Olusanya Bolajoko O
Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, 30 Guilford Street, London, UK.
J Health Popul Nutr. 2011 Dec;29(6):639-47.
Compared to singletons, multiple births are associated with a substantially-higher risk of maternal and perinatal mortality worldwide. However, little evidence exists on the perinatal profile and risk of neurodevelopmental disabilities among the survivors, especially in developing countries. This cross-sectional study, therefore, set out to determine the adverse perinatal outcomes that are potential markers for neurodevelopmental disabilities in infants with multiple gestations in a developing country. In total, 4,573 mothers, and their 4,718 surviving offspring in an inner-city maternity hospital in Lagos, Nigeria, from May 2005 to December 2007, were recruited. Comparisons of maternal and infant outcomes between single and multiple births were performed using multivariable logistic regression and generalized estimation equation analyses. Odds ratio (OR) and the corresponding 95% confidence interval (CI) for each marker were estimated. Of the 4,573 deliveries, there were 4,416 (96.6%) singletons and 157 (3.4%) multiples, comprising 296 twins and six triplets together (6.4% of all live 4,718 infants). After adjusting for maternal age, ethnicity, occupation, parity, and antenatal care, multiple gestations were associated with increased risks of hypertensive disorders and caesarean delivery. Similarly, after adjusting for potential maternal confounders, multiple births were associated with low five-minute Apgar score (OR: 1.47, 95% CI 1.13-1.93), neonatal sepsis (OR: 2.16, 95% CI 1.28-3.65), severe hyperbilirubinaemia (OR: 1.60, 95% CI 1.00-2.56), and admission to a special-care baby unit (OR: 1.56, 95% CI 1.12-2.17) underpinned by preterm delivery before 34 weeks (OR: 1.91, 95% CI 1.14-3.19), birthweight of less than 2,500 g (OR: 6.45, 95% CI 4.80-8.66), and intrauterine growth restriction (OR: 9.04, 95% CI 6.62-12.34). Overall, the results suggest that, in resource-poor settings, infants of multiple gestations are associated with a significantly-elevated risk of adverse perinatal outcomes. Since these perinatal outcomes are related to the increased risk of later neurodevelopmental disabilities, multiple-birth infants merit close developmental surveillance for timely intervention.
在全球范围内，与单胎妊娠相比，多胎妊娠与孕产妇和围产期死亡风险显著升高相关。然而，关于多胎妊娠存活者的围产期情况及神经发育障碍风险的证据很少，尤其是在发展中国家。因此，这项横断面研究旨在确定在一个发展中国家，多胎妊娠婴儿中作为神经发育障碍潜在标志物的不良围产期结局。2005年5月至2007年12月期间，在尼日利亚拉各斯一家市中心妇产医院招募了4573名母亲及其4718名存活后代。采用多变量逻辑回归和广义估计方程分析对单胎和多胎妊娠的母婴结局进行比较。估计每个标志物的比值比（OR）及相应的95%置信区间（CI）。在4573例分娩中，有4416例（96.6%）为单胎妊娠，157例（3.4%）为多胎妊娠，其中包括296例双胞胎和6例三胞胎（占所有4718例存活婴儿的6.4%）。在调整了母亲年龄、种族、职业、产次和产前护理因素后，多胎妊娠与高血压疾病和剖宫产风险增加相关。同样，在调整了潜在的母亲混杂因素后，多胎妊娠与5分钟阿氏评分低（OR：1.47，95%CI 1.13 - 1.93）、新生儿败血症（OR：2.16，95%CI 1.28 - 3.65）、严重高胆红素血症（OR：1.60，95%CI 1.00 - 2.56）以及入住特殊护理婴儿病房（OR：1.56，95%CI 1.12 - 2.17）相关，这些均由34周前早产（OR：1.91，95%CI 1.14 - 3.19）、出生体重低于2500g（OR：6.45，95%CI 4.80 - 8.66）和宫内生长受限（OR：9.04，95%CI 6.62 - 12.34）所支撑。总体而言，结果表明，在资源匮乏地区，多胎妊娠婴儿不良围产期结局风险显著升高。由于这些围产期结局与后期神经发育障碍风险增加相关，多胎妊娠婴儿值得密切的发育监测以便及时干预。
