A comprehensive analysis of twin births: clinical characteristics, morbidity trends, and risk determinants

Authors

  • Nazma Parvin Department of Pediatrics, Central Drug Addiction Treatment Centre, Dhaka, Bangladesh
  • Begum Sharifun Naher Department of Neonatology, Green Life Hospital, Dhaka, Bangladesh
  • Kazi Farhana Binta Shamim Department of Pediatrics, Sylhet M. A. G. Osmani Medical College Hospital, Sylhet, Bangladesh
  • Golam Riad Chowdhury Department of Marketing, Incepta Pharmaceuticals Limited, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2349-3291.ijcp20241031

Keywords:

Low birth weight, Very low birth weight, Twinning, Multi-pregnancy, Preterm birth

Abstract

Background: Twin births are often associated with increased risks and complications compared to singleton births. This study aims to analyze the clinical profile, morbidity pattern, and risk factors associated with twin births, focusing on maternal characteristics, neonatal outcomes, and the prevalence of conditions such as low birth weight (LBW) and preterm births.

Methods: This hospital-based observational study was conducted at a tertiary care center, involving 25 mothers who had given birth to twins and their 50 neonates. The study assessed maternal age, antenatal care, parity, medical history, and neonatal outcomes including birth weight, gestational age, respiratory and cardiac parameters, and overall health status. Data were collected through medical records and direct observations in the neonatal intensive care unit.

Results: The majority of mothers (64%) were aged between 21-30 years, with a mean age of 24.8 years. A significant proportion (92%) had regular antenatal visits, and 96% were multiparous. The majority of neonates (68%) were aged ≤12 hours at assessment, with a near-equal distribution between very low birth weight (VLBW) and LBW. Preterm births were common, affecting 84% of the neonates. Respiratory challenges were evident, with 62% of neonates having SpO2 levels below 94%. The mortality rate among the neonates was 32%.

Conclusions: The study highlights the high-risk nature of twin pregnancies, characterized by a significant prevalence of LBW, VLBW, and preterm births. The findings emphasize the need for enhanced prenatal care and specialized neonatal interventions. The high mortality rate among neonates indicates the critical need for targeted strategies to improve neonatal outcomes in twin pregnancies. These insights are crucial for informing clinical practices and developing comprehensive care protocols for managing twin pregnancies and their associated risks.

References

Clarke J. Observations on Some Causes of the Excess of the Mortality of Males above That of Females. Lond Med J. 1788;9(Pt 2):179-200.

Corsello G, Piro E. The world of twins: an update. J Matern Fetal Neonatal Med. 2010;23:59-62.

Puccio G, Giuffré M, Piccione M, Piro E, Malerba V, Corsello G. Intrauterine growth pattern and birthweight discordance in twin pregnancies: a retrospective study. Ital J Pediatr. 2014;40:43.

American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Obstetrics; Society for Maternal-Fetal Medicine; ACOG Joint Editorial Committee. ACOG Practice Bulletin #56: Multiple gestation: complicated twin, triplet, and high-order multifetal pregnancy. Obstet Gynecol. 2004;104(4):869-83.

Mutihir JT, Pam VC. Obstetric outcome of twin pregnancies in Jos, Nigeria. Niger J Clin Pract. 2007;10(1):15-8.

Hall JG. Twinning. Lancet. 2003;362(9385):735-43.

Smits J, Monden C. Twinning across the Developing World. PLoS One. 2011;6(9):e25239.

Akinboro A, Azeez MA, Bakare AA. Frequency of twinning in southwest Nigeria. Indian J Hum Genet. 2008;14(2):41-7.

Imaizumi Y. Twinning rates in Japan, 1951-1990. Acta Genet Med Gemellol (Roma). 1992;41(2-3):165-75.

Monden C, Pison G, Smits J. Twin Peaks: more twinning in humans than ever before. Hum Reprod. 2021;36(6):1666-73.

Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JHetal. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ. 2010;88(1):31-8.

Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162-72.

Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379(9832):2151-61.

