{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:37:04Z","timestamp":1788244624278,"version":"build-2803163510"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T00:00:00Z","timestamp":1610323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006507","name":"Funda\u00e7\u00e3o Oswaldo Cruz","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006507","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004586","name":"Funda\u00e7\u00e3o Carlos Chagas Filho de Amparo \u00e0 Pesquisa do Estado do Rio de Janeiro","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004586","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Twin pregnancies account for 0.5\u20132.0% of all gestations worldwide. They have a negative impact on perinatal health indicators, mainly owing to the increased risk for preterm birth. However, population-based data from low\/middle income countries are limited. The current paper aims to understand the health risks of twins, compared to singletons, amongst late preterms and early terms.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data is from \u201cBirth in Brazil\u201d, a national inquiry into childbirth care conducted in 2011\/2012 in 266 maternity hospitals. We included women with a live birth or a stillborn, and excluded births of triplets or more, totalling 23,746 singletons and 554 twins. We used multiple logistic regressions and adjusted for potential confounders.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Twins accounted for 1.2% of gestations and 2.3% of newborns. They had higher prevalence of low birth weight and intrauterine growth restriction, when compared to singletons, in all gestational age groups, except in the very premature ones (&lt;34 weeks). Amongst late preterm\u2019s, twins had higher odds of jaundice (OR 2.7, 95% CI 1.8\u20134.2) and antibiotic use (OR 1.8, 95% CI 1.1\u20133.2). Amongst early-terms, twins had higher odds of oxygen therapy (OR 2.7, 95% CI 1.3\u20135.9), admission to neonatal intensive care unit (OR 3.1, 95% CI 1.5\u20136.5), transient tachypnoea (OR 3.7, 95% CI 1.5\u20139.2), jaundice (OR 2.8, 95% CI 1.3\u20135.9) and antibiotic use (OR 2.2, 95% CI 1.14.9). In relation to birth order, the second-born infant had an elevated likelihood of jaundice, antibiotic use and oxygen therapy, than the first-born infant.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Although strongly mediated by gestational age, an independent risk remains for twins for most neonatal morbidities, when compared to singletons. These disadvantages seem to be more prominent in early-term newborns than in the late preterm ones.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0245152","type":"journal-article","created":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T07:49:22Z","timestamp":1610437762000},"page":"e0245152","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":28,"title":["Twin pregnancy and perinatal outcomes: Data from \u2018Birth in Brazil Study\u2019"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0236-2043","authenticated-orcid":true,"given":"Ana Paula","family":"Esteves-Pereira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3592-1849","authenticated-orcid":true,"given":"Ant\u00f4nio Jos\u00e9 Ledo Alves","family":"da Cunha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"Nakamura-Pereira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2034-0294","authenticated-orcid":true,"given":"Maria Elisabeth","family":"Moreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa Maria soares madeira","family":"Domingues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine Fernandes","family":"Viellas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria do Carmo","family":"Leal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Granado nogueira da Gama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,1,11]]},"reference":[{"key":"pone.0245152.ref001","doi-asserted-by":"crossref","first-page":"e25239","DOI":"10.1371\/journal.pone.0025239","article-title":"Twinning across the Developing World","volume":"6","author":"J Smits","year":"2011","journal-title":"PLoS One"},{"key":"pone.0245152.ref002","first-page":"1","article-title":"Births in the United States, 2017","author":"JA Martin","year":"2018","journal-title":"NCHS Data Brief"},{"key":"pone.0245152.ref003","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.jogoh.2017.09.002","article-title":"Trends in perinatal health in metropolitan France from 1995 to 2016: Results from the French National Perinatal Surveys","volume":"46","author":"B Blondel","year":"2017","journal-title":"J Gynecol Obstet Hum Reprod"},{"issue":"Suppl 3","key":"pone.0245152.ref004","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S1472-6483(10)62251-1","article-title":"Global epidemiology of multiple birth","volume":"15","author":"J Collins","year":"2007","journal-title":"Reprod Biomed Online"},{"key":"pone.0245152.ref005","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1053\/j.semperi.2012.02.001","article-title":"Epidemiology of twinning in developed countries","volume":"36","author":"CV Ananth","year":"2012","journal-title":"Semin Perinatol"},{"key":"pone.0245152.ref006","first-page":"1","article-title":"Three decades of twin births in the United States, 1980\u20132009","author":"JA Martin","year":"2012","journal-title":"NCHS Data Brief"},{"key":"pone.0245152.ref007","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1053\/sper.2002.34775","article-title":"Trends in the occurrence, determinants, and consequences of multiple births","volume":"26","author":"B Blondel","year":"2002","journal-title":"Semin Perinatol"},{"key":"pone.0245152.ref008","doi-asserted-by":"crossref","first-page":"2218","DOI":"10.1056\/NEJMoa1301467","article-title":"Fertility treatments and multiple births in the United States","volume":"369","author":"AD Kulkarni","year":"2013","journal-title":"N Engl J Med"},{"key":"pone.0245152.ref009","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.ajog.2016.01.185","article-title":"Seeing double: a nation of twins from sea to shining sea","volume":"214","author":"EY Adashi","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"pone.0245152.ref010","unstructured":"Brasil (2018) Sistema de Informa\u00e7\u00f5es sobre Nascidos Vivos. 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