A new study published in the journal JAMA Pediatricsindicates that the optimal time of birth for twins is at 37 completed weeks of pregnancy. Show Twins are now being born more often because of an increase in the use of assisted reproductive techniques, in which almost a quarter result in twinning. Though only about 3% of live-born babies are twins, about 15% of newborns who need admission, and babies in special care units, are twins. Moreover, twins are more often born by Cesarean section than singletons at corresponding periods of gestation. As a result of all these factors, twin health costs about three times as much as for singletons. The death rate for twins is also higher around the time of birth.
What is the association of gestational age at the time of the birth of twins with the risk of perinatal mortality and special educational need and what is the optimal week for the birth? Image Credit: Kristina Bessolova / Shutterstock It is therefore vital to know the best time of delivery for twins – a matter which is, strangely, still largely undefined. Most guidelines today operate based on observational studies because of the randomized controlled trials seeking to define the optimal timing of birth. Overall, it is considered that twin delivery should be around 37 weeks for dichorionic twins and 36 weeks for monochorionic twins. With singletons, the neurodevelopmental outcomes are best with delivery at 41 weeks, but the odds of death around the time of delivery are best at weeks 38-39. The current study was motivated by the need to understand how short-term and permanent outcomes are affected by gestational age. The studyThe current cohort study analyzed the outcomes of over 43 000 twins born at 34 weeks or higher between January 1, 1980, and December 31, 2015, in Scotland. The various relevant registers were used to retrieve the required data – the Scottish Morbidity Record SMR02, the Scottish Stillbirth and Infant Death Survey (SSBID), and the Scottish Exchange of Educational Data (ScotXed). This enabled educational records to be associated with the Morbidity Record. Related Stories
The researchers were looking for extended perinatal mortality, which means death by stillbirth or in the newborn period, and for SEN, special education needs. According to the UK Department of Education, a child with SEN is “unable to benefit fully from school without help beyond that normally given to schoolchildren of the same age.” The investigators included in this category conditions like intellectual disabilities, physical disability, autistic spectrum disorder, language or speech disorders, and psychological or social difficulties. The resultsBoys and girls were equally represented in the analysis. The most significant percentage of twins (49%) was observed to be delivered at 37-38 weeks, and 6% were preterm. About 60% of mothers were between 25 and 35 years of age, and in 57%, this was their first pregnancy. Twins had increased perinatal mortality, with the odds being over 2.5 times higher at 34-37 weeks compared to birth after that up to 39 weeks. When competing risks were analyzed, stillbirth risk was markedly less than the risk of neonatal death at 34 and 35 weeks, while the reverse held good after 37 weeks. At 37 weeks, both were equal. The twins born before 38 weeks were more likely to die in the newborn period compared to infants who were delivered after this period. The adjusted odds ratio for newborn death for twins was 16 times higher at 34 weeks, and progressively reduced from about 5.6 times, to 1.5 times higher from 35 weeks to 37 weeks. Twin children born before 37 weeks had higher odds of SEN at 34 - 36 weeks, but not after that. And the overall rate of SEN is higher for twins than for singletons. ImplicationsThe findings of this study point to 37 completed weeks of gestation as the best time for the delivery of twin infants, for both short-term and long-term outcomes. This is the first time that data has been obtained which supports the current clinical guidelines. The birth of twins before 37 weeks is associated with increased perinatal mortality and increased odds of SEN at school. The lowest SEN occurs at 37 weeks and beyond with twins. A limitation of this study is the lack of sufficient sample size beyond 39 weeks. Similarly, the study does not help to determine the effect of the death of one twin in utero before delivery. Still, available data indicates this to be a rare problem and one that has to be addressed based on individual cases. The researchers say, “This is the first nationwide study to investigate long-term educational outcomes of twins across the range of gestational age categories.” The rate of SEN is higher among twins, at about 14%, compared to 5% in singletons. They conclude, “In terms of short- and long-term outcomes, uncomplicated twin pregnancies should not be delivered before 37 completed weeks of gestation and that there is a limited benefit of prolonging pregnancy after that.” Journal reference: Murray, S., MacKay, D., Stock, S., Pell, J., and Norman, J. Association of gestational age at birth with risk of perinatal mortality and special educational need among twins. JAMA Pediatrics 2020. doi:10.1001/jamapediatrics.2019.6317 Posted in: Child Health News | Medical Procedure News | Medical Research News Tags: Cesarean Section, Children, Disability, Education, In Utero, Language, Mortality, Newborn, Pediatrics, Pregnancy, Speech, Stillbirth, Twins  Written by Dr. Liji ThomasDr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative. CitationsPlease use one of the following formats to cite this article in your essay, paper or report:
Suggested ReadingHow early do you give birth with gestational diabetes?The ideal time to give birth if you have gestational diabetes is usually around weeks 38 to 40. If your blood sugar is within normal levels and there are no concerns about your or your baby's health, you may be able to wait for labour to start naturally.
Is gestational diabetes worse with twins?2.32%; p = 0.01). In a multiple regression analysis after adjusting for age, race/ethnicity, body mass index, maximal systolic and diastolic blood pressure, smoking and parity, twin pregnancy was associated with an approximately two-fold increase in risk for developing GDM (OR 2.2, 95% CI 1.4-3.6).
How common is gestational diabetes in twin pregnancies?The incidence of GDM in twin pregnancies increased from 4.0% in period 1 to 9.3% in period 2. Composite obstetric complications rate was significantly higher in the GDM group than that in the non-GDM group during period 1 (72.0% vs. 45.5%, P = 0.009).
What is the average delivery week for twins?While 40 weeks is the full gestation period of the average pregnancy, most twin pregnancies are delivered at approximately 36 weeks (range 32-38 weeks depending on the type of twin pregnancy).
|
Average week of delivery with gestational diabetes twins
Related Posts
Copyright © 2024 muatrau Inc.
