We sought to determine the impact of advanced paternal age on the birth outcomes of
triplets in a retrospective cohort study on 15,156 triplets born in the United States
from 1995 to 1997. The study group comprised fathers aged ≥40 years. Two control groups
consisting of mature (30 to 39 years) and younger (20 to 29 years) fathers were constructed
for comparison of main end points. We applied the generalized estimating equation
framework to obtain relative risk estimates after capturing the effect of sibling
correlations within triplet clusters. Stillbirths were 35% and 26% higher among triplets
of mature and older men, respectively, whereas neonatal mortality was 28% and 23%
lower among infants of mature and older fathers, respectively, using younger fathers
as the referent category. Although only the relative risk for neonatal mortality comparing
triplets of mature and younger fathers was statistically significant, these results
constitute high indices that represent an important burden of excess early mortality
at the population level. Our findings demonstrate a “shifting phenomenon” whereby
a higher level of intrauterine demise was compensated by a higher rate of extrauterine
survival among triplets born to older fathers.
KEYWORDS
Paternal age - triplets - mortality - shifting phenomenon
REFERENCES
- 1
Kaufman G E, Malone F D, Harvey-Wilkes K B et al..
Neonatal morbidity and mortality associated with triplet pregnancy.
Obstet Gynecol.
1998;
91
342-348
- 2
Joseph K S, Marcus S, Ohlsson A et al..
Preterm birth, stillbirth and infant mortality among triplet births in Canada, 1985-96.
Pediatr Perinat Epidemiol.
2002;
16
141-148
- 3
Keith L G, Oleszczuk J J.
Triplets: a challenge to the community worldwide.
Birth.
2000;
27
189-190
- 4
Keith L G, Olezczuck J J.
Triplet births in the United States: an epidemic of high-risk pregnancies.
J Reprod Med.
2002;
47
259-264
- 5
Devine P C, Malone F D, Athanassiou A, Harvey-Wilkes K, D'Alton M E.
Maternal and neonatal outcomes of 100 consecutive triplet pregnancies.
Am J Perinatol.
2001;
18
225-235
- 6
Sassoon D A, Castro L C, Davis J L, Hobel C J.
Perinatal outcome in triplet versus twin gestations.
Obstet Gynecol.
1990;
75
817-820
- 7
Ziadeh S M.
The outcome of triplet versus twin pregnancies.
Gynecol Obstet Invest.
2000;
50
96-99
- 8
Ziadeh S M.
Perinatal outcome in 41 sets of triplets in Jordan.
Birth.
2000;
27
185-188
- 9
Tough S C, Newburn-Cook C, Johnston D W et al..
Delayed childbearing and its impact on population rate changes in lower birth weight,
multiple birth, and preterm delivery.
Pediatrics.
2002;
109
399-403
- 10
Martin J A, Park M M.
Trends in twin and triplet births: 1980-97.
Natl Vital Stat Rep.
1999;
47
1-6
- 11
Abel E L, Kruger M, Burd L.
Effects of maternal and paternal age on Caucasian and Native American preterm birth
and birth weights.
Am J Perinatol.
2002;
19
49-54
- 12
Olshan A F, Ananth C V, Savitz D A.
Intrauterine growth retardation as an endpoint in mutation epidemiology: an evaluation
based on paternal age.
Mutat Res.
1995;
344
89-94
- 13 Martin J, Curtin S, Saulnier M, Mousavi J. Development of the Matched Multiple
Birth File. In: 1995-1997. Matched Multiple Birth Dataset. NCHS CD-ROM series 21,
no. 12 Hyattsville, MD; National Center for Health Statistics 2000
- 14 National Center for Health Statistics .1995-1997 linked birth/infant death data
set. Vital Statistics of the United States: Quality Control Procedures. Hyattsville,
MD; U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention 2000: 17
- 15
Alexander G R, Kotelchuck M.
Quantifying the adequacy of prenatal care: a comparison of indices.
