Temporal Trends in the Birth Rates and Perinatal Mortality of Twins: A Population-based Study in China

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2019 Jan 17

PMID 30650106

Citations 16

Authors

Changfei Deng

Li Dai

Ling Yi

Xiaohong Li

Kui Deng

Yi Mu

Ke Wang

Jing Tao

Qi Li

Liangzhi Xu

Affiliations

Soon will be listed here.

Abstract

Objective: Until now, little was known about the epidemiological characteristics of twins in China due to a lack of reliable national data. In this study, we aimed to analyze temporal trends and perinatal mortality of twins from China.

Methods: Data on twins between 2007 and 2014 were obtained from the China National Population-Based Birth Defects Surveillance System. Twin and singleton deliveries after at least 28 weeks of gestation were recruited and followed until postnatal day 42. Twinning rates were defined as the number of twin individuals per 1000 births(stillbirths and live births). The Weinberg's differential method was utilized to estimate the number of monozygotic and dizygotic twins.

Results: During 2007-2014, the twinning rate increased by 32.3% from 16.4 to 21.7 per 1000 total births with an average of 18.8‰. Among twins, both the perinatal mortality rate (26.1 per 1000 total births) and neonatal death rate (15.7 per 1000 live births) presented a downward tendency but remained at a high level. Large urban-rural and geographic disparities were identified in twinning rates, in perinatal and neonatal mortality, and in their temporal trends.

Conclusions: The upward trend of twinning rates in China paired with the relatively high rates of perinatal and neonatal mortality among twins highlights the need for improved perinatal care in the light of socio-demographic differences.

Citing Articles

Effect of gestational weight gain on adverse birth outcomes in twin pregnancies: a prospective cohort study in Chinese women.

Zhao R, Zhang A, Wang Y, Chai Y, Du F, Xu Q BMC Pregnancy Childbirth. 2025; 25(1):169.

PMID: 39962413 PMC: 11834644. DOI: 10.1186/s12884-025-07234-7.

The impact of maternal serum biomarkers on maternal and neonatal outcomes in twin pregnancies: a retrospective cohort study conducted at a tertiary hospital.

Wu H, Yu L, Xie Z, Cai H, Wen C PeerJ. 2024; 12:e18415.

PMID: 39484218 PMC: 11526785. DOI: 10.7717/peerj.18415.

Study protocol for two randomised controlled trials evaluating the effects of Cerclage in the reduction of extreme preterm birth and perinatal mortality in twin pregnancies with a short cervix or dilatation: the TWIN Cerclage studies.

van Gils L, de Boer M, Bosmans J, Duijnhoven R, Schoenmakers S, Derks J BMJ Open. 2024; 14(5):e081561.

PMID: 38729756 PMC: 11097875. DOI: 10.1136/bmjopen-2023-081561.

Comparison of singleton and twin birth weight reference percentile curves by gestational age and sex in extremely preterm infants: a population-based study.

Song S, Zhu Z, Mao W, Zhu Y, Zhang R, Bu X BMJ Paediatr Open. 2024; 8(1).

PMID: 38627060 PMC: 11029334. DOI: 10.1136/bmjpo-2024-002502.

The adverse effect of gestational diabetes mellitus and hypertensive disorders of pregnancy on maternal-perinatal outcomes among singleton and twin pregnancies: a retrospective cohort study (2011-2019).

Nawsherwan , Liu Z, Le Z, Mubarik S, Sun Y, Naeem S Front Endocrinol (Lausanne). 2023; 14:1267338.

PMID: 38098860 PMC: 10720659. DOI: 10.3389/fendo.2023.1267338.

References

Lu X, Wu M . [Determinants of household healthcare expenditure of rural floating population in Beijing: a Tobit model approach]. Beijing Da Xue Xue Bao Yi Xue Ban. 2010; 42(5):565-9. View

Hehir M, McTiernan A, Martin A, Carroll S, Gleeson R, Malone F . Improved Perinatal Mortality in Twins--Changing Practice and Technologies. Am J Perinatol. 2015; 33(1):84-9. DOI: 10.1055/s-0035-1559807. View

Russo F, Pozzi E, Pelizzoni F, Todyrenchuk L, Bernasconi D, Cozzolino S . Stillbirths in singletons, dichorionic and monochorionic twins: a comparison of risks and causes. Eur J Obstet Gynecol Reprod Biol. 2013; 170(1):131-6. DOI: 10.1016/j.ejogrb.2013.06.014. View

