants fitting the AN/AD profile with those not fitting the AN/AD profile were negative with 3 exceptions: those with hyperbilirubinemia and those who were administered vancomycin or furosemide. A logistic-regression analysis model failed to predict which infants would be at risk for the AN/AD profile either unilaterally or bilaterally. CONCLUSIONS: Screening of NICU infants should be conducted with ABR first, followed by OAE after failure on ABR. Because the incidence of the AN/AD profile was found to be 24% in this at-risk population, additional study is warranted.

Evoked Potentials, Auditory, Brain Stem↗
PubMed1988

Multiple sclerosis and birth order.

The relation between birth order and risk of multiple sclerosis (MS) was studied among MS patients in Israel. The evaluation was both by case-control study and comparison of expected and observed birth order in Israel-born patients. Results showed an excess of first-born and a low birth order among MS patients. Conversely, in MS patients born abroad but who developed the disease in Israel, MS was connected with an excess of last-born and high birth order. These contradictory results could not be explained by bias of case selection, difference in age, or changes in family size with time, and could indicate that different etiological factors are responsible for MS in distinct populations.

Birth Order↗
PubMed2006

Teen maternal age and very preterm birth of twins.

BACKGROUND: As teen singleton pregnancy is associated with higher risks of adverse birth outcome, and twin pregnancy, regardless of maternal age, may result in poor outcome, teens pregnant with twins may represent a particularly vulnerable group. However, little has been documented regarding teen twin pregnancy outcome. OBJECTIVE: To characterize the risk of very preterm birth among teens having twins. DESIGN: Cross-sectional analysis of the US 1995-2000 Matched Multiple Birth Data Set. METHODS: We calculated the risk of very preterm birth (<33 weeks' gestation) for teen and young adult mothers of twins (< or =16 years, 17-18 years, 19-20 years), compared to 21-24 year olds, stratified by race/ethnicity. Adjusted odds ratios were estimated controlling for marital status and entry into prenatal care. RESULTS: Odds of very preterm birth decreased significantly with increasing age. Odds ratios ranged from 2.07 (1.73,2.48) to 1.20 (1.11,1.29) according to maternal age for White teen mothers, from 1.76 (1.48,2.09) to 1.13 (1.03,1.24) for Black teen mothers, and from 2.19 (1.77,2.72) to 1.15 (1.02,1.31) for Hispanic teen mothers. Odds of very preterm birth among teen mothers of twins were about the same as those for teen mothers of singletons. CONCLUSIONS: Teens having twins have higher odds of very preterm birth than young adult mothers. However, the association between age and preterm birth was similar among teen mothers having twins as for those having singletons.

Adolescent↗
PubMed1987

Increased monozygotic twinning rate after ovulation induction.

Multiple births after artificial induction of ovulation (AIO) are usually considered to be due to fertilisation of multiple ova. In the East Flanders Prospective Twin Study between 1978 and 1985 the frequency of zygotic splitting after AIO (1.2%) was significantly higher than the expected frequency (0.45%) among spontaneous twins and triplets. Moreover, after AIO the frequency of zygotic division was significantly higher in triplets than in twins. AIO seems to be the first identified biological mechanism influencing the monozygotic twinning rate.

Female↗
PubMed2005

Intracytoplasmic injection of spermatozoa and spermatogenic cells: its biology and applications in humans and animals.

Intracytoplasmic sperm injection (ICSI) has become the method of choice to overcome male infertility when all other forms of assisted fertilization have failed. Animals in which ICSI has produced normal offspring include many species. Success rate with normal spermatozoa is well above 50% in the mouse but ICSI success rates in other animals have been low, ranging from 0.3 to 16.5%. Mouse ICSI revealed that spermatozoa that cannot participate in normal fertilization can produce normal offspring by ICSI, provided their nuclei are genomically intact. Human ICSI using infertile spermatozoa has been highly successful perhaps because of the intrinsic instability of human sperm plasma membrane. The health of children born after ICSI and other assisted fertilization techniques is of major concern. Careful analyses suggest that higher incidences of congenital malformations and/or low birth weights after assisted fertilization are largely attributable to parental genetic background and increased incidence of multiple births, rather than to the techniques of assisted fertilization. Since the physiological and nutritional environments of developing embryos may cause persisting alteration in DNA methylation, extreme caution must be exercised in handling gametes and embryos in vitro. In the mouse, round spermatid injection (ROSI) has been routinely successful but its use in humans is controversial. Whether human ROSI and assisted fertilization involving younger spermatogenic cells are medically safe must be the subject of further investigations.

