Mortality associated with multiple gestation in Malawi.
BACKGROUND
Multiple gestation is associated with increased maternal, perinatal, and infant mortality. The prevalence of multiple gestation varies widely with the highest rates reported among populations in Africa. There have been few population-based studies of the impact of multiple gestation on pregnancy outcomes in sub-Saharan Africa.


METHODS
Data from a 1987-1990 prospective study of the effect of malaria chemoprophylaxis among pregnant women on birthweight and mortality of their infants in a rural area of Malawi were used to estimate the prevalence of multiple gestation and to quantify the risk of mortality associated with multiple gestation compared with single gestation.


RESULTS
There were 88 (2.2%) multiple gestations among 4049 women. Mortality was high; only 38% of mothers were known to have all their infants survive to 1 year, compared with 74% in singleton gestations. The increased mortality associated with multiple gestation was due to two factors: a higher frequency of low birthweight and a fourfold increase in perinatal mortality among the infants with birthweights > or = 2500 g and among infants with unknown birthweight. We estimated that multiple gestation contributes to 5.5% of the perinatal, 1.2% of the postperinatal, and 11.5% of the maternal deaths in this population.


CONCLUSIONS
Multiple gestation in Malawi contributed to increased perinatal and maternal mortality, but did not increase the risk of mortality after the perinatal period.
McDermott
J M
JM
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Steketee
R
R
Wirima
J
J
D001724:Birth Weight; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008295:Malawi / Q000453:epidemiology; D008428:Maternal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011272:Pregnancy, Multiple; D012307:Risk Factors; D014427:Twins