Temporal trends and adverse perinatal outcomes of twin pregnancies at differing gestational ages: an observational study from China between 2012–2020
Abstract Background With the development of assisted reproductive technology, the twinning rate in China has been increasing. However, little is known about twinning from 2014 onwards. In addition, previous studies analysing optimal gestational times have rarely considered maternal health conditions...
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| Format: | Article |
| Language: | English |
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BMC
2022-06-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-022-04766-0 |
| _version_ | 1818202874248691712 |
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| author | Peiran Chen Mingrong Li Yi Mu Yanping Wang Zheng Liu Qi Li Xiaohong Li Li Dai Yanxia Xie Juan Liang Jun Zhu |
| author_facet | Peiran Chen Mingrong Li Yi Mu Yanping Wang Zheng Liu Qi Li Xiaohong Li Li Dai Yanxia Xie Juan Liang Jun Zhu |
| author_sort | Peiran Chen |
| collection | DOAJ |
| description | Abstract Background With the development of assisted reproductive technology, the twinning rate in China has been increasing. However, little is known about twinning from 2014 onwards. In addition, previous studies analysing optimal gestational times have rarely considered maternal health conditions. Therefore, whether maternal health conditions affect the optimal gestational time remains unclear. Methods Data of women delivered between January 2012 and December 2020 were collected through China’s National Maternal Near Miss Surveillance System. Interrupted time series analysis was used to determine the rates of twinning, stillbirth, smaller than gestational age (SGA), and low Apgar scores (< 4) among twins in China. To estimate the risk of each adverse perinatal outcome for separate gestational weeks, a multivariate generalised linear model was used. Infants born at 37 weeks of gestational age or foetuses staying in utero were used as reference separately. The analyses were adjusted for the sampling distribution of the population and the cluster effect at the hospital and individual levels were considered. Results There were 442,268 infants enrolled in this study, and the adjusted rates for twinning, stillbirth, SGA, and low Apgar scores were 3.10%, 1.75%, 7.70%, and 0.79%, respectively. From 2012 to 2020, the twinning rate showed an increasing trend. Adverse perinatal outcomes, including stillbirth, SGA, and low Apgar scores showed a decreasing trend. A gestational age between 34 and 36 weeks decreased most for rate of stillbirth (average changing rate -9.72%, 95% confidence interval [CI] -11.41% to -8.00%); and a gestational age of between 37 and 38 weeks decreased most for rates of SGA (average changing rate -4.64%, 95% CI -5.42% to -3.85%) and low Apgar scores (average changing rate -17.61%, 95% CI -21.73% to -13.26%). No significant difference in changes in twinning rate or changes of each perinatal outcome was observed during periods of different fertility policies. Infants born at 37 weeks of gestation had a decreased risk of stillbirth, SGA, and low Apgar scores. Maternal antepartum or medical complications increased the risk of SGA and low Apgar scores in different gestational weeks. Conclusion China’s twinning rate showed an increasing trend, while adverse perinatal outcomes decreased from 2012 to 2020. Fertility policy changes have had little effect on the twinning rate or the rate of adverse perinatal outcomes such as stillbirth, SGA, or low Apgar scores. The optimal gestational age for twins was 37 weeks. Women pregnant with twins and with antepartum or medical complications should be cautious due to an increased risk of SGA and low Apgar scores. |
| first_indexed | 2024-12-12T03:16:23Z |
| format | Article |
| id | doaj.art-1d69627f887a46848472dd36babbe6b2 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-12T03:16:23Z |
| publishDate | 2022-06-01 |
| publisher | BMC |
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| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-1d69627f887a46848472dd36babbe6b22022-12-22T00:40:17ZengBMCBMC Pregnancy and Childbirth1471-23932022-06-0122111310.1186/s12884-022-04766-0Temporal trends and adverse perinatal outcomes of twin pregnancies at differing gestational ages: an observational study from China between 2012–2020Peiran Chen0Mingrong Li1Yi Mu2Yanping Wang3Zheng Liu4Qi Li5Xiaohong Li6Li Dai7Yanxia Xie8Juan Liang9Jun Zhu10National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan UniversityNational Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan UniversityNational Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan UniversityNational Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan