Perinatal outcomes of multiple-gestation pregnancies in Kenya, Zambia, Pakistan, India, Guatemala, and Argentina

A global network study

Irene Marete, Constance Tenge, Omrana Pasha, Shivaprasad Goudar, Elwyn Chomba, Archana Patel, Fernando Althabe, Ana Garces, Elizabeth M. McClure, Sarah Saleem, Fabian Esamai, Bhala S. Kodkany, Jose M. Belizan, Richard J. Derman, Patricia L. Hibberd, Nancy Krebs, Pierre Buekens, Robert L. Goldenberg, Waldemar A. Carlo, Dennis Wallace & 4 others Janet Moore, Marion Koso-Thomas, Linda L. Wright, Edward A. Liechty

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Aim To determine the rates of multiple gestation, stillbirth, and perinatal and neonatal mortality and to determine health care system characteristics related to perinatal mortality of these pregnancies in low- and middle-income countries. Methods Pregnant women residing within defined geographic boundaries located in six countries were enrolled and followed to 42 days postpartum. Results Multiple gestations were 0.9% of births. Multiple gestations were more likely to deliver in a health care facility compared with singletons (70 and 66%, respectively, p < 0.001), to be attended by skilled health personnel (71 and 67%, p < 0.001), and to be delivered by cesarean (18 versus 9%, p < 0.001). Multiple-gestation fetuses had a relative risk (RR) for stillbirth of 2.65 (95% confidence interval [CI] 2.06, 3.41) and for perinatal mortality rate (PMR) a RR of 3.98 (95% CI 3.40, 4.65) relative to singletons (both p < 0.0001). Neither delivery in a health facility nor the cesarean delivery rate was associated with decreased PMR. Among multiple-gestation deliveries, physician-attended delivery relative to delivery by other health providers was associated with a decreased risk of perinatal mortality. Conclusions Multiple gestations contribute disproportionately to PMR in low-resource countries. Neither delivery in a health facility nor the cesarean delivery rate is associated with improved PMR.

Original languageEnglish
Pages (from-to)125-132
Number of pages8
JournalAmerican Journal of Perinatology
Volume31
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Guatemala
Zambia
Multiple Pregnancy
Perinatal Mortality
Kenya
Pakistan
Argentina
India
Pregnancy
Health Facilities
Stillbirth
Mortality
Confidence Intervals
Delivery of Health Care
Infant Mortality
Health Personnel
Postpartum Period
Pregnant Women
Fetus
Parturition

Keywords

  • developing countries
  • multiples gestation
  • perinatal mortality rate
  • stillbirth
  • twins

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Perinatal outcomes of multiple-gestation pregnancies in Kenya, Zambia, Pakistan, India, Guatemala, and Argentina : A global network study. / Marete, Irene; Tenge, Constance; Pasha, Omrana; Goudar, Shivaprasad; Chomba, Elwyn; Patel, Archana; Althabe, Fernando; Garces, Ana; McClure, Elizabeth M.; Saleem, Sarah; Esamai, Fabian; Kodkany, Bhala S.; Belizan, Jose M.; Derman, Richard J.; Hibberd, Patricia L.; Krebs, Nancy; Buekens, Pierre; Goldenberg, Robert L.; Carlo, Waldemar A.; Wallace, Dennis; Moore, Janet; Koso-Thomas, Marion; Wright, Linda L.; Liechty, Edward A.

In: American Journal of Perinatology, Vol. 31, No. 2, 02.2014, p. 125-132.

Research output: Contribution to journalArticle

Marete, I, Tenge, C, Pasha, O, Goudar, S, Chomba, E, Patel, A, Althabe, F, Garces, A, McClure, EM, Saleem, S, Esamai, F, Kodkany, BS, Belizan, JM, Derman, RJ, Hibberd, PL, Krebs, N, Buekens, P, Goldenberg, RL, Carlo, WA, Wallace, D, Moore, J, Koso-Thomas, M, Wright, LL & Liechty, EA 2014, 'Perinatal outcomes of multiple-gestation pregnancies in Kenya, Zambia, Pakistan, India, Guatemala, and Argentina: A global network study', American Journal of Perinatology, vol. 31, no. 2, pp. 125-132. https://doi.org/10.1055/s-0033-1338173
Marete, Irene ; Tenge, Constance ; Pasha, Omrana ; Goudar, Shivaprasad ; Chomba, Elwyn ; Patel, Archana ; Althabe, Fernando ; Garces, Ana ; McClure, Elizabeth M. ; Saleem, Sarah ; Esamai, Fabian ; Kodkany, Bhala S. ; Belizan, Jose M. ; Derman, Richard J. ; Hibberd, Patricia L. ; Krebs, Nancy ; Buekens, Pierre ; Goldenberg, Robert L. ; Carlo, Waldemar A. ; Wallace, Dennis ; Moore, Janet ; Koso-Thomas, Marion ; Wright, Linda L. ; Liechty, Edward A. / Perinatal outcomes of multiple-gestation pregnancies in Kenya, Zambia, Pakistan, India, Guatemala, and Argentina : A global network study. In: American Journal of Perinatology. 2014 ; Vol. 31, No. 2. pp. 125-132.
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T1 - Perinatal outcomes of multiple-gestation pregnancies in Kenya, Zambia, Pakistan, India, Guatemala, and Argentina

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AU - Marete, Irene

AU - Tenge, Constance

AU - Pasha, Omrana

AU - Goudar, Shivaprasad

AU - Chomba, Elwyn

AU - Patel, Archana

AU - Althabe, Fernando

AU - Garces, Ana

AU - McClure, Elizabeth M.

AU - Saleem, Sarah

AU - Esamai, Fabian

AU - Kodkany, Bhala S.

AU - Belizan, Jose M.

AU - Derman, Richard J.

AU - Hibberd, Patricia L.

AU - Krebs, Nancy

AU - Buekens, Pierre

AU - Goldenberg, Robert L.

AU - Carlo, Waldemar A.

AU - Wallace, Dennis

AU - Moore, Janet

AU - Koso-Thomas, Marion

AU - Wright, Linda L.

AU - Liechty, Edward A.

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N2 - Aim To determine the rates of multiple gestation, stillbirth, and perinatal and neonatal mortality and to determine health care system characteristics related to perinatal mortality of these pregnancies in low- and middle-income countries. Methods Pregnant women residing within defined geographic boundaries located in six countries were enrolled and followed to 42 days postpartum. Results Multiple gestations were 0.9% of births. Multiple gestations were more likely to deliver in a health care facility compared with singletons (70 and 66%, respectively, p < 0.001), to be attended by skilled health personnel (71 and 67%, p < 0.001), and to be delivered by cesarean (18 versus 9%, p < 0.001). Multiple-gestation fetuses had a relative risk (RR) for stillbirth of 2.65 (95% confidence interval [CI] 2.06, 3.41) and for perinatal mortality rate (PMR) a RR of 3.98 (95% CI 3.40, 4.65) relative to singletons (both p < 0.0001). Neither delivery in a health facility nor the cesarean delivery rate was associated with decreased PMR. Among multiple-gestation deliveries, physician-attended delivery relative to delivery by other health providers was associated with a decreased risk of perinatal mortality. Conclusions Multiple gestations contribute disproportionately to PMR in low-resource countries. Neither delivery in a health facility nor the cesarean delivery rate is associated with improved PMR.

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KW - developing countries

KW - multiples gestation

KW - perinatal mortality rate

KW - stillbirth

KW - twins

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