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Bajagain R, Karki C, Mahato S, Saha R, Saha N. Multiple Pregnancy among Deliveries in a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:927-930. [PMID: 36705171 PMCID: PMC9795090 DOI: 10.31729/jnma.7897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Multiple pregnancy is associated with increased obstetric complications as well as poor perinatal outcomes in developing countries because of the increased risk to both mother and baby. So better understanding of the risk factors is required to improve the quality of perinatal care. The aim of the study was to find out the prevalence of multiple pregnancies among deliveries in a tertiary care centre. Methods A descriptive cross-sectional study was done among total deliveries in the Department of Obstetrics and Gynaecology of a tertiary care centre from inpatient records starting from 15 August 2020 to 15 February 2021 after obtaining ethical approval from the Institutional Review Committee (Reference number: 1208202005). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results Out of 4400 deliveries, multiple pregnancy was seen in 35 (0.79%) (0.53-1.06, 95% Confidence Interval). Conclusions The prevalence of multiple pregnancies was similar to the studies done in similar settings. Keywords low birth weight; multiple pregnancy; preterm.
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Affiliation(s)
- Rupa Bajagain
- Department of Obstetrics and Gynaecology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Chandrima Karki
- Department of Obstetrics and Gynaecology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Shilpi Mahato
- Department of Obstetrics and Gynaecology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Rachana Saha
- Department of Obstetrics and Gynaecology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Nitu Saha
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Anil S, Kuppan A, Samuel V, Mahesh R, Jaganath PM. Twinning rates in Chennai, India – A cross-sectional study. J Family Med Prim Care 2022; 11:1450-1454. [PMID: 35516699 PMCID: PMC9067235 DOI: 10.4103/jfmpc.jfmpc_1223_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/15/2021] [Accepted: 12/14/2021] [Indexed: 11/04/2022] Open
Abstract
Context: Aims: Settings and Design: Satistical Analysis Used: Results: Conclusions:
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Singh C, Thakur S, Shahnaz G, Dagar S, Shastri A, Khurana D. Clinical outcomes in higher-order multiples reduced to dichorionic diamniotic (DCDA) twins compared with primary twins and singletons: A prospective observational study. Int J Gynaecol Obstet 2021; 157:671-676. [PMID: 34460958 DOI: 10.1002/ijgo.13901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/18/2021] [Accepted: 09/26/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare outcomes in higher-order multiple pregnancies reduced to dichorionic diamniotic (DCDA) twins with primary DCDA twins and singleton pregnancies. METHODS This prospective observational study included all higher-order multiple pregnancies that underwent ultrasound-guided transabdominal fetal reduction at 11-13 weeks of gestation from January 2018 to June 2020. Outcomes were compared with 100 primary DCDA twins and 1078 singletons. RESULTS Sixty-four higher-order multiples underwent reduction at mean gestational age of 11.46 weeks. Of the reduced pregnancies, 3.12% resulted in miscarriage before 24 weeks compared with 2% (2/100) of primary twins and 0.74% of singletons (P = 0.09). The mean gestational age at delivery was 33.48 weeks for reduced twins, 34.52 weeks for primary twins (P = 0.10) and 38.14 weeks for singletons (P < 0.001). Compared with primary twins, the adjusted odds of preterm delivery before 34 weeks and before 36 weeks for reduced twins were 0.56 (95% confidence interval [CI] 0.48-3.54, P = 0.62) and 0.84 (95% CI 0.78-8.85, P = 0.08), respectively. There was no significant difference in rates of pre-eclampsia, Cesarean delivery, birth weight below the 10th and 3rd centiles, and perinatal mortality among primary and reduced twins. All risks were significantly lower in singleton pregnancies. CONCLUSION Reduced twins have similar obstetric and perinatal outcomes as primary twins, but adverse outcomes are significantly higher in both groups when compared with singleton pregnancies.
