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  • Title: Mortality associated with multiple gestation in Malawi.
    Author: McDermott JM, Steketee R, Wirima J.
    Journal: Int J Epidemiol; 1995 Apr; 24(2):413-9. PubMed ID: 7635604.
    Abstract:
    BACKGROUND: Multiple gestation is associated with increased maternal, perinatal, and infant mortality. The prevalence of multiple gestation varies widely with the highest rates reported among populations in Africa. There have been few population-based studies of the impact of multiple gestation on pregnancy outcomes in sub-Saharan Africa. METHODS: Data from a 1987-1990 prospective study of the effect of malaria chemoprophylaxis among pregnant women on birthweight and mortality of their infants in a rural area of Malawi were used to estimate the prevalence of multiple gestation and to quantify the risk of mortality associated with multiple gestation compared with single gestation. RESULTS: There were 88 (2.2%) multiple gestations among 4049 women. Mortality was high; only 38% of mothers were known to have all their infants survive to 1 year, compared with 74% in singleton gestations. The increased mortality associated with multiple gestation was due to two factors: a higher frequency of low birthweight and a fourfold increase in perinatal mortality among the infants with birthweights > or = 2500 g and among infants with unknown birthweight. We estimated that multiple gestation contributes to 5.5% of the perinatal, 1.2% of the postperinatal, and 11.5% of the maternal deaths in this population. CONCLUSION: Multiple gestation in Malawi contributed to increased perinatal and maternal mortality, but did not increase the risk of mortality after the perinatal period. Data from a 1987-1990 prospective study of the effect of malaria chemoprophylaxis among pregnant women on birth weight and mortality of their infants in a rural area of Malawi were used to estimate the prevalence of multiple gestation and to quantify the risk of mortality associated with multiple gestation compared with single gestation. There were 88 (2.2%) multiple gestations among 4049 women enrolled at their first antenatal clinic visit at 1 of 4 antenatal clinics in the Mangochi District Malaria Research Project from 1987 to 1990. 87 had twin pregnancies and 1 had triplets. 25 (28%) of the 88 women delivered at home vs. 1659 (42%) of the 3962 women with singleton pregnancies (p 0.016). Mortality was high among the 177 infants of the 88 multiple gestations. In 20 (23%) of the pregnancies all of the infants were either fetal deaths or died within the 1st year. One of the infant pairs died in 29 (33%) of the pregnancies; 7 of the survivors were lost to follow-up. Only 33 (38%) of mothers were known to have all their infants survive to 1 year, compared with 74% in singleton gestations. Multiple gestation infants had higher rates of perinatal and postperinatal deaths and loss to follow-up than singleton infants (p 0.0001, 0.004, and 0.04, respectively). The risk of death for an infant of a multiple gestation was more than twice the risk for an infant of a singleton gestation. The increased mortality associated with multiple gestation was caused by 2 factors: a higher frequency of low birth weight and a 4-fold increase in perinatal mortality among the infants with birth weights or = 2500 g and among infants with unknown birth weight. It was estimated that multiple gestation contributed to 5.5% of perinatal, 1.2% of the postperinatal, and 11.5% of the maternal deaths in this population. Multiple gestation in Malawi contributed to increased perinatal and maternal mortality but did not increase the risk of mortality after the perinatal period.
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