Twinning rates and survival of twins in rural Nepal

Joanne Katza, Keith West, Subarna K. Khatryb, Steven C. LeClerq, Parul S Christian, Elizabeth Kimbrough Pradhana, Sharada Ram Shresthab

Research output: Contribution to journalArticle

Abstract

Background. Twin pregnancies are common but there are few data on rates of twinning or survival of liveborn twin infants in developing countries. Methods. The rates of multiple births were calculated in a population-based cohort of married women of childbearing age who were enrolled in a randomized community trial to assess the impact of vitamin A or beta-carotene on maternal and infant health and survival. Results. The rate of twinning was 16.1 per 1000 pregnancies (7.4 if only twin pregnancies resulting in two liveborn infants were used). The rate for triplets and quadruplets was 0.19 and 0.06 per 1000 pregnancies. Twinning rates were higher among women of higher parity, but were not associated with maternal age. Twinning rates among twins where at least one was live born (or increased in utero survival) were 30% (95% CI : -1%, 71%) and 44% (95% CI : 9%, 89%) higher among women receiving vitamin A and beta-carotene supplements than placebo, after adjusting for maternal age, gestational age, and parity. The perinatal mortality rate was 8.54 times higher for twins than singletons, 7.32 higher for neonatal mortality, and 5.84 higher for cumulative 24-week mortality. This difference was reduced but not erased by adjusting for gestational age. No difference in survival of liveborn twin infants was seen by supplement group. A higher mortality rate among male twins was largely explained by gestational age. Conclusions. Multiple births are relatively common occurrences in rural Nepal, and carry a much higher mortality risk for the infants than for singletons. Vitamin A or beta-carotene supplementation appeared to increase the rate of twinning, or improve the survival of twins in utero, but did not increase twin survival after birth.

Original languageEnglish (US)
Pages (from-to)802-807
Number of pages6
JournalInternational Journal of Epidemiology
Volume30
Issue number4
StatePublished - 2001

Fingerprint

Nepal
Survival Rate
Survival
beta Carotene
Vitamin A
Gestational Age
Multiple Birth Offspring
Twin Pregnancy
Maternal Age
Infant Mortality
Parity
Mortality
Pregnancy
Perinatal Mortality
Developing Countries
Placebos
Parturition
Population

Keywords

  • Beta-carotene
  • Infant mortality
  • Neonatal mortality
  • Nepal
  • Perinatal mortality
  • Pregnancy
  • Twins
  • Vitamin A

ASJC Scopus subject areas

  • Epidemiology

Cite this

Katza, J., West, K., Khatryb, S. K., LeClerq, S. C., Christian, P. S., Pradhana, E. K., & Shresthab, S. R. (2001). Twinning rates and survival of twins in rural Nepal. International Journal of Epidemiology, 30(4), 802-807.

Twinning rates and survival of twins in rural Nepal. / Katza, Joanne; West, Keith; Khatryb, Subarna K.; LeClerq, Steven C.; Christian, Parul S; Pradhana, Elizabeth Kimbrough; Shresthab, Sharada Ram.

In: International Journal of Epidemiology, Vol. 30, No. 4, 2001, p. 802-807.

Research output: Contribution to journalArticle

Katza, J, West, K, Khatryb, SK, LeClerq, SC, Christian, PS, Pradhana, EK & Shresthab, SR 2001, 'Twinning rates and survival of twins in rural Nepal', International Journal of Epidemiology, vol. 30, no. 4, pp. 802-807.
Katza J, West K, Khatryb SK, LeClerq SC, Christian PS, Pradhana EK et al. Twinning rates and survival of twins in rural Nepal. International Journal of Epidemiology. 2001;30(4):802-807.
Katza, Joanne ; West, Keith ; Khatryb, Subarna K. ; LeClerq, Steven C. ; Christian, Parul S ; Pradhana, Elizabeth Kimbrough ; Shresthab, Sharada Ram. / Twinning rates and survival of twins in rural Nepal. In: International Journal of Epidemiology. 2001 ; Vol. 30, No. 4. pp. 802-807.
@article{cc52c456ab64475daa23029cb43d807c,
title = "Twinning rates and survival of twins in rural Nepal",
abstract = "Background. Twin pregnancies are common but there are few data on rates of twinning or survival of liveborn twin infants in developing countries. Methods. The rates of multiple births were calculated in a population-based cohort of married women of childbearing age who were enrolled in a randomized community trial to assess the impact of vitamin A or beta-carotene on maternal and infant health and survival. Results. The rate of twinning was 16.1 per 1000 pregnancies (7.4 if only twin pregnancies resulting in two liveborn infants were used). The rate for triplets and quadruplets was 0.19 and 0.06 per 1000 pregnancies. Twinning rates were higher among women of higher parity, but were not associated with maternal age. Twinning rates among twins where at least one was live born (or increased in utero survival) were 30{\%} (95{\%} CI : -1{\%}, 71{\%}) and 44{\%} (95{\%} CI : 9{\%}, 89{\%}) higher among women receiving vitamin A and beta-carotene supplements than placebo, after adjusting for maternal age, gestational age, and parity. The perinatal mortality rate was 8.54 times higher for twins than singletons, 7.32 higher for neonatal mortality, and 5.84 higher for cumulative 24-week mortality. This difference was reduced but not erased by adjusting for gestational age. No difference in survival of liveborn twin infants was seen by supplement group. A higher mortality rate among male twins was largely explained by gestational age. Conclusions. Multiple births are relatively common occurrences in rural Nepal, and carry a much higher mortality risk for the infants than for singletons. Vitamin A or beta-carotene supplementation appeared to increase the rate of twinning, or improve the survival of twins in utero, but did not increase twin survival after birth.",
keywords = "Beta-carotene, Infant mortality, Neonatal mortality, Nepal, Perinatal mortality, Pregnancy, Twins, Vitamin A",
author = "Joanne Katza and Keith West and Khatryb, {Subarna K.} and LeClerq, {Steven C.} and Christian, {Parul S} and Pradhana, {Elizabeth Kimbrough} and Shresthab, {Sharada Ram}",
year = "2001",
language = "English (US)",
volume = "30",
pages = "802--807",
journal = "International Journal of Epidemiology",
issn = "0300-5771",
publisher = "Oxford University Press",
number = "4",

