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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2012

Open Access 01-12-2012 | Research article

A prospective study of twinning and perinatal mortality in urban Guinea-Bissau

Authors: Morten Bjerregaard-Andersen, Najaaraq Lund, Frida Staarup Jepsen, Luis Camala, Margarida Alfredo Gomes, Kaare Christensen, Lene Christiansen, Dorte Møller Jensen, Peter Aaby, Henning Beck-Nielsen, Christine Stabell Benn, Morten Sodemann

Published in: BMC Pregnancy and Childbirth | Issue 1/2012

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Abstract

Background

Despite twinning being common in Africa, few prospective twin studies have been conducted. We studied twinning rate, perinatal mortality and the clinical characteristics of newborn twins in urban Guinea-Bissau.

Methods

The study was conducted at the Bandim Health Project (BHP), a health and demographic surveillance site in Bissau, the capital of Guinea-Bissau. The cohort included all newborn twins delivered at the National Hospital Simão Mendes and in the BHP study area during the period September 2009 to August 2011 as well as singleton controls from the BHP study area. Data regarding obstetric history and pregnancy were collected at the hospital. Live children were examined clinically. For a subset of twin pairs zygosity was established by using genetic markers.

Results

Out of the 5262 births from mothers included in the BHP study area, 94 were twin births, i.e. a community twinning rate of 18/1000. The monozygotic rate was 3.4/1000. Perinatal mortality among twins vs. singletons was 218/1000 vs. 80/1000 (RR = 2.71, 95% CI: 1.93-3.80). Among the 13783 hospital births 388 were twin births (28/1000). The hospital perinatal twin mortality was 237/1000.
Birth weight < 2000g (RR = 4.24, CI: 2.39-7.51) and caesarean section (RR = 1.78, CI: 1.06-2.99) were significant risk factors for perinatal twin mortality. Male sex (RR = 1.38, CI: 0.97-1.96), unawareness of twin pregnancy (RR = 1.64, CI: 0.97-2.78) and high blood pressure during pregnancy (RR = 1.77, CI: 0.88-3.57) were borderline non-significant. Sixty-five percent (245/375) of the mothers who delivered at the hospital were unaware of their twin pregnancy.

Conclusions

Twins had a very high perinatal mortality, three-fold higher than singletons. A birth weight < 2000g was the strongest risk factor for perinatal death, and unrecognized twin pregnancy was common. Urgent interventions are needed to lower perinatal twin mortality in Guinea-Bissau.
Appendix
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Metadata
Title
A prospective study of twinning and perinatal mortality in urban Guinea-Bissau
Authors
Morten Bjerregaard-Andersen
Najaaraq Lund
Frida Staarup Jepsen
Luis Camala
Margarida Alfredo Gomes
Kaare Christensen
Lene Christiansen
Dorte Møller Jensen
Peter Aaby
Henning Beck-Nielsen
Christine Stabell Benn
Morten Sodemann
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2012
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-12-140

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