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Affiliation(s)
- Chanchal Singh
- Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, New Delhi, India
| | - Seema Thakur
- Department of Medical Genetics and Fetal Medicine, Madhukar Rainbow Children's Hospital, New Delhi, India
| | - Gazala Shahnaz
- Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, New Delhi, India
| | - Savita Dagar
- Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, New Delhi, India
| | - Aditi Shastri
- Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, New Delhi, India
| | - Deeksha Khurana
- Indian Institute of Public Health, Public Health Foundation of India, Bengaluru, India
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Twinning and Multiple Birth Rates According to Maternal Age in the City of São Paulo, Brazil: 2003–2014. Twin Res Hum Genet 2016; 19:679-686. [DOI: 10.1017/thg.2016.75] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The present study investigates the twinning rates in the city of São Paulo, Brazil, during the years 2003–2014. The data were drawn from the Brazilian Health Department database of Sistema de Informações de Nascidos Vivos de São Paulo—SINASC (Live Births Information System of São Paulo). In general, more information is available on the incidence of twinning in developed countries than in developing ones. A total of 24,589 twin deliveries and 736 multiple deliveries were registered in 140 hospitals of São Paulo out of a total of 2,056,016 deliveries during the studied time period. The overall average rates of singleton, twin, and multiple births per 1,000 maternities (‰) were 987.43, 11.96 (dizygotic (DZ) rate was 7.15 and monozygotic (MZ) 4.42), and 0.36, respectively. We further regressed maternal age and historical time period on percentage of singleton, twin, and multiple birth rates. Our results indicated that maternal age strongly positively predicted twin and multiple birth rates, and negatively predicted singleton birth rates. The historical time period also positively, although weakly, predicted twin birth rates, and had no effect on singleton or multiple birth rates. Further, after applying Weinberg's differential method, we computed regressions separately for the estimated frequencies of DZ and MZ twin rates. DZ twinning was strongly positively predicted by maternal age and, to a smaller degree, by time period, while MZ twinning increased marginally only with higher maternal age. Factors such as increasing body mass index or air pollution can lead to the slight historical increase in DZ twinning rates. Importantly, consistent with previous cross-cultural and historical research, our results support the existence of an age-dependent physiological mechanism that leads to a strong increase in twinning and multiple births, but not singleton births, among mothers of higher age categories. From the ultimate perspective, twinning and multiple births in later age can lead to higher individual reproductive success near the end of the reproductive career of the mother.
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Huang H, Clancy KBH, Burhance C, Zhu Y, Madrigal L. Women who deliver twins are more likely to smoke and have high frequencies of specific SNPs: Results from a sample of African-American women who delivered preterm, low birth weight babies. Am J Hum Biol 2015; 27:605-12. [PMID: 25882505 DOI: 10.1002/ajhb.22723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/16/2015] [Accepted: 03/03/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES We examine if there are genetic and environmental differences between mothers of singleton and multiple pregnancies in a sample of African-American mothers. METHODS We focus on genomic areas suggested to increase or decrease the odds of multiple pregnancies. We computed the odds ratio (OR) and the 95% confidence interval (CI) for each SNP unadjusted or adjusted with smoking. SNPs' allelic differences between mothers of multiple pregnancies and singletons were also tested using Fisher's exact test. We considered additive terms for the SNPs' genotypes, smoking, and a multiplicative interaction term of two selected SNPs' genotypes. RESULTS We found significant interactions between smoking and SNPs of the CYP19A, MDM4, MTHFR and TP53 genes which correlated with higher odds of twinning. We also found a significant interaction between SNPs at the TP53 (rs8079544) and MTHFR gene (rs4846049), where the interaction between the homozygotes (TT for rs8079544, GG for rs4846049) correlated with lowered odds of multiple pregnancy. CONCLUSIONS We provide a mechanistic explanation and preliminary evidence for previous reports that mothers of twins are more likely to have smoked, despite seemingly conflicting evidence for the fertility-reducing effects of nicotine. Nicotine, as an aromatase inhibitor, inhibits estrogen synthesis and may allow for greater production of gonadotropins. While smoking may have deleterious effects on fertility across many genotypes, in women of specific genotypes it may raise their odds of producing twins. TP53 involvement suggests the necessity of future work examining relationships between women who bear multiples and cancer risk.
