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PubMed1993

Isolated cleft palate in Danish multiple births, 1970-1990.

The etiology of most cases of isolated cleft palate (CP) is unknown. The relative importance of genes and environment can be studied using the classical twin method but only few and potentially highly selected CP twin data are available. The present CP twin study was based on four Danish nationwide ascertainment sources of CP multiple births in the period 1970-1990. The ascertainment sources covered the time period from 15 completed weeks of pregnancy to adolescence for the older cohorts. A total of 18 CP cases in multiple births were identified; two monozygotic twin pairs of which one was concordant and eight were dizygotic, discordant twin pairs. Three cases were from two triplet sets, and four discordant twin pairs were of unknown zygosity. The twin concordance rates suggest that genetic factors play a major role in the etiology of CP, but environmental and/or stochastic factors are probably acting as well.

Adolescent↗
PubMed1994

The changing pattern of multiple births in the United States: maternal and infant characteristics, 1973 and 1990.

OBJECTIVE: To evaluate changes in the incidence and proportion of live births by plurality in the United States between 1960 and 1990, and to compare the distribution of singleton, twin, and triplet and higher-order births (triplet+) by maternal and infant characteristics for 1973 and 1990. METHODS: Vital statistics data were used to conduct a population-based analysis of all live births from 1960-1990 and to compare changes in the incidence and outcomes of live births between 1973 and 1990 by maternal and infant characteristics. RESULTS: Between 1960 and 1973, the number of twin births paralleled that of singletons, whereas the number of triplet+ births remained fairly constant. Between 1973 and 1990, twin births increased at twice the rate of singletons (65 versus 32%), and triplet+ births increased at seven times the rate of singletons (221 versus 32%). The resulting frequencies of occurrence changed from one in 55 to one in 43 births for twins and from one in 3323 to one in 1341 for triplet+ births. In 1990, preterm births accounted for 9.7% of singleton births, compared to 47.9% of twin births and 87.8% of triplet+ births. Because of the greater frequency of twin and triplet+ births in 1990, the observed number of very low and low birth weight infants was 24.2% greater among twin births and 142.3% greater among triplet+ births than would be expected if the 1973 ratios to singleton births had remained constant. CONCLUSION: The rise in multiple births, with the associated greater risks of prematurity and low birth weight, is of national importance. Comprehensive and aggressive prenatal care to assure the best outcomes should be the goal for clinicians caring for these women.

Adolescent↗
PubMed1990

Cerebral palsy in multiple births in Western Australia: genetic aspects.

A study of cerebral palsy in multiple births was undertaken to test genetic involvement and assess the impact of the special conditions of pregnancy and parturition in these cases. Complete ascertainment of cerebral palsy in multiple gestations that occurred in Western Australia between 1956 and 1985 was obtained from the Western Australian Cerebral Palsy Register. There were 74 twins and 5 triplets. Data on sex, birth order, motor handicap, outcome in co-twins and triplets, zygosity, and pedigree information was obtained from the Register, hospital records, and, where possible, by interview of the parent(s) of the propositi. There was a significantly higher (P = 0.0026) concordance rate in MZ than in DZ twin pairs. However, pedigree studies showed no other relatives with a motor handicap similar to that of the propositi. This is consistent with a multifactorial cause in at least some of the cases. The sex ratio of affected twins was found to be 2.1 compared to 1.3 for singletons and all 5 affected triplets were boys. The trend of increasing sex ratio with increasing plurality was significant at the 1% level.

Birth Order↗
PubMed1992

Higher multiple births and the modern management of infertility in Britain. The British Association of Perinatal Medicine.

OBJECTIVE: To assess prospectively the number of triplet and higher multiple births born in 1989 and their methods of conception. To assess obstetric factors and the effect of these pregnancies on neonatal medical services. DESIGN: All consultant paediatricians received a monthly card asking whether they had been involved in the management of triplet and higher multiple pregnancies delivered after 22 weeks gestation. Detailed questionnaire sent to those giving a positive response. SETTING: British Paediatric Surveillance Unit organized mailings to all members of the British Paediatric Association working in the British Isles. SUBJECTS: 156 pregnancies resulting in 482 babies (143 triplets, 12 quadruplets and 1 quintuplet set). These data were compared to nationally collected OPCS data. MAIN OUTCOME MEASURES: Method of conception, obstetric performance, neonatal outcome. RESULTS: Of the 156 pregnancies, 47 (31%) were conceived naturally, 52 (34%) had ovarian stimulation (usually with clomiphene or gonadotrophins) 37 (24%) had IVF and 17 (11%) GIFT. All quadruplet and quintuplet pregnancies were established after assisted reproduction. Mothers who had had IVF were significantly older than those who had ovulation induction alone. The median gestation at birth was 33 weeks. Overall 181 (40%) of the babies required intensive care for a median duration of 5 days. The perinatal mortality of the triplets alone and quads and quins together was 70 and 104 per 1000 respectively. CONCLUSIONS: Assisted reproduction is the major cause of triplets and higher multiple births and ovarian stimulation is the single most important technique currently in use. These babies are very likely to be born pre term and make considerable demands on neonatal intensive care facilities.

