IS PREVENTION OF PRETERM BIRTHS IN TWIN PREGNANCIES POSSIBLE - ANALYSIS OF THE RESULTS OF A PREVENTION PROGRAM IN FRANCE (1989-1991)

Objectives: A policy aimed at the prevention of early preterm births i n twin pregnancies has been evaluated. The prevention program included : early diagnosis of twinning, information of the mothers about the ri sk of prematurity, attempts to restrain physical activity and early wo rk leave prescription when indicated. Study design: Cohort study of al l twin births in a given geographical area (Hauts-de-Seine district); 546 mothers with pregnancy duration of greater than or equal to 26 wee ks were included; 1088 newborns were followed up to the 28th day of li fe. Results: The recommended prevention program is largely used (88% o f early diagnosis of twinning, 62% of the women informed and 73% of pr escription for reduced physical activity). The very preterm (26-28 wee ks) and early preterm (less than or equal to 32 weeks) birth rates are low: 1.5 and 8.5%, respectively. The stillbirth rate is 11 per thousa nd and the neonatal mortality rate (0-27 days) is 10 per thousand live births, with a persistent difference between the first and the second twin. Conclusion: The present study demonstrates the open access and acceptability of the prevention policy; in addition, the perinatal out comes are better than those of comparable published cohorts.