PEDIATRICS Vol. 108 No. 5 November 2001, pp. 1055-1061
Received Jan 19, 2001; accepted May 24, 2001.
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From the * Perinatal Epidemiology Research Unit, Departments of
Obstetrics and Gynecology and Pediatrics, Dalhousie University,
Halifax, Nova Scotia; Objective. To examine whether the
recent substantial increase in preterm birth among twins has been
associated with changes in fetal and infant mortality.
Design. Cohort study based on information in the linked
live birth, stillbirth, and mortality databases of Statistics Canada.
Setting. Ten of 12 provinces and territories in Canada.
Participants. All twin live births and stillbirths between
1985 and 1996, along with information on deaths during infancy
(1985-1997).
Main Outcome Measure. Fetal and infant mortality rates.
Results. The rate of preterm birth among twin live births
increased significantly by 17% (95% confidence interval: 14%-20%)
from 42.5% between 1985 and 1987 to 49.6% between 1994 and 1996. Overall, stillbirth rates among twins declined from 22.4 per 1000 total births in 1985 to 1987 to 18.8 per 1000 total births in 1994 to 1996. Among twin fetuses Conclusions. The recent increase in preterm birth among
twins was associated with a substantial reduction in stillbirth rates
at and near term gestation. Infant mortality rates declined
concurrently, although the absence of a significant decrease in infant
mortality among twin live births at 32 to 33 and 34 to 36 weeks'
gestational age needs additional scrutiny.
Department of Social and Preventive Medicine,
Université Laval, Sainte-Foy, Quebec; § Departments of
Paediatrics, Obstetrics and Gynecology and Health Administration,
University of Toronto, Toronto, Ontario;
Bureau of Reproductive and
Child Health, Health Canada, Ottawa, Ontario; ¶ Departments of
Pediatrics, Epidemiology and Biostatistics, McGill University,
Montreal, Quebec, Canada.
34 weeks' gestation, stillbirth rates decreased
from 9.5 per 1000 in 1985 to 1987 to 5.4 per 1000 fetuses at risk in
1994 to 1996. Infant mortality rates among twin live births declined
substantially in all categories of gestational age above 24 weeks
except for live births at 32 to 33 and 34 to 36 weeks' gestation.
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