Bellizzi Saverio, Sobel Howard, Betran Ana Pilar, Temmerman Marleen
World Health Organization, Western Pacific Regional Office, Manila, Philippines.
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
J Glob Health. 2018 Jun;8(1):010404. doi: 10.7189/jogh.08.010404.
Around the world, the incidence of multiple pregnancies reaches its peak in the Central African countries and often represents an increased risk of death for women and children because of higher rates of obstetrical complications and poor management skills in those countries. We sought to assess the association between twins and early neonatal mortality compared with singleton pregnancies. We also assessed the role of skilled birth attendant and mode of delivery on early neonatal mortality in twin pregnancies.
We conducted a secondary analysis of individual level data from 60 nationally-representative Demographic and Health Surveys including 521 867 singleton and 14 312 twin births. We investigated the occurrence of deaths within the first week of life in twins compared to singletons and the effect of place and attendance at birth; also, the role of caesarean sections against vaginal births was examined, globally and after countries stratification per caesarean sections rates. A multi-level logistic regression was used accounting for homogeneity within country, and homogeneity within twin pairs.
Early neonatal mortality among twins was significantly higher when compared to singleton neonates (adjusted odds ratio (aOR) 7.6; 95% confidence interval (CI) = 7.0-8.3) in these 60 countries. Early neonatal mortality was also higher among twins than singletons when adjusting for birth weight in a subgroup analysis of those countries with data on birth weight (n = 20; less than 20% of missing values) (aOR = 2.8; 95% CI = 2.2-3.5). For countries with high rates (>15%) of caesarean sections (CS), twins delivered vaginally in health facility had a statistically significant (aOR = 4.8; 95% CI = 2.4-9.4) increased risk of early neonatal mortality compared to twins delivered through caesarean sections. Home twin births without SBA was associated with increased mortality compared with delivering at home with SBA (aOR = 1.3; 95% CI = 1.0-1.8) and with vaginal birth in health facility (aOR = 1.7; 95% CI = 1.4-2.0).
Institutional deliveries and increased access of caesarian sections may be considered for twin pregnancies in low- and middle- income countries to decrease early adverse neonatal outcomes.
在全球范围内，多胎妊娠的发生率在中非国家达到峰值，并且由于这些国家产科并发症发生率较高以及管理技能较差，多胎妊娠往往意味着妇女和儿童死亡风险增加。我们试图评估双胎妊娠与单胎妊娠相比，双胎与早期新生儿死亡率之间的关联。我们还评估了熟练接生员和分娩方式对双胎妊娠早期新生儿死亡率的作用。
我们对来自60项具有全国代表性的人口与健康调查的个体层面数据进行了二次分析，其中包括521867例单胎分娩和14312例双胎分娩。我们调查了双胎与单胎相比在出生后第一周内的死亡情况以及出生地点和接生情况的影响；此外，还在全球范围内以及根据剖宫产率对国家进行分层后，研究了剖宫产与阴道分娩的作用。使用了多水平逻辑回归分析，以考虑国家内部的同质性以及双胎对内部的同质性。
在这60个国家中，双胎的早期新生儿死亡率显著高于单胎新生儿（调整后的优势比（aOR）为7.6；95%置信区间（CI）=7.0 - 8.3）。在对有出生体重数据的国家（n = 20；缺失值少于20%）进行的亚组分析中，调整出生体重后，双胎的早期新生儿死亡率也高于单胎（aOR = 2.8；95% CI = 2.2 - 3.5）。对于剖宫产率高（>15%）的国家，与通过剖宫产分娩的双胎相比，在医疗机构经阴道分娩的双胎早期新生儿死亡风险有统计学显著增加（aOR = 4.8；�% CI = 2.4 - 9.4）。与有熟练接生员在家中分娩以及在医疗机构经阴道分娩相比，没有熟练接生员的双胎在家中分娩与死亡率增加相关（aOR = 1.3；95% CI = 1.0 - 1.8）以及与在医疗机构经阴道分娩相比（aOR = 1.7；95% CI = 1.4 - 2.0）。
对于低收入和中等收入国家的双胎妊娠，可考虑进行机构分娩并增加剖宫产的可及性，以减少早期不良新生儿结局。
