Causes and consequences ct recent increases in preterm birth among twins

Objective: To examine the causes and consequences of the recent increase in preterm birth among twins. Methods: We studied all twin births among residents of the province of Nova Scotia, Canada, between 1988 and 1997, Rates of preterm birth, preterm lab or induction, preterm cesarean, small-for-gestational age (SGA), respirator y distress syndrome (RDS), stillbirth, perinatal mortality, and infant mort ality were compared between past and more recent years. Changes in perinata l mortality were examined using logistic repression to adjust for the effec ts of other determinants. Results: The study included 2516 twin births (73 stillbirths and 2443 live births). The rate of preterm birth increased from 42.3% in 1988-1992 to 48. 2% of twin live births in 1993-1997 (14% increase, P = .04). Twin live birt hs born after preterm labor induction increased from 3.5% in 1988-1989 to 8 .6% in 1996-1997 (P for trend = .007). Of live births between 34 and 36 wee ks' gestation, the proportion born SGA decreased from 17.5% in 1988-1992 to 9.2% in 1993-1997 (P = .005), Over the same period, rates of prophylactic maternal steroid therapy increased substantially and rates of RDS declined. Perinatal mortality rates among pregnancies reaching 34 weeks decreased fr om 12.9 per 1000 total births in 1988-1992 to 4.2 per 1000 total births in 1993-1997 (P = .05). Conclusion: Increases in preterm labor induction appear to be responsible f or the recent increase in preterm birth among twins. These changes have bee n accompanied by decreases in perinatal morbidity and mortality among twin pregnancies that reach 34 weeks' gestation. (C) 2001 by the American Colleg e of Obstetricians and Gynecologists.