Variations in multiple birth rates and impact on perinatal outcomes in Europe

Anna Heino, Mika Gissler, Ashna D. Hindori-Mohangoo, Béatrice Blondel, Kari Klungsøyr, Ivan Verdenik, Ewa Mierzejewska, Petr Velebil, Helga Sól Ólafsdóttir, Alison Macfarlane, Jennifer Zeitlin, Gerald Haidinger, Sophie Alexander, Pavlos Pavlou, Laust Mortensen, Luule Sakkeus, Nicholas Lack, Aris Antsaklis, Istvan Berbik, Sheelagh BonhamMarina Cuttini, Janis Misins, Jone Jaselioniene, Yolande Wagener, Miriam Gatt, Jan Nijhuis, Karin Van Der Pal, Kari Klungsoyr, Katarzyna Szamotulska, Henrique Barros, Mihai Horga, Jan Cap, Natasa Tul Mandić, Francisco Bolúmar, Karin Gottvall, Sylvie Berrut, Jeannette Klimont, Wei Hong Zhang, Michèle Dramaix-Wilmet, Mélissa Van Humbeeck, Charlotte Leroy, Anne Frédérique Minsart, Virginie Van Leeuw, Evelyne Martens, Myriam De Spiegelaere, Freddy Verkruyssen, Michel Willems, Willem Aelvoet, Jean Tafforeau, Aline Touvrey-Lecomte, Euro-Peristat Scientific Committee, Audrey Billy

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    68 Citations (Scopus)


    Objective: Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR) exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse perinatal outcomes at a population level. Methods: We used national aggregate birth data on multiple pregnancies, maternal age, gestational age (GA), stillbirth and neonatal death collected in the Euro-Peristat project (29 countries in 2010, N = 5 074 643 births). We also used European Society of Human Reproduction and Embryology (ESHRE) data on assisted conception and single embryo transfer (SET). The impact of MBR on outcomes was studied using meta-analysis techniques with randomeffects models to derive pooled risk ratios (pRR) overall and for four groups of country defined by their MBR. We computed population attributable risks (PAR) for these groups. Results: In 2010, the average MBR was 16.8 per 1000 women giving birth, ranging from 9.1 (Romania) to 26.5 (Cyprus). Compared to singletons, multiples had a nine-fold increased risk (pRR 9.4, 95% Cl 9.1-9.8) of preterm birth (<37 weeks GA), an almost 12-fold increased risk (pRR 11.7, 95% CI 11.0-12.4) of very preterm birth (<32 weeks GA). Pooled RR were 2.4 (95% Cl1.5-3.6) for fetal mortality at or after 28 weeks GA and 7.0 (95% Cl 6.1-8.0) for neonatal mortality. PAR of neonatal death and very preterm birth were higher in countries with high MBR compared to low MBR (17.1% (95% CI 13.8-20.2) versus 9.8% (95% Cl 9.6-11.0) for neonatal death and 29.6% (96% CI 28.5-30.6) versus 17.5% (95% CI 15.7-18.3) for very preterm births, respectively). Conclusions: Wide variations in MBR and their impact on population outcomes imply that efforts by countries to reduce MBR could improve perinatal outcomes, enabling better long-term child health.

    Original languageEnglish
    Article numbere0149252
    JournalPLoS ONE
    Issue number3
    Publication statusPublished - Mar 2016


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