Impact of maternal anaemia on birth outcomes of teen twin pregnancies: a comparative analysis with mature young mothers

Maternal clinical predictors of preterm birth in twin pregnancies: A systematic review involving 2,930,958 twin pregnancies

In twin pregnancies, which are at high risk of preterm birth, it is not known if maternal clinical characteristics pose additional risks. We undertook a systematic review to assess the risk of both spontaneous and iatrogenic early (<34 weeks) or late preterm birth (<37 weeks) in twin pregnancies based on maternal clinical predictors. We searched the electronic databases from January 1990 to November 2017 without language restrictions. We included studies on women with monochorionic or dichorionic twin pregnancies that evaluated clinical predictors and preterm births. We reported our findings as odds ratio (OR) with 95% confidence intervals (CI) and pooled the estimates using random-effects meta-analysis for various predictor thresholds. From 12, 473 citations, we included 59 studies (2,930,958 pregnancies). The risks of early preterm birth in twin pregnancies were significantly increased in women with a previous history of preterm birth (OR 2.67, 95% CI 2.16-3.29, I² = 0%), teenagers (OR 1.81, 95% CI 1.68-1.95, I² = 0%), BMI > 35 (OR 1.63, 95% CI 1.30-2.05, I² = 52%), nulliparous (OR 1.51, 95% CI 1.38-1.65, I² = 73%), non-white vs. white (OR 1.31, 95% CI 1.20-1.43, I² = 0%), black vs. non-black (OR 1.38, 95% CI 1.07-1.77, I² = 98%), diabetes (OR 1.73, 95% CI 1.29-2.33, I² = 0%) and smokers (OR 1.30, 95% CI 1.23-1.37, I² = 0%). The odds of late preterm birth were also increased in women with history of preterm birth (OR 3.08, 95% CI 2.10-4.51, I² = 73%), teenagers (OR 1.36, 95% CI 1.18-1.57, I² = 57%), BMI > 35 (OR 1.18, 95% CI 1.02-1.35, I² = 46%), nulliparous (OR 1.41, 95% CI 1.23-1.62, I² = 68%), diabetes (OR 1.44, 95% CI 1.05-1.98, I² = 55%) and hypertension (OR 1.49, CI 1.20-1.86, I² = 52%). The additional risks posed by maternal clinical characteristics for early and late preterm birth should be taken into account while counseling and managing women with twin pregnancies.

Survival of triplets who are born to teen mothers in the United States

OBJECTIVE

The purposes of this study were to assess survival among triplets who are born to teen mothers and to determine whether fetal number influences the mortality rates of the offspring of teen mothers when compared with the offspring of older women.

STUDY DESIGN

A retrospective cohort study of 354 triplet births to teenage mothers and 6858 to young mature mothers (20-29 years) who were delivered from 1995 through 1998. We compared the occurrence of stillbirth and neonatal and infant mortality rates between the 2 categories by means of the generalized estimating equation. Similar analyses were conducted for singleton pregnancies and twin pregnancies.

RESULTS

Triplets of teenage mothers experienced a higher level of stillbirth (odds ratio, 3.24; 95% CI, 1.44-7.24), neonatal mortality (odds ratio, 2.00; 95% CI, 1.11-3.61), and infant death (odds ratio, 1.66; 95% CI, 1.01-2.87). Moreover, as the plurality increased from singleton infant to triplet, the offspring of teenagers fared progressively worse ( P < .0001).

CONCLUSION

This study confirms the association between teenage motherhood and feto-infant death and indicates that this mortality relationship varies in a dose-dependent fashion.

Low maternal age and neonatal survival of extremely preterm twins (20-28 weeks of gestation)

OBJECTIVE

We investigated the relationship between low maternal age and neonatal survival among extremely preterm twins.

METHODS

This was a retrospective cohort study on live births of extremely preterm twins delivered to teenaged mothers (aged 15-19 years) in the United States within the period 1995 through 1998. Overall neonatal and early and late neonatal mortality in this category was compared with that of a similar group of twins born to young adult mothers (aged 20-29 years). We used the generalized estimating equation framework in computing relative risks after adjusting for intracluster correlations.

RESULTS

Analysis involved 2,290 extremely preterm liveborn twins of teenaged mothers and 8,709 born to young adult mothers. Overall, neonatal mortality was 29% higher among the extremely preterm twins born to teenaged mothers (adjusted odds ratio [OR] 1.29; 95% confidence interval [CI] 1.04%, 1.59%). The disparity in neonatal survival was chiefly in the early neonatal period (adjusted OR 1.34; 95% CI 1.07%, 1.67%), while late neonatal mortality was comparable (adjusted OR 0.91; 95% CI 0.58%, 1.42%). In addition, twins of teenaged mothers had significantly higher level of mortality, except for the birth weight category of 1,000-1,499 g.

CONCLUSION

Low maternal age was found to be associated with elevated risk of neonatal death among extremely preterm twins. The preponderance of deaths among extremely preterm twins of teenaged mothers in the early neonatal period appeared to be responsible for the disparity in survival. This information may be useful for targeted interventions aimed at enhancing survival of extremely preterm twins born to teenagers, as well as for instituting optimal management options in the clinical setting.

LEVEL OF EVIDENCE

II-2