{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:56:11Z","timestamp":1792418171631,"version":"4.4.0"},"reference-count":30,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2001,11,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective.<\/jats:title>\n                  <jats:p>To examine whether the recent substantial increase in preterm birth among twins has been associated with changes in fetal and infant mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design.<\/jats:title>\n                  <jats:p>Cohort study based on information in the linked live birth, stillbirth, and mortality databases of Statistics Canada.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting.<\/jats:title>\n                  <jats:p>Ten of 12 provinces and territories in Canada.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants.<\/jats:title>\n                  <jats:p>All twin live births and stillbirths between 1985 and 1996, along with information on deaths during infancy (1985\u20131997).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measure.<\/jats:title>\n                  <jats:p>Fetal and infant mortality rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results.<\/jats:title>\n                  <jats:p>The rate of preterm birth among twin live births increased significantly by 17% (95% confidence interval: 14%\u201320%) from 42.5% between 1985 and 1987 to 49.6% between 1994 and 1996. Overall, stillbirth rates among twins declined from 22.4 per 1000 total births in 1985 to 1987 to 18.8 per 1000 total births in 1994 to 1996. Among twin fetuses \u226534 weeks' gestation, stillbirth rates decreased from 9.5 per 1000 in 1985 to 1987 to 5.4 per 1000 fetuses at risk in 1994 to 1996. Infant mortality rates among twin live births declined substantially in all categories of gestational age above 24 weeks except for live births at 32 to 33 and 34 to 36 weeks' gestation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions.<\/jats:title>\n                  <jats:p>The recent increase in preterm birth among twins was associated with a substantial reduction in stillbirth rates at and near term gestation. Infant mortality rates declined concurrently, although the absence of a significant decrease in infant mortality among twin live births at 32 to 33 and 34 to 36 weeks' gestational age needs additional scrutiny.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.108.5.1055","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:55:51Z","timestamp":1092441351000},"page":"1055-1061","source":"Crossref","is-referenced-by-count":55,"title":["Changes in Stillbirth and Infant Mortality Associated With Increases in Preterm Birth Among Twins"],"prefix":"10.1542","volume":"108","author":[{"given":"K. S.","family":"Joseph","sequence":"first","affiliation":[{"name":"From the Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvie","family":"Marcoux","sequence":"additional","affiliation":[{"name":"Department of Social and Preventive Medicine, Universite\u0301 Laval, Sainte-Foy, Quebec;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne","family":"Ohlsson","sequence":"additional","affiliation":[{"name":"Departments of Paediatrics, Obstetrics and Gynecology and Health Administration, University of Toronto, Toronto, Ontario;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiliang","family":"Liu","sequence":"additional","affiliation":[{"name":"Bureau of Reproductive and Child Health, Health Canada, Ottawa, Ontario;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander C.","family":"Allen","sequence":"additional","affiliation":[{"name":"From the Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics, Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi Wu","family":"Wen","sequence":"additional","affiliation":[{"name":"Bureau of Reproductive and Child Health, Health Canada, Ottawa, Ontario;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Fetal and Infant Heath Study Group of the Canadian Perinatal Surveillance System","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2001,11,1]]},"reference":[{"key":"2021121003524148500_B1"},{"key":"2021121003524148500_B2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/00003081-199803000-00005","article-title":"What is the population-based risk of preterm birth among twins and other multiples?","volume":"41","author":"Kiely","year":"1998","journal-title":"Clin Obstet Gynecol"},{"key":"2021121003524148500_B3","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/S0020-7292(98)00230-6","article-title":"Iatrogenic multiple birth, multiple pregnancy and assisted reproductive technologies.","volume":"64","author":"Keith","year":"1999","journal-title":"Int J Gynaecol Obstet"},{"key":"2021121003524148500_B4","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1016\/S0140-6736(99)04345-7","article-title":"Deliveries and children born after in-vitro fertilization in Sweden 1982\u201395; a retrospective cohort study.","volume":"354","author":"Bergh","year":"1999","journal-title":"Lancet"},{"key":"2021121003524148500_B5","first-page":"223","article-title":"Multiple births: trends and patterns in Canada, 1974\u201390.","volume":"4","author":"Millar","year":"1992","journal-title":"Health Rep"},{"key":"2021121003524148500_B6"},{"key":"2021121003524148500_B7"},{"key":"2021121003524148500_B8"},{"key":"2021121003524148500_B9","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1056\/NEJM199811123392004","article-title":"Determinants of preterm birth rates in Canada from 1981 through 1983 and from 1992 through 1994.","volume":"339","author":"Joseph","year":"1998","journal-title":"N Engl J