Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand.
PLoS One. 2024 Apr 18;19(4):e0301222. doi: 10.1371/journal.pone.0301222. eCollection 2024.
In low- and middle-income countries twin births have a high risk of complications partly due to barriers to accessing hospital care. This study compares pregnancy outcomes, maternal and neonatal morbidity and mortality of twin to singleton pregnancy in refugee and migrant clinics on the Thai Myanmar border.
A retrospective review of medical records of all singleton and twin pregnancies delivered or followed at antenatal clinics of the Shoklo Malaria Research Unit from 1986 to 2020, with a known outcome and estimated gestational age. Logistic regression was done to compare the odds of maternal and neonatal outcomes between twin and singleton pregnancies.
Between 1986 and 2020 this unstable and migratory population had a recorded outcome of pregnancy of 28 weeks or more for 597 twin births and 59,005 singleton births. Twinning rate was low and stable (<9 per 1,000) over 30 years. Three-quarters (446/597) of the twin pregnancies and 96% (56,626/59,005) of singletons birthed vaginally. During pregnancy, a significantly higher proportion of twin pregnancies compared to singleton had pre-eclampsia (7.0% versus 1.7%), gestational hypertension (9.9% versus 3.9%) and eclampsia (1.0% versus 0.2%). The stillbirth rate of twin 1 and twin 2 was higher compared to singletons: twin 1 25 per 1,000 (15/595), twin 2 64 per 1,000 (38/595) and singletons 12 per 1,000 (680/58,781). The estimated odds ratio (95% confidence interval (CI)) for stillbirth of twin 1 and twin 2 compared to singletons was 2.2 (95% CI 1.3-3.6) and 5.8 (95% CI 4.1-8.1); and maternal death 2.0 (0.95-11.4), respectively, As expected most perinatal deaths were 28 to <32 week gestation.
In this fragile setting where access to hospital care is difficult, three in four twins birthed vaginally. Twin pregnancies have a higher maternal morbidity and perinatal mortality, especially the second twin, compared to singleton pregnancies.
在中低收入国家，由于获得医院护理的障碍，双胞胎妊娠存在较高的并发症风险。本研究比较了泰国缅甸边境难民营和移民诊所中双胞胎妊娠和单胎妊娠的妊娠结局、产妇和新生儿发病率和死亡率。
对 1986 年至 2020 年在 Shoklo 疟疾研究单位产前诊所分娩或接受随访、已知结局和估计胎龄的所有单胎和双胎妊娠的病历进行回顾性分析。采用 logistic 回归比较双胎妊娠和单胎妊娠的产妇和新生儿结局的比值比。
在 1986 年至 2020 年间，这一不稳定且流动的人群中，597 例双胎妊娠和 59005 例单胎妊娠的记录妊娠达到 28 周或以上。30 年来，双胞胎的出生率一直较低且稳定（<9/1000）。四分之三（446/597）的双胞胎妊娠和 96%（56626/59005）的单胎妊娠经阴道分娩。在妊娠期间，与单胎妊娠相比，双胎妊娠发生子痫前期（7.0%对 1.7%）、妊娠期高血压（9.9%对 3.9%）和子痫（1.0%对 0.2%）的比例显著更高。与单胎妊娠相比，双胞胎 1 和双胞胎 2 的死胎率更高：双胞胎 1 为 25/1000（15/595），双胞胎 2 为 64/1000（38/595），单胎妊娠为 12/1000（680/58781）。双胞胎 1 和双胞胎 2 与单胎妊娠相比，死胎的估计比值比（95%置信区间（CI））分别为 2.2（95%CI 1.3-3.6）和 5.8（95%CI 4.1-8.1）；而母亲死亡的比值比分别为 2.0（0.95-11.4）。如预期的那样，大多数围产期死亡发生在 28 至<32 孕周。
在这个难以获得医院护理的脆弱环境中，四分之三的双胞胎经阴道分娩。与单胎妊娠相比，双胞胎妊娠产妇发病率和围产儿死亡率更高，尤其是第二胎。
