TY - JOUR
T1 - Variations in multiple birth rates and impact on perinatal outcomes in Europe
AU - Euro-Peristat Scientific Committee
AU - Heino, Anna
AU - Gissler, Mika
AU - Hindori-Mohangoo, Ashna D.
AU - Blondel, Béatrice
AU - Klungsøyr, Kari
AU - Verdenik, Ivan
AU - Mierzejewska, Ewa
AU - Velebil, Petr
AU - Ólafsdóttir, Helga Sól
AU - Macfarlane, Alison
AU - Zeitlin, Jennifer
AU - Haidinger, Gerald
AU - Alexander, Sophie
AU - Pavlou, Pavlos
AU - Mortensen, Laust
AU - Sakkeus, Luule
AU - Lack, Nicholas
AU - Antsaklis, Aris
AU - Berbik, Istvan
AU - Bonham, Sheelagh
AU - Cuttini, Marina
AU - Misins, Janis
AU - Jaselioniene, Jone
AU - Wagener, Yolande
AU - Gatt, Miriam
AU - Nijhuis, Jan
AU - Van Der Pal, Karin
AU - Klungsoyr, Kari
AU - Szamotulska, Katarzyna
AU - Barros, Henrique
AU - Horga, Mihai
AU - Cap, Jan
AU - Mandić, Natasa Tul
AU - Bolúmar, Francisco
AU - Gottvall, Karin
AU - Berrut, Sylvie
AU - Klimont, Jeannette
AU - Zhang, Wei Hong
AU - Dramaix-Wilmet, Michèle
AU - Van Humbeeck, Mélissa
AU - Leroy, Charlotte
AU - Minsart, Anne Frédérique
AU - Van Leeuw, Virginie
AU - Martens, Evelyne
AU - De Spiegelaere, Myriam
AU - Verkruyssen, Freddy
AU - Willems, Michel
AU - Aelvoet, Willem
AU - Tafforeau, Jean
AU - Zile, Irisa
N1 - Publisher Copyright:
© 2016 Heino et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2016/3
Y1 - 2016/3
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/84961839072
U2 - 10.1371/journal.pone.0149252
DO - 10.1371/journal.pone.0149252
M3 - Article
C2 - 26930069
AN - SCOPUS:84961839072
SN - 1932-6203
VL - 11
JO - PLOS ONE
JF - PLOS ONE
IS - 3
M1 - e0149252
ER -
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