Differences in outcome between twins and singletons born very preterm: results from a population-based European cohort
Differences in outcome between twins and singletons born very preterm: results from a population-based European cohort
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DOI：
10.1093/humrep/dep430
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发表时间：
2010-04-01
影响因子：
6.1
通讯作者：
Draper, Elizabeth S.
中科院分区：
文献类型：
--
作者：
Papiernik, Emile;Zeitlin, Jennifer;Draper, Elizabeth S.
大约10%的双胞胎是在怀孕32周之前出生的，而且早产率正在上升。早产双胞胎往往比相同胎龄的单胞胎有更好的结局，但可用于极早产儿的数据较少。这项研究旨在确定早产双胞胎和单胎之间的结局是否不同。这项研究是在2003年对欧洲10个地区的极早产儿进行的基于人群的队列研究。对怀孕24周和31周的双胞胎和单胞胎的死亡率和出院发病率进行了比较，这些双胞胎和单胞胎在分娩开始时还活着，没有致命的先天性异常。在考虑了临床特征、妊娠并发症和保健因素后，双胞胎在孕28周至31周之间的死亡率和36周矫正孕期的氧依赖低于单胎(分别为3.9%比6.5%和7.1%比10.4%)，但在控制了医疗和保健因素后，这一优势消失了。高血压、生长受限和出血是双胞胎出生的较少常见并发症，更多的双胞胎在产前接受皮质类固醇治疗，并出生在III级单位。相比之下，在妊娠24至27周期间，双胞胎的调整死亡率和III/IV级脑室出血的调整风险更高[调整后OR为1.5(95%可信区间1.1-2.2)和1.5(1.0-2.1)]。这些不良后果集中在出生体重不一致的同性双胞胎中。在怀孕24周到27周之间，如果出生体重不一致的同性双胞胎，双胞胎死亡和严重脑出血的风险比单胞胎高。
About 10% of twins are born before 32 weeks of gestation and very preterm birth rates are increasing. Preterm twins tend to have more favourable outcomes than singletons of the same gestational age, but fewer data are available for very preterm infants. This study aims to determine whether outcomes differ between very preterm twins and singletons.This study was of a population-based cohort of very preterm babies in 10 European regions in 2003. Mortality and morbidity to discharge from hospital were compared for twins and singletons between 24 and 31 weeks of gestation, who were alive at the onset of labour and without lethal congenital anomalies. Clinical characteristics, pregnancy complications and healthcare factors were taken into consideration.Between 28 and 31 weeks of gestation, mortality and oxygen dependency at 36 corrected weeks of gestation were lower for twins than singletons (3.9 versus 6.5% and 7.1 versus 10.4%, respectively), but this advantage disappeared after controlling for medical and healthcare factors. Hypertension, growth restriction and haemorrhaging were less frequent complications of twin birth and more twins received antenatal corticosteroids and were born in level III units. In contrast, between 24 and 27 weeks of gestation, twins had higher adjusted risks of mortality and Grade III/IV intraventricular haemorrhaging [adjusted ORs 1.5 (95% CI 1.1-2.2) and 1.5 (1.0-2.1)]. These adverse outcomes were concentrated among twins from same sex pairs with discordant birthweights.Between 24 and 27 weeks of gestation, risks of mortality and severe cranial haemorrhaging were higher for twins than singletons if they were from same sex pairs with discordant birthweights.