Hug L, Alexander M, You D, Alkema L. UN Inter-agency Group for Child Mortality Estimation. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health. 2019;7(6):710-20.

Cheung YB, Yip P, Karlberg J. Mortality of twins and singletons by gestational age: a varying-coefficient approach. Am J Epidemiol. 2000;152(12):1107-16.

Herlihy N, Odom E, Cohen N, Stroustrup A, Rebarber A, Fox NS. Long-Term Outcomes of Small for Gestational Age Twins Born at 34 Weeks or Later. Am J Perinatol. 2018;35(3):254-261.

Wainstock T, Yoles I, Sergienko R, Sheiner E. Twins vs singletons-Long-term health outcomes. Acta Obstet Gynecol Scand. 2023;102(8):1000-6.

Esposito G, Cantarutti A, Mauri PA, Franchi M, Fedele F, Corrao G, et al. Prevalence and Factors Associated With Intertwin Birth Weight Discordance Among Same-Sex Twins in Lombardy, Northern Italy. Twin Res Hum Genet. 2023;26(2):177-83.

Jain S, Kumar M, Tripathi S, Singh SN. Oral Application of Mother's Own Milk for Prevention of Late Onset Sepsis in Preterm Very Low Birth Weight Neonates: A Randomized Controlled Trial. Breastfeed Med. 2022;17(1):59-64.

Narsimha D, Juned S, Prathyusha P, Tarangini P, Narendra DJ, Sridevi DA. Prevalence of Preeclampsia and eclampsia Risk factors among pregnant women in a tertiary care hospital, Ongole. JETIR. 2020;7(12).

Ansari N, Manalai P, Maruf F, Currie S, Stekelenburg J, Roosmalen J, et al. Quality of care in early detection and management of pre-eclampsia/eclampsia in health facilities in Afghanistan. BMC Pregnancy Childbirth. 2019;19(1):36.

Hannoun A, Usta IM, Awwad J, Moukalled D, Yahya F, Jurdi A, et al. Effect of parity on maternal and neonatal outcomes in twin gestations. Acta Obstet Gynecol Scand. 2012;91(1):117-21.

Thakur N, Rai N. A Retrospective Study of Predictors of Mortality in Low Birth Weight Neonates in a District Hospital of Lucknow, India. IJNMR. 2022.

Li S, Gao J, Liu J, Hu J, Chen X, He J, et al. Perinatal Outcomes and Risk Factors for Preterm Birth in Twin Pregnancies in a Chinese Population: A Multi-center Retrospective Study. Front Med (Lausanne). 2021;8:657862.

Ponce J, Cobo T, Murillo C, Gonce A, Domínguez N, Crovetto F, et al. Preterm Prelabour Rupture of Membranes before Viability in Twin Pregnancies: What Can We Expect? J Clin Med. 2023;12(8):2949.

Assa NP, Artana IWD, Kardana IM, Putra PJ, Sukmawati M. The characteristics of neonatal sepsis in Low Birth Weight (LBW) infants at Sanglah General Hospital, Bali, Indonesia. Intisari Sains Medis. 2020.

Cutland CL, Lackritz EM, Mallett-Moore T, Bardají A, Chandrasekaran R, Lahariya C, et al. Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine. 2017;35(48):6492-500.

Devaguru A, Gada S, Potpalle D, Dinesh Eshwar M, Purwar D. The Prevalence of Low Birth Weight Among Newborn Babies and Its Associated Maternal Risk Factors: A Hospital-Based Cross-Sectional Study. Cureus. 2023;15(5):e38587.

Hossain A, Rafy KH, Rahman A, Hasan M, Azam G. Clinical Study of Morbidity and Mortality Pattern of Preterm Very Low Birth Weight Babies in Neonatal Period. Sch J App Med Sci, 2022;87-91.

Santana DS, Surita FG, Cecatti JG. Multiple Pregnancy: Epidemiology and Association with Maternal and Perinatal Morbidity. Rev Bras Ginecol Obstet. 2018;40(9):554-62.

Downloads

Published

2024-04-25

Issue

Section

Original Research Articles