Double jeopardy: twin infant mortality in the United States, 1983 and 1984

Article Abstract:

Pregnancies involving twins have a higher risk for complications and fetal death from the time of conception than do single pregnancies. Twins have a higher perinatal death rate and a higher infant mortality than single infants. Few studies have documented the factors associated with the increased mortality seen with twins. This study examined the factors associated with infant mortality in both black and white twins. Data were obtained from the Linked Birth/Infant Death Data Sets for 1983 and 1984 from the National Center for Health Statistics. Both maternal and twin infant characteristics were examined. Data were available for 41,554 white and 10,062 black twin pairs born alive during the two study years; of these, 30,191 and 6,572 respectively were same sex pairs. One third of white twins and two thirds of black twins were born with low birth weights and 9 percent of white twins and 16 percent of black twins born with very low birth weights. These percentages were much higher than for single birth infants. There were 3,911 white and 1,595 black infant twin deaths, for an infant mortality of 47.1 and 79.3 per thousand respectively - almost five times that for singleton births. Mortality was highest for infants born with very low birth weights. Pregnancies in which white twins of the same sex or whose weight differed by more than 25 percent were much more likely to result in a death than pregnancies involving white twins of different sex. These differences were not as pronounced in black twins. The leading causes of death were ones associated with low birth weight and included respiratory distress syndrome, other respiratory problems, and disorders of brief gestation. Congenital abnormalities were the underlying cause in 10 percent of white and 5 percent of black twin infant deaths. Characteristics of the mother that were associated with increased risk for infant death included high-risk behavior such as smoking or poor nutritional habits. These results indicate that the high risks for complications seen in twins are partially caused by the higher rate of low birth weights and by some maternal characteristics. Efforts should focus on strategies to prevent and treat low birth weights in twin infants and to alter maternal characteristics that adversely affect unborn twins. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Infants, Infant mortality

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Reduction of cardiovascular disease-related mortality among postmenopausal women who use hormones: evidence from a national cohort

Article Abstract:

Considerable evidence exists to show that women who take estrogen (a female hormone) supplements after menopause have a reduced risk for cardiovascular disease; however, research results have been contradictory and often based on short follow-up periods. The National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, performed on a large sample of women who were followed for up to 16 years, addressed this issue. The current report reviews data from 1,807 white women whose average age was 65.7 years at the time the study began (between 1971 and 1975). Menopause was categorized as natural (1,377 women) or surgical (430 women, resulting from the removal of the ovaries). The subjects' histories of smoking, cholesterol levels, blood pressure, diabetic status, and hormonal use were evaluated. Results showed that women who underwent surgical menopause had a higher rate of hormone use than those who underwent natural menopause, and hormone users had lower blood pressure, rates of diabetes, and body mass index. A greater proportion of hormone users than nonusers had a smoking history. While users and nonusers had similar cholesterol levels and histories of myocardial infarction (heart attack), women using hormone supplements had a risk of death from cardiovascular disease that was 34 percent lower than that of nonusers. An elevated risk of death from cardiovascular disease was found for women with a history of diabetes, previous myocardial infarction, smoking history, or high blood pressure. These findings indicate that women who use hormone supplements after menopause reduce their risk of death due to cardiovascular diseases. The majority of subjects studied took estrogen alone; current approaches use combinations of female hormones. Additional research is needed to evaluate the effects of these agents on mortality from cardiovascular disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Reports, Cardiovascular diseases, Prevention, Menopause, Postmenopausal women, Estrogen, Estrogens, National Health and Nutrition Examination Survey

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Twin delivery: influence of the presentation and method of delivery on the second twin

Article Abstract:

The best route for delivering twins, either vaginally or by cesarean, is a continuing source of controversy. Many doctors prefer cesarean delivery, especially when either or both twins are not positioned head first. They believe that twin infant mortality and morbidity (disease or injury) will thus be reduced. Between 1980 and 1985, the rate of cesarean section increased from 25 to 40 percent of twin deliveries. A review of twin deliveries in a hospital for the period covering 1980 to 1987 was performed to examine morbidity and mortality for twin pregnancies in relation to type of delivery. Only data were included from twin deliveries where the first twin presented head first at birth (vertex), no lethal anomalies were involved, and each twin weighed more than 1,000 grams; a total of 397 sets of twins fit these requirements. Results showed that 10 stillbirths occurred in 7 twin sets, and nonlabor cesareans were performed in 25 cases. These 32 cases were excluded from the final results. Cesarean was performed in 79 cases, of which 11 only involved the second twin. There were 116 cases where vaginal delivery was performed and the second twin was in a breech or bottom-first birth position. Only in one case did the second twin die during delivery. This resulted from twin-to-twin transfusion. No other deaths during delivery occurred in the other groups. There was one infant death following delivery and a number of infants suffered diseases following delivery such as respiratory distress syndrome. These were related to the infant's birth weight or to premature birth, but did not correlate with birth position or type of delivery. These results indicate that vaginal delivery is completely safe for delivering second twins, even when they are in a breech position, unless other complicating factors such a low birth weight or prematurity are involved. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Cesarean section

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