Med"},{"key":"2021121003524148500_B10","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1001\/jama.284.3.335","article-title":"Trends in twin birth outcomes and prenatal care utilization in the United States, 1981\u20131997.","volume":"284","author":"Kogan","year":"2000","journal-title":"JAMA"},{"key":"2021121003524148500_B11","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1001\/jama.280.21.1849","article-title":"Secular trends in preterm birth: a hospital-based cohort study.","volume":"280","author":"Kramer","year":"1998","journal-title":"JAMA"},{"key":"2021121003524148500_B12","first-page":"57","article-title":"Causes and consequences of recent changes in the character of twin births.","volume":"98","author":"Joseph","year":"2001","journal-title":"Obset Gynecol"},{"key":"2021121003524148500_B13","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/0010-4809(81)90004-5","article-title":"A generalized iterative record linkage computer system for use in medical follow up studies.","volume":"14","author":"Howe","year":"1981","journal-title":"Computers in Biomedical Research"},{"key":"2021121003524148500_B14"},{"key":"2021121003524148500_B15"},{"key":"2021121003524148500_B16","first-page":"535","article-title":"Recent trends in infant mortality rates and proportions of low- birth-weight live births in Canada.","volume":"157","author":"Joseph","year":"1997","journal-title":"Can Med Assoc J"},{"key":"2021121003524148500_B17","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1542\/peds.101.3.438","article-title":"Before viability: a geographically based outcome study of infants weighing 500 grams or less at birth.","volume":"101","author":"Sauve","year":"1998","journal-title":"Pediatrics"},{"key":"2021121003524148500_B18","doi-asserted-by":"crossref","first-page":"121","DOI":"10.2307\/2531248","article-title":"Longitudinal data analysis for discrete and continuous outcomes.","volume":"42","author":"Zeger","year":"1986","journal-title":"Biometrics"},{"key":"2021121003524148500_B19"},{"key":"2021121003524148500_B20"},{"key":"2021121003524148500_B21","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1001\/jama.284.7.843","article-title":"The contribution of mild and moderate preterm birth to infant mortality.","volume":"284","author":"Kramer","year":"2000","journal-title":"JAMA"},{"key":"2021121003524148500_B22","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1046\/j.1365-3016.2000.00298.x","article-title":"for the Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. Gestational age- and birth weight-specific declines in infant mortality in Canada, 1985\u201394.","volume":"14","author":"Joseph","year":"2000","journal-title":"Paediatr Perinatal Epidemiol"},{"key":"2021121003524148500_B23","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1017\/S0001566000005687","article-title":"Congenital malformations in twins: a population study.","volume":"35","author":"Ka\u0308llen","year":"1986","journal-title":"Acta Genet Med Gemellol"},{"key":"2021121003524148500_B24","first-page":"1037","article-title":"Calculated risk of chromosomal abnormalities in twin gestations.","volume":"76","author":"Rodis","year":"1990","journal-title":"Obstet Gynecol"},{"key":"2021121003524148500_B25","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1136\/adc.61.11.1044","article-title":"The intrauterine hazards of twins.","volume":"61","author":"Bryan","year":"1986","journal-title":"Arch Dis Child"},{"key":"2021121003524148500_B26","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/00003081-199803000-00009","article-title":"What are the rates and mechanisms of first and second trimester pregnancy loss in twins?","volume":"41","author":"Grobman","year":"1998","journal-title":"Clin Obstet Gynecol"},{"key":"2021121003524148500_B27","doi-asserted-by":"crossref","first-page":"850","DOI":"10.2105\/AJPH.84.5.850","article-title":"International infant mortality rates: bias from reporting differences.","volume":"84","author":"Howell","year":"1994","journal-title":"Am J Public Health"},{"key":"2021121003524148500_B28","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1093\/ije\/24.3.583","article-title":"International rankings of infant mortality and the United States vital statistics natality data collecting system\u2013failure and success.","volume":"24","author":"Sepkowitz","year":"1995","journal-title":"Int J Epidemiol"},{"key":"2021121003524148500_B29","first-page":"1047","article-title":"Recent trends in Canadian infant mortality rates: effect of changes in the registration of liveborns weighing less than 500 g.","volume":"155","author":"Joseph","year":"1996","journal-title":"Can Med Assoc J"},{"key":"2021121003524148500_B30","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1046\/j.1365-3016.1999.00191.x","article-title":"Changes in the registration of stillbirths less than 500 g in Canada, 1985\u201395.","volume":"13","author":"Joseph","year":"1999","journal-title":"Paediatr Perinatal Epidemiol"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/108\/5\/1055\/892224\/pe1101001055.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/108\/5\/1055\/892224\/pe1101001055.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T11:18:13Z","timestamp":1639135093000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/108\/5\/1055\/63690\/Changes-in-Stillbirth-and-Infant-Mortality"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2001,11,1]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2001,11,1]]},"published-print":{"date-parts":[[2001,11,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.108.5.1055","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[2001,11,1]]}}}