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Perinatal Mortality in the Normal Siblings of Anomalous Triplets

Hamisu M. Salihu, MD, PhD^*, Makeda J. Williams, MPH, PhD and Donath Emusu, MD, MPH^*

From the *Departments of Maternal and Child Health and Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama.

OBJECTIVE: To estimate the risk of survival of unaffected cofetuses of anomalous triplets.

METHODS: Retrospective cohort study of triplets delivered in the United States from 1995 through 1998. Four triplet clusters were identified: cluster A (all members anomaly-free); cluster B (1 anomalous member); cluster C (2 anomalous members), and cluster D (all 3 members anomalous). We compared the risk for stillbirth and infant mortality among nonanomalous fetuses in clusters A, B, and C after adjusting for intracluster correlations.

RESULTS: A total of 7,560 triplet clusters (98.9%) were analyzed after excluding cluster D (1.1%). The total stillbirth rate was 20.9 (cluster A), 61.0 (cluster B), and 81.1 (cluster C) per 1,000 (P for trend < .001), and infant mortality rate was 56.4 (cluster A), 108.8 (cluster B), and 196.1 (cluster C) per 1,000 (P for trend < .001). Using cluster A as the referent category, the risk for stillbirth among anomaly-free clustermates climbed with increase in the number of siblings with anomalies in a dose-response pattern (adjusted odds ratio, 95% confidence interval 1.5, 0.7–3.1, for cluster B; and 5.2, 1.4–18.8, for cluster C; P for trend = .03). For infant mortality, the only rise in risk was in cluster C (3.3, 1.6–6.7), whereas cluster B showed comparable risk with the referent category (0.8, 0.5–1.4; P for trend > .05).

CONCLUSION: The presence of anomalous fetuses compromises the survival of normal cotriplets. These findings could prove useful for counseling affected parents and highlight the need for follow-up of normal coinfants of anomalous fetuses.

LEVEL OF EVIDENCE: II-2

This article has been cited by other articles:

				A. T. N. Tita, H. M. Salihu, and P. S. Ramsey Impact of Anomalous Triplets on Morbidity Outcomes of Normal In Utero Siblings. Obstet. Gynecol., June 1, 2006; 107(6): 1352 - 1356. [Abstract] [Full Text] [PDF]