Public Health Rep.
1996;
3
408-418
- 16
Alexander G R, Kogan M, Martin J, Papiernik E.
What are the fetal growth patterns of singletons, twins and triplets in the United
States?.
Clin Obstet Gynecol.
1998;
41
115-125
- 17
Kogan M D, Martin J A, Alexander G R et al..
The changing pattern of prenatal care utilization in the United States, 1981-1995,
using different prenatal care indices.
JAMA.
1998;
279
1623-1628
- 18
Buescher P A, Taylor K P, Davis M H, Bowing J M.
The quality of the new birth certificate data: a validation study in North Carolina.
Am J Public Health.
1993;
83
1163-1165
- 19
Reichman N E, Hade E M.
Validation of birth certificate data: a study of women in New Jersey's HealthStart
Program.
Ann Epidemiol.
2001;
11
186-193
- 20
Zeger S L, Liang K Y.
Longitudinal data analysis for discrete and continuous outcomes.
Biometrics.
1986;
42
121-130
- 21
Bujan L, Mieusset R, Mondinat C, Mansat A, Pontonnier F.
Sperm morphology in fertile men and its age related variation.
Andrologia.
1988;
20
121-128
- 22
Schwartz D, Mayaux M J, Spira A et al..
Study of a group of 484 fertile men. Part II: relationship between age (20-59) and
semen characteristics.
Int J Androl.
1981;
4
450-456
- 23
Sohal R S, Sohal B H, Brunk U T.
Relationship between antioxidant defenses and longevity in different mammalian species.
Mech Ageing Dev.
1990;
53
217-227
- 24
Ames B N.
Dietary carcinogens and anticarcinogens: oxygen radicals and degenerative diseases.
Science.
1983;
221
1256-1263
- 25
Olshan A F, Schnitzer P G, Baird P A.
Paternal age and the risk of congenital heart defects.
Teratology.
1991;
50
80-84
- 26
Savitz D A, Schwingl P, Keels M A.
Influence of paternal age, smoking an alcohol consumption on congenital anomalies.
Teratology.
1991;
44
429-440
- 27
Lian Z H, Zack M M, Erikson J D.
Paternal age and the occurrence of birth defects.
Am J Hum Genet.
1986;
39
648-660
- 28
Buehler J W, Kleinman J C, Hogue C JR et al..
Birth weight-specific infant mortality, United States, 1960 and 1980.
Public Health Rep.
1987;
102
151-161
- 29
McCormick M C.
The contribution of low birth weight to infant mortality and childhood morbidity.
N Engl J Med.
1985;
312
82-90
- 30
Dhont M, De Sutter P, Ruyssinck G, Martens G, Bekaert A.
Perinatal outcome of pregnancies after assisted reduction: a case-control study.
Am J Obstet Gynecol.
1999;
181
688-695
- 31
Wang J X, Clark A M, Kirby C A et al..
The obstetric outcome of singleton pregnancies following in-vitro fertilization/gamete
intra-fallopian transfer.
Hum Reprod.
1994;
9
141-146
- 32
Tanbo T, Dale P O, Lunde O, Moe N, Åbyholm T.
Obstetric outcome in singleton pregnancies after assisted reproduction.
Obstet Gynecol.
1995;
86
188-192
- 33
Zuppa A A, Maragliano G, Scapillati M E, Crescimbini B, Tortorolo G.
Neonatal outcome of spontaneous and assisted twin pregnancies.
Eur J Obstet Gynecol.
2001;
95
68-72
- 34
Reynolds M A, Schieve L A, Martin J A, Jeng G, Macaluso M.
Trends in multiple births conceived using assisted reproductive technology, United
States, 1997-2000.
Pediatrics.
2003;
111
1159-1162
Hamisu SalihuM.D. Ph.D.
Department of Maternal and Child Health, University of Alabama at Birmingham, 1665
University Boulevard
Birmingham, AL 35294
