Teen Twin Pregnancies: Differences in Fetal Growth Outcomes among Blacks and Whites

ABSTRACT

We set out to determine the magnitude of black-white disparity in intrauterine fetal growth inhibition among twin births to teenagers (age 15 to 19) in the United States using a retrospective cohort study design. We compared the risk for low and very low birthweight, preterm and very preterm, and small for gestational age between black and white twins born to teen mothers during the period 1995 through 1998. The methodology of generalized estimating equations was used to adjust for the presence of intracluster correlation within twin pairs. A total of 29,307 individual twins were analyzed. For all fetal growth indices examined, infants born to black mothers remained disadvantaged except for preterm birth, for which the risk was comparable to that of whites (adjusted OR, 1.03; 95% confidence interval [CI] 0.95 to 1.11). The racial gap was most marked for low birthweight (OR, 1.27; 95% CI, 1.19, 1.37]) and very low birthweight (OR, 1.30; 95% CI, 1.19 to 1.42). Black twins had an equal level of elevated risk for very preterm and small for gestational age (OR, 1.17; 95% CI, 1.07 to 1.27 and OR, 1.17; 95% CI, 1.07 to 1.28, respectively). In conclusion, we found significant differences in fetal growth parameters between black and white twins born to teen gravidas. Our findings confirm similar black disadvantage reported for singletons. Current prevention strategies aimed at reducing adverse fetal outcomes among teenagers in the United States need to consider the heightened risk among neonates born to black mothers.

Teens - twin pregnancy - birth outcomes

REFERENCES

• 1 Powers W F, Kiely J L. The risks confronting twins: a national perspective.  Am J Obstet Gynecol. 1994;  170 456-461
• 2 Powers W F, Wampler N S. Further defining the risks confronting twins.  Am J Obstet Gynecol. 1996;  175 1522-1528
• 3 Pollack H, Lantz P, Frohna J G. Maternal smoking and adverse outcomes among singletons and twins.  Am J Public Health. 2000;  90 395-400
• 4 Hartley R S, Emmanuel I, Hitti J. Perinatal mortality and neonatal morbidity rates among twin pairs at different gestational ages: optimal delivery timing at 37 to 38 weeks’ gestation.  Am J Obstet Gynecol. 2001;  184 451-458
• 5 Martin J, Curtin S, Saulnier M, Mousavi J. Development of the matched multiple birth file. In: 1995-1998 Matched Multiple Birth Dataset. NCHS CD-ROM series 21, No. 13a Hyattsville, MD; National Center for Health Statistics 2003
• 6 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;  41 114-125
• 7 Alexander G R, Kotelchuck M. Quantifying the adequacy of prenatal care: a comparison of indices.  Public Health Rep. 1996;  111 408-418
• 8 Alexander G R, Cornely D A. Prenatal care utilization: its measurement and relationship to pregnancy outcome.  Am J Prev Med. 1987;  3 243-253
• 9 Kogan M D, Martin J A, Alexander G R, Kotelchuck M, Ventura S J, Frigoletto F D. The changing pattern of prenatal care utilization in the United States, 1981-1995, using different prenatal care indices.  JAMA. 1998;  279 1623-1628
• 10 Buescher P A, Taylor K P, Davis M H, Bowling J M. The quality of the new birth certificate data: a validation study in North Carolina.  Am J Public Health. 1993;  83 1163-1165
• 11 DiGiuseppe D L, Aron D C, Ranbom L, Harper D L, Rosenthal G E. Reliability of birth certificate data: a multi-hospital comparison to medical records information.  Matern Child Health J. 2002;  6 169-179
• 12 Zeger S L, Liang K Y. Longitudinal data analysis for discrete and continuous outcomes.  Biometrics. 1986;  42 121-130
• 13 Leland N L, Petersen D J, Braddock M, Alexander G. Variations in pregnancy outcomes by race among 10-14 year-old mothers in the United States.  Public Health Rep. 1995;  110 53-58
• 14 Vital Statistics of the United States, 1979-1990. Vol. I and II. Hyattsville, MD; National Center for Health Statistics; 1984-1994