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Affiliation(s)
- Hong Huang
- School of Information, University of South Florida, 4202 E. Fowler Av, Tampa, Florida, 33620
| | - Kathryn B H Clancy
- Department of Anthropology, University of Illinois at Urbana-Champaign, 109 Davenport Hall, 607 S. Mathews Ave., Urbana, Illinois, 61801
| | - Crystal Burhance
- Department of Anthropology, University of South Florida, 4202 E. Fowler Av, Tampa, Florida, 33620
| | - Yilliang Zhu
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida
| | - Lorena Madrigal
- Department of Anthropology, University of South Florida, 4202 E. Fowler Av, Tampa, Florida, 33620
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Multiple births in sub-saharan Africa: epidemiology, postnatal survival, and growth pattern. Twin Res Hum Genet 2014; 18:100-7. [PMID: 25544149 DOI: 10.1017/thg.2014.82] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The study endeavored to assess the epidemiology, postnatal survival, and growth pattern of multiple births in Sub-Saharan Africa (SSA). It was based on the data of 25 demographic health surveys conducted in the subcontinent since 2008. The records of 213,889 children born in the preceding 59 months of the surveys were included. The multiple birth rate was computed as the number of multiple confinements per 1,000 births. Factors associated with multiple births were identified using logistic regression and their survival pattern was assessed using the Kaplan-Meier method. The multiple birth rate was 17.1 (95% confidence interval: 17.7-16.6) and showed considerable variation across the 25 countries included in the study. Odds of multiple births were significantly increased with advanced maternal age, parity, and maternal height but not with wealth index, age at first birth, and month of birth. At the end of the fourth year of age, the cumulative survival probability was as low as 0.77 in multiple births as compared to 0.93 in their counterparts. The odds of neonatal, infant and under-five mortality were 5.55, 4.39, and 3.72 times increased in multiple births, respectively. Multiple births tend to be malnourished than singletons and the odds of wasting, stunting, and underweight were 1.31, 1.83, and 1.73 times raised, consecutively. Nevertheless, multiple births regain their weight-for-age (WFA) and height-for-age (HFA) deficits by the end of the fourth year of age. Counseling pregnant mothers with multiple gestation to give birth at a health institution and providing close medical follow-up during and after the neonatal period can improve the survival of multiple births.
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Abstract
Twins are two independent babies delivered during the same pregnancy and are divided as monozygotic or dizygotic based on their origin. Dizygotic twins are similar to two siblings and have different genetic information. In contrary, monozygotic twins have a similar genetic identity and provide a unique opportunity to evaluate the contribution of genetic and environmental factors of the disease. The endocrine and metabolic disorders affect a large number of the population including the twins. Diabetes, obesity, and autoimmune thyroid disease are the most common endocrine disorders in general practice. It is essential to understand the genetic basis of endocrine disorders for therapy, prognostication and risk assessment for future generations. In this article, we review the endocrine disorders in relation to their occurrence in monozygotic twins to highlight the genetic and environmental contribution.
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Affiliation(s)
| | - K. D. Modi
- Department of Endocrinology, CARE Hospitals, Hyderabad, Telangana, India
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Gupta P, Faridi MM, Goel N, Zaidi ZH. Reappraisal of twinning: epidemiology and outcome in the early neonatal period. Singapore Med J 2014; 55:310-7. [PMID: 25017406 PMCID: PMC4294058 DOI: 10.11622/smedj.2014083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The present study aimed to determine the epidemiology, maternal complications and adverse neonatal outcomes associated with twin births at a tertiary care hospital in India. METHODS A prospective observational study was conducted on all successively born twin pairs (≥ 23 weeks of gestation) and their mothers from January to September 2005. Main outcome measures included maternal medical/obstetric complications, labour characteristics and the morbidities/mortality observed during the early neonatal period. RESULTS The twinning rate was 1 in 54 deliveries. Around 10% of mothers had a predisposition for twinning in the form of familial tendency or consumption of clomiphene. Anaemia (85%) was the most common maternal complication, followed by gestational hypertension (17%). Nearly one-third of births were delivered via Caesarean section. Prematurity (61%) was the most common neonatal complication followed by early-onset neonatal sepsis (21%). The risk of early neonatal death was 27%. Shorter gestation and low birth weight were significantly associated with adverse neonatal outcome (p < 0.05). Factors such as chorionicity, mode of delivery, birth order, inter-twin delivery time interval, gender and intra-pair birth weight discordance did not affect neonatal morbidity or mortality (p ≥ 0.05). CONCLUSION The rates of maternal complications and early neonatal morbidities/mortality were quite high in twin gestations. Except for the prematurity and low birth weight, none of the other factors, including inter-twin delivery time interval of more than 15 mins, were found to affect neonatal outcome.