UniversityNational Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan UniversityNational Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan UniversityNational Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan UniversityNational Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan UniversityNational Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan UniversityNational Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan UniversityNational Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan UniversityAbstract Background With the development of assisted reproductive technology, the twinning rate in China has been increasing. However, little is known about twinning from 2014 onwards. In addition, previous studies analysing optimal gestational times have rarely considered maternal health conditions. Therefore, whether maternal health conditions affect the optimal gestational time remains unclear. Methods Data of women delivered between January 2012 and December 2020 were collected through China’s National Maternal Near Miss Surveillance System. Interrupted time series analysis was used to determine the rates of twinning, stillbirth, smaller than gestational age (SGA), and low Apgar scores (< 4) among twins in China. To estimate the risk of each adverse perinatal outcome for separate gestational weeks, a multivariate generalised linear model was used. Infants born at 37 weeks of gestational age or foetuses staying in utero were used as reference separately. The analyses were adjusted for the sampling distribution of the population and the cluster effect at the hospital and individual levels were considered. Results There were 442,268 infants enrolled in this study, and the adjusted rates for twinning, stillbirth, SGA, and low Apgar scores were 3.10%, 1.75%, 7.70%, and 0.79%, respectively. From 2012 to 2020, the twinning rate showed an increasing trend. Adverse perinatal outcomes, including stillbirth, SGA, and low Apgar scores showed a decreasing trend. A gestational age between 34 and 36 weeks decreased most for rate of stillbirth (average changing rate -9.72%, 95% confidence interval [CI] -11.41% to -8.00%); and a gestational age of between 37 and 38 weeks decreased most for rates of SGA (average changing rate -4.64%, 95% CI -5.42% to -3.85%) and low Apgar scores (average changing rate -17.61%, 95% CI -21.73% to -13.26%). No significant difference in changes in twinning rate or changes of each perinatal outcome was observed during periods of different fertility policies. Infants born at 37 weeks of gestation had a decreased risk of stillbirth, SGA, and low Apgar scores. Maternal antepartum or medical complications increased the risk of SGA and low Apgar scores in different gestational weeks. Conclusion China’s twinning rate showed an increasing trend, while adverse perinatal outcomes decreased from 2012 to 2020. Fertility policy changes have had little effect on the twinning rate or the rate of adverse perinatal outcomes such as stillbirth, SGA, or low Apgar scores. The optimal gestational age for twins was 37 weeks. Women pregnant with twins and with antepartum or medical complications should be cautious due to an increased risk of SGA and low Apgar scores.https://doi.org/10.1186/s12884-022-04766-0TwinsTrendStillbirthSGALow apgar scoreGestational age |
| spellingShingle | Peiran Chen Mingrong Li Yi Mu Yanping Wang Zheng Liu Qi Li Xiaohong Li Li Dai Yanxia Xie Juan Liang Jun Zhu Temporal trends and adverse perinatal outcomes of twin pregnancies at differing gestational ages: an observational study from China between 2012–2020 BMC Pregnancy and Childbirth Twins Trend Stillbirth SGA Low apgar score Gestational age |
| title | Temporal trends and adverse perinatal outcomes of twin pregnancies at differing gestational ages: an observational study from China between 2012–2020 |
| title_full | Temporal trends and adverse perinatal outcomes of twin pregnancies at differing gestational ages: an observational study from China between 2012–2020 |
| title_fullStr | Temporal trends and adverse perinatal outcomes of twin pregnancies at differing gestational ages: an observational study from China between 2012–2020 |
| title_full_unstemmed | Temporal trends and adverse perinatal outcomes of twin pregnancies at differing gestational ages: an observational study from China between 2012–2020 |
| title_short | Temporal trends and adverse perinatal outcomes of twin pregnancies at differing gestational ages: an observational study from China between 2012–2020 |
| title_sort | temporal trends and adverse perinatal outcomes of twin pregnancies at differing gestational ages an observational study from china between 2012 2020 |
| topic | Twins Trend Stillbirth SGA Low apgar score Gestational age |
| url | https://doi.org/10.1186/s12884-022-04766-0 |
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