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ORIGINAL RESEARCH |
From the Division of Epidemiology, School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey; Environmental and Community Medicine, and Section of Epidemiology and Biostatistics and Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, Piscataway, New Jersey; and Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.
Address reprint requests to: Kitaw Demissie, MD, PhD, UMDNJ School of Public Health, Division of Epidemiology, 675 Hoes Lane, Piscataway, NJ 08854; E-mail: demisski{at}umdnj.edu.
OBJECTIVE: To examine the association of intrapair birth weight discordance with fetal and neonatal mortality.
METHODS: We used the United States (1995–1997) Matched Multiple Birth File (n = 297,155).
RESULTS: Among twin live births and stillborn fetuses, 29.9% had less than 5% birth weight discordance, 24.2% had 5–9%, 29.6% had 10–19%, 11.1% had 20–29%, 3.4% had 30–39%, and 1.8% had 40% or more. The stillborn fetus rate increased progressively with increasing birth weight discordance for smaller and larger twins of the same sex. Compared with the less than 5% birth weight discordance category, the adjusted odds ratios (OR) (95% confidence intervals [CIs]) for stillborn fetus associated with 5–9%, 10–19%, 20–29%, 30–39%, and 40% or more birth weight discordance, respectively, were 0.81 (95% CI 0.58, 1.11), 1.41 (95% CI 1.07, 1.84), 1.74 (95% CI 1.28, 2.35), 3.06 (95% CI 2.21, 4.24), and 4.29 (95% CI 3.05, 6.04) for smaller twins. The corresponding ORs (95% CIs) for larger twins were 0.78 (95% CI 0.57, 1.08), 1.26 (95% CI 0.96, 1.66), 1.77 (95% CI 1.27, 2.46), 3.38 (95% CI 2.33, 4.92), and 2.91 (95% CI 1.89, 4.47). Similar associations were observed among smaller but not larger twins of opposite sex. Among larger but not smaller twins of the same sex, increasing birth weight discordance was associated with overall neonatal deaths. This association was not apparent among smaller and larger twins of opposite sex. However, increasing birth weight discordance was associated with neonatal deaths related to congenital malformations among smaller and larger twins.
CONCLUSION: The results provide evidence that increased twin birth weight discordance was associated with increased risk of intrauterine death and malformation-related neonatal deaths.
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