The Presence of Maternal Hypertension as an Effect Modifier in the Relationship Between Intrapair Birth Weight Discordance and Infant Mortality in Live Twin Births Pubblico
Carssow, Katherine Lee (2011)
Abstract
Objective: To determine whether the presence of maternal
hypertension interacts with intrapair twin
birth weight discordance to affect the association between birth
weight discordance and infant
mortality among live twin births.
Study Design and Methods: The study used the matched multiple birth
data set compiled by the
National Center for Health Statistics (NCHS), which contains
matched records for all multiple births in
the United States from national birth and death certificate data
from 1995-2000. Birth weight
discordance was expressed as a percentage based on the weight of
the larger twin, and classified into 5
categories: <15%, 15-19%, 20-24%, 25-29%, and ≥30%. Infant
mortality was defined as any set of twins
in which one or more members did not survive the first year of
life. Crude prevalence and odds ratios of
infant mortality were calculated for each level of birth weight
discordance, presence of maternal
hypertension, and selected covariates.
Results: The analysis used a total sample size of 289,953 live twin
sets. The crude rates of infant
mortality in the highest and lowest categories of birth weight
discordance were 9.4% and 2.5%,
respectively. The unadjusted association between weight discordance
and infant mortality was
significant both with and without considering the interaction
between weight discordance and maternal
hypertension. The association between maternal hypertension and
birth weight discordance was also
significant (OR 1.62, 95% CI 1.54-1.70).When the model associating
death with birth weight discordance
was adjusted for maternal demographics along with parity, placental
abruption, gestational age, and
presence of a congenital anomaly, the effect was attenuated. The
p-value for the interaction term in the
final model was p=0.70.
Conclusion: Interaction between birth weight discordance and
maternal hypertension does not appear
to effect the association between weight discordance and infant
mortality when important covariates
are considered.
Table of Contents
Chapter 1
Background and Literature Review...4
Chapter 2
Methods...9
Results...13
Discussion...16
Chapter 3
Public Health Implications...19
References...21
Tables...27
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