Maternal Morbidity and Mortality in Multiple Pregnancy

描述(申请人提供)：2002年，美国有超过132,500个多胞胎，是有记录以来最高的数字。自1980年以来，多胞胎的发生率急剧上升，双胞胎增加了83%，三胞胎和更高级别的出生(四胞胎和五胞胎)增加了453%以上。与单胞胎相比，多胞胎婴儿更有可能早产和出生体重极低，这些都是导致他们过高发病率和死亡率的重要因素。相比之下，人们对多胎妊娠如何影响母亲健康的了解要少得多。基于医院的研究报告了更高的先兆子痫、妊娠期糖尿病、胎膜早破、早产以及危及生命的并发症和产妇进入重症监护的比率。然而，这些研究受到样本量小以及经常未能控制母亲年龄和产次等混杂因素的限制。本申请中提出的研究的目的是通过使用国家生命统计数据来计算按产妇年龄、种族和产次划分的多个具体发病率和死亡率风险，以填补这一知识空白。这项研究将使用三个国家的数据集：1995-2000年的配对多胎出生数据集(双胞胎和三胞胎怀孕的产妇发病率)，1990-2000年的活产数据集(单胎妊娠的产妇发病率)，以及1990-2000年的死亡多原因死亡数据集(单胎、双胞胎和三胞胎怀孕的产妇死亡)，研究样本为42,736,904个单胎活产，322,758对双胞胎配对，12,133对三胞胎配对，以及3,580名产妇死亡。根据2003年修订的活产证明，还将分析另外811,929例怀孕(799,422个单胞胎，11,999个双胞胎和508个三胞胎)的数据，以通过受孕方法确定产妇发病率和死亡风险。这一建议的主要假设是，较高的多元性是影响产妇发病率和死亡率的主要因素，较大的产妇年龄和初产进一步加强了这一假设。

DESCRIPTION (provided by applicant): In 2002, there were more than 132,500 multiple births in the United States, the highest number ever recorded. The incidence of multiple births has risen dramatically since 1980, with an 83% increase in twins and more than a 453% increase in triplets and higher-order births (quadruplets and quintuplets). Compared to singletons, infants of multiple births are much more likely to be born early preterm and very low birthweight, important well-documented factors that contribute to their excess morbidity and mortality. In contrast, far less is known about how multiple pregnancies affects the health of the mother. Hospital-based studies report higher rates of preeclampsia, gestational diabetes, PPROM, preterm labor, as well as life threatening complications and maternal admission to intensive care. These studies are limited, though, by their small sample sizes and frequent failure to control for the confounding factors of maternal age and parity. The objective of the study proposed in this application is to fill this knowledge gap by using national vital statistics data to formulate plurality-specific morbidity and mortality risks by maternal age, race, and parity. Three national data sets will be used for this study: the Matched Multiple Birth Data Set for 1995-2000 (for maternal morbidity in twin and triplet pregnancies), the Live Birth Data Set for 1990-2000 (for maternal morbidity in singleton pregnancies), and the Mortality Multiple Cause of Death Data Set for 1990-2000 (for maternal deaths in singleton, twin, and triplet pregnancies), for a study sample of 42,736,904 singleton live births, 322,758 matched sets of twins, 12,133 matched sets of triplets, and 3,580 maternal deaths. Data on an additional 811,929 pregnancies (799,422 singletons, 11,999 twins, and 508 triplets) based on the 2003 revision of the live birth certificate will also be analyzed to determine maternal morbidity and mortality risks by method of conception. The main hypothesis of this proposal is that higher plurality is the predominant factor affecting maternal morbidity and mortality, further potentated by older maternal age and primiparity.