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Title: Trends in the incidence and mortality of multiple births by socioeconomic deprivation and maternal age in England: population-based cohort study.
Authors: Smith, Lucy K.
Manktelow, Bradley N.
Draper, Elizabeth S.
Boyle, Elaine M .
Johnson, Samantha J.
Field, David J.
First Published: 3-Apr-2014
Publisher: BMJ Publishing Group
Citation: BMJ Open 2014;4:e004514
Abstract: Objective To investigate temporal trends in multiple birth rates and associated stillbirth and neonatal mortality by socioeconomic deprivation and maternal age in England. Design Population cohort study. Setting England. Participants All live births and stillbirths (1 January 1997 to 31 December 2008). Main outcome measures Multiple maternity rate, stillbirth and neonatal death rate by year of birth, decile of socioeconomic deprivation and maternal age. Results The overall rate of multiple maternities increased over time (+0.64% per annum 95% CI (0.47% to 0.81%)) with an increase in twin maternities (+0.85% per annum 95% CI (0.67% to 1.0%)) but a large decrease in triplet and higher order maternities (−8.32% per annum 95% CI (−9.39% to −7.25%)). Multiple maternities were significantly lower in the most deprived areas, and this was most evident in the older age groups. Women over 40 years of age from the most deprived areas had a 34% lower rate of multiple births compared with similar aged women from the most deprived areas (rate ratio (RR) 0.66 95% CI (0.61 to 0.73)). Multiple births remain at substantially higher risk of neonatal mortality (RR 6.30 95% CI (6.07 to 6.53)). However, for stillbirths, while twins remain at higher risk, this has decreased over time (1997–2000: RR 2.89 (2.69 to 3.10); 2005–2008: RR 2.22 95% CI (2.06 to 2.40)). Socioeconomic inequalities existed in mortality for singletons and multiple births. Conclusions This period has seen increasing rates of twin pregnancies and decreasing rates of higher order births which have coincided with changes in recommendations regarding assisted reproductive techniques. Socioeconomic differences in multiple births may reflect differential access to these treatments. Improved monitoring of multiple pregnancies is likely to have led to the reductions in stillbirths over this time.
DOI Link: 10.1136/bmjopen-2013-004514
ISSN: 2044-6055
eISSN: 2044-6055
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Description: PMCID: PMC3987713
Appears in Collections:Published Articles, Dept. of Health Sciences

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