Journal Article

Primiparity, assisted reproduction, and preterm birth in twin pregnancies: a population based study

Erez, Offer, Dukler, Doron, Mazor, Moshe, Shoham-Vardi, Ilana, Mayer, Amit

2008

Overview

Objective To determine the prevalence of pregnancy complications among primiparous patients with twin gestation in our population and to investigate the association between the increased rates of assisted reproduction (ART) in twin gestation and preterm birth (PTD). Material and methods A retrospective population based cohort study was designed, including all twin deliveries after 24 weeks gestation ( n  = 2,601). The study group included 666 primiparous women and the comparison group 1,935 multiparous women. Maternal characteristics and perinatal outcome were evaluated. Women with fetal malformations were excluded. A multiple logistic regressions analysis for independent risk factors was performed including factors that were significantly different between the study groups in the univariate analysis. Patient’s data were obtained from computerized database and analyzed using SPSS statistical package. Results Primiparous women had a significantly higher rate of preeclampsia, chronic hypertension, ART, prelabor rupture of membranes (PROM) preterm deliveries (PTD), labor dystocia, cesarean section (CS) and vacuum extraction of the first twin than the multiparous group. Primiparous patients had a significantly lower gestational age at delivery and neonatal birth weight of the first and second twin. In multiple logistic regressions analysis primiparity and ART were independent risk factors for PTD, (OR 1.45, 95% CI 1.18–1.78; OR 1.36, 95% CI 1.09–1.71, respectively). Conclusions (1) Primiparous patients with twin gestation represent a unique population with high rate of infertility and underlying diseases such as chronic hypertension in comparison to the multiparous women with twin gestation; (2) primiparity is an independent risk factor for prematurity in twin gestations; and (3) although primiparous women had an increased maternal complications, neonatal mortality rates were not significantly different from multiparous women.

• Publisher: Springer-Verlag,Springer Nature B.V
• Subject: Cohort Studies / Endocrinology / Female / Fertilization in Vitro / Gynecology / Health risk assessment / Human Genetics / Humans / Hypertension / Israel - epidemiology / Medicine / Medicine & Public Health / Obstetrics/Perinatology/Midwifery / Original Article / Parity / Population / Population-based studies / Preeclampsia / Pregnancy / Pregnancy Complications - epidemiology / Pregnancy Outcome / Pregnancy, Multiple - statistics & numerical data / Premature birth / Premature Birth - epidemiology / Prevalence / Regression Analysis / Reproductive Techniques, Assisted - adverse effects / Retrospective Studies / Risk Factors / Womens health