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Maternal and Perinatal Outcomes of Twin Pregnancy in 23 Low- and Middle-Income Countries

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  • Joshua P Vogel
  • Maria Regina Torloni
  • Armando Seuc
  • Ana Pilar Betrán
  • Mariana Widmer
  • João Paulo Souza
  • Mario Merialdi

Abstract

Background: Twin pregnancies in low- and middle-income countries (LMICs) pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources. We conducted a secondary analysis of the WHO Global Survey dataset to analyze maternal and perinatal outcomes in twin pregnancies and factors associated with perinatal morbidity and mortality in twins. Methods: We examined maternal and neonatal characteristics in twin deliveries in 23 LMICs and conducted multi-level logistic regression to determine the association between twins and adverse maternal and perinatal outcomes. Results: 279,425 mothers gave birth to 276,187 (98.8%) singletons and 6,476 (1.2%) twins. Odds of severe adverse maternal outcomes (death, blood transfusion, ICU admission or hysterectomy) (AOR 1.85, 95% CI 1.60–2.14) and perinatal mortality (AOR 2.46, 95% CI 1.40–4.35) in twin pregnancies were higher, however early neonatal death (AOR 2.50, 95% CI 0.95–6.62) and stillbirth (AOR 1.22, 95% CI 0.58–2.57) did not reach significance. Amongst twins alone, maternal age 15%, born second, preterm birth and low birthweight were associated with perinatal mortality. Marriage and caesarean section were protective. Conclusions: Twin pregnancy is a significant risk factor for maternal and perinatal morbidity and mortality in low-resource settings; maternal risk and access to safe caesarean section may determine safest mode of delivery in LMICs. Improving obstetric care in twin pregnancies, particularly timely access to safe caesarean section, is required to reduce risk to mother and baby.

Suggested Citation

  • Joshua P Vogel & Maria Regina Torloni & Armando Seuc & Ana Pilar Betrán & Mariana Widmer & João Paulo Souza & Mario Merialdi, 2013. "Maternal and Perinatal Outcomes of Twin Pregnancy in 23 Low- and Middle-Income Countries," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-7, August.
    • Handle: RePEc:plo:pone00:0070549
    DOI: 10.1371/journal.pone.0070549
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    References listed on IDEAS

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    1. Jeroen Smits & Christiaan Monden, 2011. "Twinning across the Developing World," PLOS ONE, Public Library of Science, vol. 6(9), pages 1-5, September.
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    1. Godlonton, Susan & Okeke, Edward N., 2016. "Does a ban on informal health providers save lives? Evidence from Malawi," Journal of Development Economics, Elsevier, vol. 118(C), pages 112-132.
    2. Okeke, Edward N. & Chari, A.V., 2018. "Health care at birth and infant mortality: Evidence from nighttime deliveries in Nigeria," Social Science & Medicine, Elsevier, vol. 196(C), pages 86-95.

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