Adult↗
PubMed1993

[[Perinatal mortality rates in single and multiple births, and the effects of maternal age, birthweight, and other factors on the perinatal mortality rates in Japan]].

"The perinatal mortality rate (PMR) was analyzed using... Vital Statistics for 1950-1991 in Japan. Secular changes in the PMRs were analyzed according to sex and single-multiple births. This paper also investigated the effects of maternal age, birth order, gestational age, and birthweight on the PMR." (SUMMARY IN ENG)

Age Factors↗
PubMed2004

Views of bereaved multiple-birth parents on life support decisions, the dying process, and discussions surrounding death.

OBJECTIVE: This study assessed the experiences of bereaved parents of multiples with resuscitation and life-support discussions, the death process, and conversations with health-care professionals about death. STUDY DESIGN: In all, 71 bereaved parents of multiples recruited from Internet support groups completed a narrative e-mail survey assessing many facets of bereavement. Numeric data were analyzed using simple quantitative analysis, with a grounded theory approach used for qualitative data. RESULTS: Most decisions were collaborative, with occasional directive comments. Some decisions were made during crises. Occasionally, parents initiated life-support discussions. Multidisciplinary meetings occurred with 30%, but were desired by more parents. A total of 18% of parents encountered criticism of choices. Most parents attended resuscitation, and found meaning in holding their dying children. Many desire privacy, availability of symptom management, and family or clergy involvement. Photographs of multiples together are valued. Parents offered many suggestions for compassionate death notification, which most felt should occur in person if parents are not present for the death. Respondents valued clear, prompt discussion of the cause of death, and clinician availability for later review of clinical events or decisions. CONCLUSIONS: Multiple-birth parents' choices resemble those of singleton parents at the end of an infant's life.

Attitude to Death↗
PubMed2004

Food fortification with folic acid and rate of multiple births, 1994-2000.

BACKGROUND: Since fortification of cereal grain products with synthetic folic acid (FA) became mandatory in January 1998, women in the United States who have become pregnant have been exposed to a higher level of FA than women who became pregnant previously. Some studies have suggested that increased FA consumption might increase the risk of multiple gestation pregnancies. METHODS: Women who had a live birth in Kaiser Foundation Health Plan hospitals from January 1, 1994 through December 31, 2000; all multiple births; and the use of ovulation-inducing drugs were ascertained from electronic databases. Medical records of a sample of women with multiple births who did not use ovulation-inducing drugs were reviewed to determine whether they used assisted reproductive technology. Exposure to FA-fortified foods was based on date of delivery. RESULTS: The rate of multiple births increased from 13.6 to 14.8 per 1000 live births from 1994 through 2000. The percentage of women who had a multiple birth and who filled a prescription for an ovulation-inducing drug in the 12 months before delivery increased from a low of 6.6% in 1994 to a high of 14.9% in 2000. After excluding women using ovulation-inducing drugs, the increased rate of multiple births was no longer observed. CONCLUSIONS: While the rates of multiple births have increased since FA fortification became mandatory, this increase can be explained by the increased use of ovulation-inducing drugs. Our findings show no relationship between food fortification with FA and the rates of multiple births in this large, managed health care population.

Adult↗
PubMed1996

Excess males in preterm birth: interactions with gestational age, race, and multiple birth.

OBJECTIVE: To confirm an excess of males among preterm births and study its interaction with other risk factors to better understand its potential etiologic significance. METHODS: Fetal gender was analyzed in 1,781,960 white and 103,329 black singleton births, and in 37,429 white twin births using vital statistics data from the six New England states for 1977-1988. RESULTS: A 7.2% excess of males was found among white singleton preterm births. There was only a 2.8% excess among comparable blacks, a highly significant difference between the races (P < .001). The effect was roughly constant for 20-37 weeks' gestation. Being married increased the effect for white, but not black, women, and was also found among white fetal deaths. Among white twins, male excess in preterm births occurred only in 20-33 week's gestations. CONCLUSIONS: Male fetal gender is associated with singleton preterm birth, an effect most evident in white women, particularly if married. Among preterm white twins, there is also a male excess, limited to gestations under 34 weeks. The excess of males in selected groups suggests the existence of a mechanism of preterm birth influenced by fetal gender. Preterm births in blacks and in twin gestations greater than 33 weeks may be more often due to alternative mechanisms that are independent of fetal gender.

