Getahun Darios, Amre Devendra K, Ananth Cande V, Demissie Kitaw, Rhoads George G
Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08901-1977, USA.
Am J Obstet Gynecol. 2006 Dec;195(6):1506-11. doi: 10.1016/j.ajog.2006.01.043. Epub 2006 May 4.
The purpose of this study was to examine temporal changes in stillbirth, neonatal and infant mortality rates among triplet births in the US, and to assess the contributions of triplet delivery at < 34 weeks to these changes.
Data on triplet live births, and fetal and infant deaths (1990-2002) delivered at > or = 22 weeks and fetuses weighing > or = 500 g (n = 66,986) were derived from the US linked birth/infant death data files. Relative risk (RR), quantifying changes in triplet stillbirth, neonatal (death within the first 28 days) and infant mortality (death within the first year) rates between 1990 and 1991 and 2001 and 2002, were derived. Temporal changes in triplet births at < 34 weeks, and changes in stillbirth, and neonatal and infant mortality rates were examined through logistic regression models before and after adjusting for confounders.
Triplet births at < 34 weeks increased by 25% between 1990 and 1991 (48.7%) and 2001 and 2002 (60.9%). Stillbirth, neonatal and infant mortality rates declined by 52% (RR 0.48, 95% confidence interval [CI] 0.36-0.63), 32% (RR 0.68, 95% CI 0.58-0.80), and 38% (RR 0.62, 95% CI 0.53-0.71), respectively, between 1990 and 1991 and 2001 and 2002. The increase in triplet births at < 34 weeks was not associated with the stillbirth decline, but was associated with an excess 14% and 12% increase in neonatal and infant deaths, respectively.
Our findings suggest that the increase in triplet births at < 34 weeks' gestation is not associated with changes in triplet stillbirths, but is associated with increases in triplet neonatal and infant mortality.
本研究旨在探讨美国三胞胎分娩中死产、新生儿及婴儿死亡率的时间变化，并评估孕周<34周的三胞胎分娩对这些变化的影响。
从美国出生/婴儿死亡关联数据文件中获取1990 - 2002年孕周≥22周、体重≥500g的三胞胎活产、胎儿及婴儿死亡数据（n = 66,986）。计算1990 - 1991年与2001 - 2002年三胞胎死产、新生儿（出生后28天内死亡）及婴儿死亡率（出生后第一年内死亡）变化的相对风险（RR）。通过逻辑回归模型在调整混杂因素前后，研究孕周<34周的三胞胎分娩的时间变化以及死产、新生儿及婴儿死亡率的变化。
孕周<34周的三胞胎分娩在1990 - 1991年（48.7%）至2001 - 2002年（60.9%）期间增加了25%。1990 - 1991年与2001 - 2002年期间，死产、新生儿及婴儿死亡率分别下降了52%（RR 0.48，95%置信区间[CI] 0.36 - 0.63）、32%（RR 0.68，95% CI 0.58 - 0.80）和38%（RR 0.62，95% CI 0.53 - 0.71）。孕周<34周的三胞胎分娩增加与死产率下降无关，但分别与新生儿及婴儿死亡额外增加14%和12%有关。
我们的研究结果表明，孕周<34周的三胞胎分娩增加与三胞胎死产变化无关，但与三胞胎新生儿及婴儿死亡率增加有关。
