Twins and Their Health Cost: Consequences of Multiple Births on Parental Health and Mortality in Denmark and England and Wales

Do short birth intervals have long-term implications for parental health? Results from analyses of complete cohort Norwegian register data

BACKGROUND

Short and very long interbirth intervals are associated with worse perinatal, infant and immediate maternal outcomes. Accumulated physiological, mental, social and economic stresses arising from raising children close in age may also mean that interbirth intervals have longer term implications for the health of mothers and fathers, but few previous studies have investigated this.

METHODS

Discrete-time hazards models were estimated to analyse associations between interbirth intervals and mortality risks for the period 1980-2008 in complete cohorts of Norwegian men and women born during 1935-1968 who had had two to four children. Associations between interbirth intervals and use of medication during 2004-2008 were also analysed using ordinary least-squares regression. Covariates included age, year, education, age at first birth, parity and change in coparent since the previous birth.

RESULTS

Mothers and fathers of two to three children with intervals between singleton births of less than 18 months, and mothers of twins, had raised mortality risks in midlife and early old age relative to parents with interbirth intervals of 30-41 months. For parents with three or four children, longer average interbirth intervals were associated with lower mortality. Short intervals between first and second births were also positively associated with medication use. Very long intervals were not associated with raised mortality or medication use when change of coparent since the previous birth was controlled.

CONCLUSIONS

Closely spaced and multiple births may have adverse long-term implications for parental health. Delayed entry to parenthood and increased use of fertility treatments mean that both are increasing, making this a public health issue which needs further investigation.

Sonography in obese and overweight pregnant women: clinical, medicolegal and technical issues

Obesity has increased dramatically worldwide over the last two decades, becoming a social concern. In pregnancy, obesity is associated with increased risk of maternal death and of significant complications, such as pre-eclampsia, diabetes and postpartum hemorrhage. Several papers have also reported an increased risk of major anomalies in the offspring of obese pregnant women. At the same time, carrying out an ultrasound examination on an obese pregnant woman is a difficult task, due to the impaired acoustic window. This Review discusses the clinical, technical and medicolegal problems associated with ultrasound examination in obese and/or overweight women and provides tips for performing these examinations.