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Affiliation(s)
- P Gupta
- WZ-D/14-15, Dayal Sir Road, Uttam Nagar, New Delhi 110059, India.
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Conroy J, McGettigan PA, McCreary D, Shah N, Collins K, Parry-Fielder B, Moran M, Hanrahan D, Deonna TW, Korff CM, Webb D, Ennis S, Lynch SA, King MD. Towards the identification of a genetic basis for Landau-Kleffner syndrome. Epilepsia 2014; 55:858-65. [DOI: 10.1111/epi.12645] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2014] [Indexed: 01/15/2023]
Affiliation(s)
- Judith Conroy
- Department of Genetics; Children's University Hospital; Dublin Ireland
- Academic Centre on Rare Diseases; School of Medicine and Medical Science; University College Dublin; Dublin Ireland
| | - Paul A. McGettigan
- Academic Centre on Rare Diseases; School of Medicine and Medical Science; University College Dublin; Dublin Ireland
- School of Agriculture and Food Science; University College Dublin; Dublin Ireland
| | - Dara McCreary
- Department of Neurology; Children's University Hospital; Dublin Ireland
| | - Naisha Shah
- School of Medicine and Medical Science; University College Dublin; Dublin Ireland
| | | | | | - Margaret Moran
- Department of Neurology; Children's University Hospital; Dublin Ireland
- Royal Children's Hospital; Melbourne VIC Australia
| | - Donncha Hanrahan
- Royal Belfast Hospital for Sick Children; Belfast United Kingdom
| | | | | | - David Webb
- Department of Neurology; Our Lady's Children's Hospital Crumlin; Dublin Ireland
| | - Sean Ennis
- Academic Centre on Rare Diseases; School of Medicine and Medical Science; University College Dublin; Dublin Ireland
- The National Centre for Medical Genetics; Our Lady's Children's Hospital Crumlin; Dublin Ireland
| | - Sally A. Lynch
- Department of Genetics; Children's University Hospital; Dublin Ireland
- Academic Centre on Rare Diseases; School of Medicine and Medical Science; University College Dublin; Dublin Ireland
- The National Centre for Medical Genetics; Our Lady's Children's Hospital Crumlin; Dublin Ireland
| | - Mary D. King
- Academic Centre on Rare Diseases; School of Medicine and Medical Science; University College Dublin; Dublin Ireland
- Department of Neurology; Children's University Hospital; Dublin Ireland
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Adegbola O, Akindele OM. Twin pregnancies in Sub-Saharan Africa - Lagos experience. J Matern Fetal Neonatal Med 2012; 25:2447-50. [PMID: 22712669 DOI: 10.3109/14767058.2012.703717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A total of 2,879 deliveries were conducted within 2 years and 92 were twin deliveries constituting 3.2% or 1 in 31 deliveries. The mean age and parity was 30.4 ± 3.9 years and 1.3 ± 1.4 respectively. Male infants constituted 54.4% of the twins with a sex ratio of 1.2 boys to 1.0 girl. Among twin deliveries, presentation of cephalic-cephalic was the commonest. Caesarean section rate was 65.2% in the overall twin pregnancies. Commonest indication for perinatal admission was prematurity. None of the twins delivered before 28 weeks gestation survived whereas survival was almost certain from 32 weeks gestation. There was generally no significance difference in the outcome of the babies with respect to chorionicity. Perinatal mortality was high compared with that of singleton with prematurity being the leading cause of death.
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Affiliation(s)
- Omololu Adegbola
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria.
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