Ερευνητικό υλικό ΕΚΠΑ

Variations in multiple birth rates and impact on perinatal outcomes in Europe

Αγγλικά

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. © 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.

2016

Heino, A.
Gissler, M.
Hindori-Mohangoo, A.D.
Blondel, B.
Klungsøyr, K.
Verdenik, I.
Mierzejewska, E.
Velebil, P.
Ólafsdóttir, H.S.
Macfarlane, A.
Zeitlin, J.
Haidinger, G.
Alexander, S.
Pavlou, P.
Mortensen, L.
Sakkeus, L.
Lack, N.
Antsaklis, A.
Berbik, I.
Bonham, S.
Cuttini, M.
Misins, J.
Jaselioniene, J.
Wagener, Y.
Gatt, M.
Nijhuis, J.
Van Der Pal, K.
Klungsoyr, K.
Szamotulska, K.
Barros, H.
Horga, M.
Cap, J.
Mandić, N.T.
Bolúmar, F.
Gottvall, K.
Berrut, S.
Klimont, J.
Zhang, W.-H.
Dramaix-Wilmet, M.
Van Humbeeck, M.
Leroy, C.
Minsart, A.-F.
Van Leeuw, V.
Martens, E.
De Spiegelaere, M.
Verkruyssen, F.
Willems, M.
Aelvoet, W.
Tafforeau, J.
Renard, F.
Walckiers, D.
Cuignet, D.
Demoulin, P.
Cloots, H.
Hendrickx, E.
Kongs, A.
Stylianou, D.
Kyprianou, T.
Skordes, N.
Roos, J.L.
Anderson, A.-M.N.
Mortensen, L.H.
Ritvanen, A.
Colle, M.-H.B.
Ego, A.
Rey, G.
Heller, G.
Scharl, A.
Drakakis, P.
Bjarnadottir, R.I.
Hardardóttir, H.
Ragnarsdóttir, B.
Stefánsdóttir, V.
Haraldsdóttir, S.
Mulligan, A.
Tamburini, C.
Boldrini, R.
Prati, S.
Loghi, M.
Castagnaro, C.
Marchetti, S.
Burgio, A.
Da Frè, M.
Zile, I.
Isakova, J.
Gaidelyte, R.
Jaselione, J.
Billy, A.
Touvrey-Lecomte, A.
Van Der, K.
De Bruin, P.
Achterberg, P.
Hukkelhoven, C.
De Winter, G.
Ravelli, A.
Rijninks-Van Driel, G.
Tamminga, P.
Groesz, M.
Elferink-Stinkens, P.
Osen, A.
Ebbing, M.
Correia, S.
Cucu, A.
Novak-Antolič, Ž.
Jane, M.
Vidal, M.J.
Barona, C.
Mas, R.
Alcaide, A.R.
Lundqvist, E.
König, C.
Schmid, M.
Dattani, N.
Chalmers, J.
Monteath, K.
Climson, M.
Marr, L.
Gibson, R.
Thomas, G.
Osborne, R.
Brown, R.
Sweet, D.
Evans, J.
Magill, S.
Graham, A.
Reid, H.
Falconer, T.
McConnell, K.
McComb, N.
Euro-Peristat Scientific Committee

PLOS ONE

Public Library of Science

11

3

adverse outcome; Article; birth rate; controlled study; Europe; female; gestational age; human; maternal age; multiple birth rate; multiple pregnancy; newborn death; newborn mortality; outcome assessment; parameters concerning the fetus, newborn and pregnancy; perinatal outcome; premature labor; risk assessment; risk factor; stillbirth; adult; birth rate; fetus death; fetus mortality; infant; infant mortality; meta analysis; mortality; multiple pregnancy; newborn; perinatal death; pregnancy; Premature Birth, Adult; Birth Rate; Europe; Female; Fetal Death; Fetal Mortality; Humans; Infant; Infant Mortality; Infant, Newborn; Maternal Age; Perinatal Death; Pregnancy; Pregnancy, Multiple; Premature Birth; Stillbirth

https://doi.org/10.1371/journal.pone.0149252

10.1371/journal.pone.0149252

https://pergamos.lib.uoa.gr/uoa/dl/object/3056814