Lower perinatal mortality in preterm born twins than in singletons: a nationwide study from The Netherlands

Blanka Vasak*, Jessica J. Verhagen, Steven V. Koenen, Maria P. H. Koster, Paul A. O. M. de Reu, Arie Franx, Jan G. Nijhuis, Gouke J. Bonsel, Gerard H. A. Visser

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

19 Citations (Web of Science)


BACKGROUND: Twin pregnancies are at increased risk for perinatal morbidity and death because of many factors that include a high incidence of preterm delivery. Compared with singleton pregnancies, overall perinatal risk of death is higher in twin pregnancies; however, for the preterm period, the perinatal mortality rate has been reported to be lower in twins.

OBJECTIVE: The purpose of this study was to compare perinatal mortality rates in relation to gestational age at birth between singleton and twin pregnancies, taking into account socioeconomic status, fetal sex, and parity.

STUDY DESIGN: We studied perinatal mortality rates according to gestational age at birth in 1,502,120 singletons pregnancies and 51,658 twin pregnancies without congenital malformations who were delivered between 2002 and 2010 after 28 weeks of gestation. Data were collected from the nationwide Netherlands Perinatal Registry.

RESULTS: Overall the perinatal mortality rate in twin pregnancies (6.6/1000 infants) was higher than in singleton pregnancies (4.1/1000 infants). However, in the preterm period, the perinatal mortality rate in twin pregnancies was substantially lower than in singleton pregnancies (10.4 per 1000 infants as compared with 34.5 per 1000 infants, respectively) for infants who were born at

CONCLUSION: Overall the perinatal mortality rate was higher in twin pregnancies than in singleton pregnancies, which is most likely caused by the high preterm birth rate in twins and not by a higher mortality rate for gestation, apart from term pregnancies. During the preterm period, the antepartum mortality rate was much lower in twin pregnancies than in singleton pregnancies. We suggest that this might be partially due to a closer monitoring of twin pregnancies, which indirectly suggests a need for closer surveillance of singleton pregnancies.

Original languageEnglish
Article numberARTN 161.e1-e9
Number of pages9
JournalAmerican Journal of Obstetrics and Gynecology
Issue number2
Publication statusPublished - Feb 2017


  • gestational age
  • perinatal mortality
  • preterm mortality
  • singleton pregnancies
  • twin pregnancies
  • RISK

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