Animals↗
PubMed1998

Paternal work in the power industry: effects on children at delivery.

Although reports on reproductive disturbances among occupational groups of electrical workers have been discussed, few studies have focused explicitly on the children of workers employed in the power industry. Birth outcome and cancer in the offspring of fathers who were exposed to electric and magnetic fields at time of sperm production were studied in two cohorts. In Study 1, male occupation in the power industry was identified in censuses. Study 2 is a prospective cohort study of newly employed power industry workers. Birth data were obtained by record linkage between censuses and several available health registers in Sweden. Multiple births, birth weight, sex, survival, congenital malformations, and cancer have been analyzed with relation to the father's exposure to electric and magnetic fields one year before the child was born. There were six cancer cases among infants in the exposed group (2.4 expected) and six in the unexposed group (3.2 expected) in Study 1. Jointly, the 12 cancer cases found among the infants were more than expected (P = 0.02). However, this total excess may be random. No cancer cases were observed in the prospective study. For chromosomal abnormalities, such as Down's syndrome, one case was observed among infants of exposed fathers and three cases among unexposed fathers in Study 1. In Study 2, no cases were observed. There was a slightly higher proportion of malformation diagnoses among infants of exposed fathers than among infants of unexposed fathers in Study 2, but this could be random (odds ratio = 1.59; 95% Confidence interval 0.43-1.48). No clear-cut effects on infants fathered by men who were exposed to electric and magnetic fields around the time of sperm production could be seen in these two studies.

Adult↗
PubMed1985

The repetition of spontaneous preterm labour.

The likelihood of repetition of preterm birth after spontaneous onset of labour has been studied in 6572 reproductive careers after excluding stillbirths, multiple births, all careers in which any labour had been induced, and all careers in which the gestation length in any pregnancy was not certain. The analysis was controlled not only for pregnancy number, but for the nature of the reproductive outcomes. In most reproductive sequences there was a weak correlation between the gestation in one pregnancy and subsequent ones. The risk of preterm birth was tripled after one previous preterm birth with or without a preceding abortion, and increased six-fold after two previous preterm births. However, the attributable risk was low, and most multiparae with preterm births did not have a previous history.

Female↗
PubMedDate not supplied

Multiple gestation: reflections on epidemiology, causes, and consequences.

Multiple births (of all orders) increased in epidemic proportions in the years 1971-1997. Twins increased 53%, 32%, 31%, and 83% in white, Afro-American, Native American and Mexican American women, respectively. Triplet, quadruplet, and quintuplet+ births increased >400%, >1,100%, and >500%, respectively, in the same years. The principal causes of these changes are related to the increasing age of the maternal cohort and an increasing incidence of fertility-inhibiting diseases and conditions in association with advancing maternal age. Major immediate consequences of these changes include disproportionately large numbers of infants born at <33 weeks' gestation (1.7% for singletons vs. 41.2% for triplets) and at <1,500 g birth weight (1.1% for singletons vs. 31.9% for triplets). Additional short-term consequences include an almost 2,000% increase in infant deaths (per 1,000 live births) among triplets compared with singletons (190.4 vs. 11.2). Long-term risks include a 300% increase in the relative risk of handicap in triplets compared with singletons (2.9 vs. 1.0), and a 650% increase in the rate of cerebral palsy per 1,000 live births in triplets compared with singletons (26.6 vs. 1.6). Peripartum costs relate to prematurity rather than plurality, as do lifetime survivorship costs, which relate to morbidities and subsequent health-related problems.

Female↗