EPIDEMIOLOGY OF TWINNING IN A POPULATION-BASED SAMPLE OF LIVE BIRTHS, 1997-2007 Open Access
Dawson, April (2011)
Abstract
PURPOSE: Twin birth rates in the United States have
increased 70% over the last three
decades. Twinning is associated with significantly increased risk
of infant and maternal
morbidity and mortality. Although previous studies have examined
risk factors for
twinning, most are in populations that pre-date the widespread use
of fertility treatments.
METHODS: We analyzed data from the National Birth Defects
Prevention Study
(NBDPS), an ongoing multi-center case control study of major birth
defects in the United
States. The study population included NBDPS control mothers, a
random sample of
mothers of liveborn infants without major birth defects in the
study regions, who reported
gestation of twin or singleton infants. We assessed associations of
twinning among
mothers that did not report any use of fertility treatments with
maternal demographic
characteristics and periconceptional exposures using logistic
regression to estimate
adjusted odds ratios (aOR) and 95% confidence intervals (CI).
RESULTS: Between October 1997 and December 2007, 227 (2.7%) of
8305 mothers
reported gestation of twins. Among mothers who did not report any
use of fertility
treatments, 154 (1.9%) of 7936 mothers reported gestation of twins.
Non-Hispanic black
mothers were more likely to report twin gestation than non-Hispanic
white mothers (aOR
1.68, 95% CI: 1.10-2.55) and mothers of twins were more likely to
smoke during
pregnancy (aOR 1.64, 95% CI: 1.10-2.45) than mothers of singletons.
Mothers of twins
were more likely to have two or more previous live births than no
previous live births
(aOR: 1.49, 95% CI: 0.95-2.32) and were less likely to report
periconceptional oral
contraceptive use (aOR 0.59, 95% CI: 0.33-1.05) than mothers of
singletons. Factors
such as maternal age, height, pre-pregnancy weight, education,
annual household income,
and periconceptional folic acid use were not statistically
significant predictors of
twinning among mothers who did not report any use of fertility
treatments.
CONCLUSION: Factors such as parity, oral contraceptive use,
maternal race/ethnicity,
and tobacco smoking may have an impact on the frequency of twinning
among women
who do not use fertility treatments.
Table of Contents
TABLE OF CONTENTS
INTRODUCTION 1
METHODS AND MATERIALS 7
Study Population 7
Exposures of Interest 7
Outcome of Interest 9
Analysis 10
RESULTS 11
DISCUSSION 15
REFERENCES 21
APPENDIX 35
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