• 23
    Jan
  • Single Motherhood and Neonatal Survival of Twins: Results

Out of a total of 446,570 twins delivered in the United States, 395,540 (88.6%) were live births to either white (325,130 or 82.2%) or to black mothers (70,410 or 17.8%). Results of comparisons between twins of married versus those of single gravidas with respect to selected sociodemographic characteristics stratified by race are summarized in Table 1. Regardless of race, single mothers were younger, less educated and less likely to have adequate prenatal care than their married counterparts. They were also more likely to smoke and consume alcohol during pregnancy. However, there was racial divergence concerning parity. Among blacks, primiparity was more preponderant among single mothers, while the contrary was the case among whites.


Table 1. Proportions (Percentages) of Sociodemographic characteristics of Mothers of Twin Births according to Marital Status within Specific Racial Groups

Black (N=70,410)

White (N=325,130)

Single (N=46,690)% Married (N=23,720)%

P Value

Single (N=64,301)% Married (N=260,829)%

P Value

Maternal age <35 years >35 years 93.05 6.95 82.66 17.34 O.0001 89.32 10.68 78.03 21.97 O.0001
Parity Primipara Multipara Not stated 47.94 51.41 0.64 44.86 54.60 0.54 O.0001 57.89 41.42 0.69 59.45 39.97 0.58 O.0001
Maternal education <12 years >12 years Not Stated 72.53 25.12 2.35 41.39 56.65 1.96 O.0001 75.22 22.75 2.02 36.34 62.51 1.15 O.0001

Maternal smoking

Yes

No

Not stated

11.38 76.95 11.67 4.54 81.66 13.79 <0.0001 21.65 53.66 24.69 6.85 73.29 19.86 O.0001
Prenatal care Adequate Not adequate 51.20 48.80 69.97 30.03 O.0001 57.67 42.33 77.62 22.38 O.0001

In general, twins of married mothers were delivered three days later than those of single mothers [mean gestational age (± standard deviation) = 35.8 weeks (±3.1) versus 35.4 weeks (±3.7)]. This difference remained unchanged when the comparison was done in each racial category (Table 2). Similarly, twins of married mothers weighed 189 g more than their counterparts delivered by single gravidas [Mean birthweight (± standard error) = 2,422 g (±642) versus 2,233 g (±687)]. The magnitude of the single-married mother disparity in twin birthweight was greater among whites (143 g) than among blacks (114 g). Race-specific differences in the occurrence of LB W, VLB W, preterm, very preterm and small-for-gestational age are presented in Table 2. For any of these neonatal morbidity indices, twins of single mothers were disadvantaged irrespective of the racial group. Apcalis Oral Jelly

Figure 1. Crude Neonatal

Figure 1. Crude Neonatal Mortality Rates by Marital Status among Black and White Twins

Table 2. Comparison of Neonatal Morbidity according to Marital Status within Racial Groups

Black (N=70,410)

White (N=325,130)

Single

Married P Value

Single

Married

P Value

Gestational age (weeks)*

35.15 ±4.0

35.40 ±3.6 O.0001

35.64 ±3.5

35.88 ±3.1

0.0001

Birthweight (grams)*

2150.1 ±712.4 2264.4 ±700.1

<0.0001

2293.4 ±660.7  2436.5 ±634.1

0.0001

%

%

% %

Low birthweight (<2/500 g)

66.32

59.32 O.0001

59.06

49.42

0.0001

Very low birthweight (<1,500 g)

17.44

13.83 O.0001

11.72

8.23

0.0001

Preterm (<37 weeks)

59.62

57.72 O.0001

55.25

53.05

0.0001

Very preterm (<33 weeks)

22.94

18.82 O.0001

16.83

12.39

0.0001

Small for gestational age

14.49

11.43 0.0001

12.66

8.23

0.0001

* Values are mean ± standard deviation.

In the entire study population (white and black twins), a total of 10,094 of neonatal deaths were counted, equivalent to a neonatal mortality rate of 25.5 per 1,000. Of these, 6,206 neonatal deaths occurred among twins of married gravidas, while 3,888 were recorded among twins of single mothers, corresponding to an overall crude neonatal mortality rates of 21.8 per 1,000 and 35.0 per 1,000, respectively. The preponderance of these deaths occurred in the early neonatal period (85% of neonatal deaths), although disparities were detected in both early (18.6/1,000 versus 30.0/1,000) and late (3.2/1,000 versus 5.5/1,000) neonatal periods. When the mortality events were separated by race, twins born to single mothers still depicted lower survival probabilities (Figure 1). Gestational age-specific neonatal mortality rates and ratios are shown in Table 3.