Female↗
PubMedDate not supplied

The cost-effectiveness of screening programs using single and multiple birth cohort simulations: a comparison using a model of cervical cancer.

Despite early recognition of the theoretical advantages of simulations that include different population subgroups/ strata and different birth cohorts, many modeling-based economic evaluations of cervical screening have been based on unrealistic single birth cohort simulations. The authors examined the effect of a multiple birth cohort simulation on the incremental cost-effectiveness estimates of cervical screening programs, compared to a conventional single cohort simulation. The choice of hypothetical cohort that starts the simulation had a major impact on the cost-effectiveness estimates: Compared with a single birth cohort simulation, the incremental cost-effectiveness of a shift from biennial to triennial screening was 30% higher when using the multiple cohort simulation. Multiple cohort simulations using the different age structures of 4 countries had little impact on the cost effectiveness ratios (variation <5%). Future modeling-based evaluations of screening policies should better reflect the age range of the population that is targeted by carefully specifying the nature of the starting cohort(s).

Adult↗
PubMed1979

Incidence of multiple births in an Indian rural community.

In this paper we report on the incidence of multiple births in a rural community of India in the period 1966-75. The incidence is an improvement on estimates reported earlier by various authors and the information would be useful for studying secular trends.

Epidemiologic Methods↗
PubMed2004

The prevalence of preterm deliveries in Berlin has not changed over 7 years: the impact of multiple births.

The problem of preterm deliveries has worsened in developed countries over the past decade. To evaluate whether multiple deliveries had an impact on this development, we analyzed the data of the Berlin Perinatal Survey from 1993-1999 for 206,308 deliveries. The prevalence of preterm deliveries was fairly constant during this period, and the proportion of preterm deliveries in the case of multiples remained constant. But the prevalence of preterm neonates increased significantly in Berlin due to an increased prevalence of multiple births. There was a significant increase of mothers aged over 30, of German nationality, and with preceding infertility treatment, while the prevalence rates of nearly all other risk factors for prematurity decreased over time. The risk of infertility treatments resulting in multiple deliveries increased in these years. On average, infertility treatment led to an about 10 times higher risk of producing multiples than singletons OR (95% CI) of 9.6 (8.6-10.6).

Adult↗
PubMed1994

Anticonvulsant teratogenesis: 2. Statistical methods for multiple birth outcomes.

The purpose of this paper is to demonstrate the application of generalized estimating equations to assess an exposure effect using multiple birth outcomes. This multivariate approach provides the flexibility of regression modeling and improved power, as compared to series of univariate analyses or collapsing the multiple end-points to a single indicator of affectedness. Motivating the discussion will be a large cohort study designed to assess the effects of anticonvulsant medications on a variety of birth outcomes, including major malformations, and growth and weight parameters, as well as a broad spectrum of minor physical anomalies. Because the study is still in progress, the aim here is not to present a definitive analysis, but to present and describe the application of these recently developed statistical methods to analyze studies with multiple outcomes. For simplicity, we will focus on the control and drug-exposed groups only from that study (ignoring the seizure history group), and we will concentrate on an analysis of minor physical anomalies.

Abnormalities, Drug-Induced↗
PubMed2002

The context and long-term impacts of multiple birth loss: a peer support network perspective.

Following my own experience with the death of a twin baby, I founded the Center for Loss in Multiple Birth (CLIMB) Inc. During the last 13 years I have worked with nearly 7000 bereaved parents of twins, triplets or other high multiples throughout the US and worldwide. The role of a peer support organisation and the range of families with multiples who have contacted it is described. They come from diverse backgrounds with many forms of bereavement: death during pregnancy, at birth or after of both or all babies, of one twin, of one or more higher order multiples; multifetal pregnancy reduction or selective fetocide; the death of one or more multiples in childhood. Some have had more than one multiple pregnancy and loss. Many are concerned for the surviving children. A peer support organisation has an important role to play in increasing public awareness of the needs of these families as well as influencing policy on infertility treatments that carry a high risk of producing multiple pregnancies with the associated risk of death and disability for one or more of the babies.

Alaska↗
PubMedDate not supplied

The frequency of multiple births in central Anatolia.

The purposes of the present study were to contribute additional data regarding the frequency of multiple births in Ankara, and to reassess both the relation between maternal age and twinning, and the inter-relation between twinning and seasonality. The frequency of twinning was found to be 0.0084858 +/- 0.00028 (0.85%), triplets 0.0001087 +/- 0.000031 (0.011%), and quadruplets 0.000009 (0.0009%). It is observed that there is a correlation between the frequency of twinning, maternal age and parity, and that the rate of twinning increases with maternal age. The twinning rate varies according to the month of the year in which birth takes place. Accordingly, the frequency of twin births is greater between May and August, and lower between September and December.

Adult↗