Fell D, Joseph K . Temporal trends in the frequency of twins and higher-order multiple births in Canada and the United States. BMC Pregnancy Childbirth. 2012; 12:103. PMC: 3533860. DOI: 10.1186/1471-2393-12-103. View

Joseph K, Marcoux S, Ohlsson A, Liu S, Allen A, Kramer M . Changes in stillbirth and infant mortality associated with increases in preterm birth among twins. Pediatrics. 2001; 108(5):1055-61. DOI: 10.1542/peds.108.5.1055. View

Oleszczuk J, Cervantes A, Kiely J, Keith D, Keith L . Maternal race/ethnicity and twinning rates in the United States, 1989-1991. J Reprod Med. 2001; 46(6):550-7. View

Imaizumi Y . Perinatal mortality in twins and factors influencing mortality in Japan, 1980--98. Paediatr Perinat Epidemiol. 2001; 15(3):298-305. DOI: 10.1046/j.1365-3016.2001.00361.x. View

Ananth C, Chauhan S . Epidemiology of twinning in developed countries. Semin Perinatol. 2012; 36(3):156-61. DOI: 10.1053/j.semperi.2012.02.001. View

Luo Z, Zhao Y, Ouyang F, Yang Z, Guo Y, Zhang J . Diabetes and perinatal mortality in twin pregnancies. PLoS One. 2013; 8(9):e75354. PMC: 3776783. DOI: 10.1371/journal.pone.0075354. View

10.

Collins J . Global epidemiology of multiple birth. Reprod Biomed Online. 2008; 15 Suppl 3:45-52. DOI: 10.1016/s1472-6483(10)62251-1. View

11.

McClure E, Saleem S, Goudar S, Moore J, Garces A, Esamai F . Stillbirth rates in low-middle income countries 2010 - 2013: a population-based, multi-country study from the Global Network. Reprod Health. 2015; 12 Suppl 2:S7. PMC: 4464024. DOI: 10.1186/1742-4755-12-S2-S7. View

12.

Hur Y, Kwon J . Changes in twinning rates in South Korea: 1981-2002. Twin Res Hum Genet. 2005; 8(1):76-9. DOI: 10.1375/1832427053435445. View

13.

Smits J, Monden C . Twinning across the Developing World. PLoS One. 2011; 6(9):e25239. PMC: 3182188. DOI: 10.1371/journal.pone.0025239. View

14.

Ooki S . The effect of an increase in the rate of multiple births on low-birth-weight and preterm deliveries during 1975-2008. J Epidemiol. 2010; 20(6):480-8. PMC: 3900826. DOI: 10.2188/jea.je20100022. View

15.

Blondel B, Kogan M, Alexander G, Dattani N, Kramer M, Macfarlane A . The impact of the increasing number of multiple births on the rates of preterm birth and low birthweight: an international study. Am J Public Health. 2002; 92(8):1323-30. PMC: 1447238. DOI: 10.2105/ajph.92.8.1323. View

16.

Yang X, Li Y, Li C, Zhang W . Current overview of pregnancy complications and live-birth outcome of assisted reproductive technology in mainland China. Fertil Steril. 2013; 101(2):385-91. DOI: 10.1016/j.fertnstert.2013.10.017. View

17.

Hoekstra C, Zhao Z, Lambalk C, Willemsen G, Martin N, Boomsma D . Dizygotic twinning. Hum Reprod Update. 2007; 14(1):37-47. DOI: 10.1093/humupd/dmm036. View

18.

Pharoah P, Dundar Y . Monozygotic twinning, cerebral palsy and congenital anomalies. Hum Reprod Update. 2009; 15(6):639-48. DOI: 10.1093/humupd/dmp019. View

19.

Getahun D, Demissie K, Marcella S, Rhoads G . The impact of changes in preterm birth among twins on stillbirth and infant mortality in the United States. J Perinatol. 2014; 34(11):823-9. PMC: 4337858. DOI: 10.1038/jp.2014.119. View

20.

Vogel J, Torloni M, Seuc A, Betran A, Widmer M, Souza J . Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries. PLoS One. 2013; 8(8):e70549. PMC: 3731264. DOI: 10.1371/journal.pone.0070549. View