Table 3. Gestational Age-Specific Neonatal Mortality Rates among Black and White Mothers by Marital Status

Black

White

Gestational

Single

Married

Relative

95%

Single

Married

Relative

95%

Age (Weeks)

(Rate/1,000) (Rate/1,000)

Risk

CI

(Rate/1,000) (Rate/1,000)

Risk

CI

24 353 362

1.0

0.8-1.2

492 500

1.0

0.9-1.1
25 244 202

1.2

0.9-1.6

290 307

0.9

0.8-1.1
26 147 114

1.3

0.9-1.9

189 196

1.0

0.8-1.2
27 83 97

0.9

0.6-1.3

111 125

0.9

0.7-1.1
28 47 64

0.7

0.4-1.2

91 71

1.3

1.0-1.7
29 49 37

1.3

0.8-2.3

60 47

1.3

1.0-1.7
30 34 31

1.1

0.6-2.0

41 30

1.4

1 .CM .8
31 17 25

0.7

0.4-1.2

19 18

1.1

0.7-1.6
32 14 8.4

1.7

0.8-3.7

10 12

0.8

0.6-1.3
33 11 6.3

1.8

0.8-3.7

12 7.2

1.7

1.1-2.4
34 5.8 2.1

2.8

0.9-7.9

7.3 5.3

1.4

1.0-2.0
35 3.4 0.8

4.3

1.0-19.2

3.1 3.3

0.9

0.6-1.5
36 4.3 2.7

1.6

0.7-3.4

3.0 2.8

1.1

0.7-1.6
37 1.2 1.5

0.8

0.3-2.6

1.9 2.4

0.8

0.5-1.3
38 2.9 1.6

1.8

0.6-4.9

2.0 1.9

1.1

0.6-1.8
39 2.0 4.0

0.5

0.2-1.4

3.6 1.8

2.0

1.1-3.4
40 2.5 1.1

2.3

0.3-18.9

2.5 4.0

0.6

0.3-1.4
41 3.3 5.4

0.6

0.1-3.7

3.0 4.6

0.7

0.2-2.0
>42 6.2 2.5

2.5

0.3-20.2

1.3 4.5

0.3

0.1-1.3

Total

16.2

11.4

1.4

1.3-1.6

19.3

13.5

1.4

1.3-1.5

Table 4 displays adjusted hazard ratios for the association between marital status and neonatal, early neonatal and late neonatal mortality. In both racial groups, twins born to single mothers had significantly higher likelihood of dying in the neonatal period as compared to those of married mothers. However, it is noticeable that the level of this disparity among whites doubled that observed among blacks. In the early neonatal period, twins of white single mothers still bore a significantly higher probability of dying relative to those of married mothers, whereas the survival disparity virtually disappeared among black mothers. In both racial groups, the late neonatal period corresponds to the time segment with the greatest disparity in neonatal mortality between twins of married and those of single mothers. Excess deaths associated with single motherhood are generally higher among whites than blacks (Table 4). Finally, when a variable coding for gestational age was included into the adjusted model, the association between single motherhood and all the three mortality indices disappeared in both racial groups (Table 4). canadian antibiotics

Table 4. Hazard Ratio and Excess Neonatal Mortality among Twins of Single Mothers (Married Mothers Are the Referent Group)

Blacks

Whites

AHR (95% CI)   Excess Mortality %

AHR (95% CI)

Excess Mortality %

Neonatal Early Neonatal Late Neonatal 1.12 (1.01-1.25)            10.7 1.08 (0.96-1.21)             7.4 1.40 (1.11-1.76)            28.6 1.23 (1.14-1.31) 1.19 (1.11-1.28) 1.43 (1.24-1.65) 18.7 16.0 30
Neonatal Early Neonatal Late Neonatal

* With adjustment for gestational age

0.92 (0.82-1.03)            -8.7                          1.02 (0.94-1.10) 0.90 (0.79-1.01)           -11.1                           1.00 (0.93-1.09) 1.12 (0.89-1.43)            10.7                          1.15 (0.99-1.34)

2.0 0.0 13.0
*AHR = adjusted hazard ratio; CI = Confidence Interval; Adjusted estimates for the top model were generated by taking into account the confounding effects of education, parity, adequacy of prenatal care, and maternal smoking during pregnancy.; JThe following variables were adjusted for in the bottom model: gestational age, education, parity, adequacy of prenatal care, and maternal smoking during pregnancy.
Online Pharmacy