}

TY - JOUR

T1 - Twinning rates and survival of twins in rural Nepal

AU - Katza, Joanne

AU - West, Keith

AU - Khatryb, Subarna K.

AU - LeClerq, Steven C.

AU - Christian, Parul S

AU - Pradhana, Elizabeth Kimbrough

AU - Shresthab, Sharada Ram

PY - 2001

Y1 - 2001

N2 - Background. Twin pregnancies are common but there are few data on rates of twinning or survival of liveborn twin infants in developing countries. Methods. The rates of multiple births were calculated in a population-based cohort of married women of childbearing age who were enrolled in a randomized community trial to assess the impact of vitamin A or beta-carotene on maternal and infant health and survival. Results. The rate of twinning was 16.1 per 1000 pregnancies (7.4 if only twin pregnancies resulting in two liveborn infants were used). The rate for triplets and quadruplets was 0.19 and 0.06 per 1000 pregnancies. Twinning rates were higher among women of higher parity, but were not associated with maternal age. Twinning rates among twins where at least one was live born (or increased in utero survival) were 30% (95% CI : -1%, 71%) and 44% (95% CI : 9%, 89%) higher among women receiving vitamin A and beta-carotene supplements than placebo, after adjusting for maternal age, gestational age, and parity. The perinatal mortality rate was 8.54 times higher for twins than singletons, 7.32 higher for neonatal mortality, and 5.84 higher for cumulative 24-week mortality. This difference was reduced but not erased by adjusting for gestational age. No difference in survival of liveborn twin infants was seen by supplement group. A higher mortality rate among male twins was largely explained by gestational age. Conclusions. Multiple births are relatively common occurrences in rural Nepal, and carry a much higher mortality risk for the infants than for singletons. Vitamin A or beta-carotene supplementation appeared to increase the rate of twinning, or improve the survival of twins in utero, but did not increase twin survival after birth.

AB - Background. Twin pregnancies are common but there are few data on rates of twinning or survival of liveborn twin infants in developing countries. Methods. The rates of multiple births were calculated in a population-based cohort of married women of childbearing age who were enrolled in a randomized community trial to assess the impact of vitamin A or beta-carotene on maternal and infant health and survival. Results. The rate of twinning was 16.1 per 1000 pregnancies (7.4 if only twin pregnancies resulting in two liveborn infants were used). The rate for triplets and quadruplets was 0.19 and 0.06 per 1000 pregnancies. Twinning rates were higher among women of higher parity, but were not associated with maternal age. Twinning rates among twins where at least one was live born (or increased in utero survival) were 30% (95% CI : -1%, 71%) and 44% (95% CI : 9%, 89%) higher among women receiving vitamin A and beta-carotene supplements than placebo, after adjusting for maternal age, gestational age, and parity. The perinatal mortality rate was 8.54 times higher for twins than singletons, 7.32 higher for neonatal mortality, and 5.84 higher for cumulative 24-week mortality. This difference was reduced but not erased by adjusting for gestational age. No difference in survival of liveborn twin infants was seen by supplement group. A higher mortality rate among male twins was largely explained by gestational age. Conclusions. Multiple births are relatively common occurrences in rural Nepal, and carry a much higher mortality risk for the infants than for singletons. Vitamin A or beta-carotene supplementation appeared to increase the rate of twinning, or improve the survival of twins in utero, but did not increase twin survival after birth.

KW - Beta-carotene

KW - Infant mortality

KW - Neonatal mortality

KW - Nepal

KW - Perinatal mortality

KW - Pregnancy

KW - Twins

KW - Vitamin A

UR - http://www.scopus.com/inward/record.url?scp=0034839147&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034839147&partnerID=8YFLogxK

M3 - Article

C2 - 11511607

AN - SCOPUS:0034839147

VL - 30

SP - 802

EP - 807

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

SN - 0300-5771

IS - 4

ER -