Placenta previa in singleton and twin births in the United States, 1989 through 1998: a comparison of risk factor profiles and associated conditions.
OBJECTIVE
The purpose of this study was to compare risk factor profiles for placenta previa between singleton and twin live births.


METHODS
This cohort study was based on United States natality data files (1989 through 1998) and comprised 37,956,020 singleton births and 961,578 twin births. Women who were diagnosed with placenta previa were included only if they were delivered by cesarean delivery. Risk factors for placenta previa that were examined included sociodemographic (age, gravidity, education, marital status, and race), behavioral (prenatal care, smoking, and alcohol use), previous preterm birth, and medical and obstetric factors. Effect modification between maternal age and gravidity and the dose-response relationship with number of cigarettes smoked/day on placenta previa risk were also evaluated.


RESULTS
The rate of placenta previa was 40% higher among twin births (3.9 per 1,000 live births, n = 3,793 births) than among singleton births (2.8 per 1,000 live births, n = 104,754 births). Comparison of risk factors for placenta previa between the singleton and twin births revealed fairly similar risk factor profiles. Compared with primigravid women <20 years old, the risk for placenta previa increased by advancing age and by increasing number of pregnancies among both singleton and twin births. The number of cigarettes smoked per day also showed a dose-response trend for placenta previa risk in the two groups.


CONCLUSIONS
The increased rate of placenta previa among twin births underscores the need to monitor carefully such pregnancies with heightened suspicion and awareness for the development of this condition.
Ananth
Cande V
CV
Section of Epidemiology and Biostatistics, University of Medicine and Dentistry of New Jersey- Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick, NJ, USA.
Demissie
Kitaw
K
Smulian
John C
JC
Vintzileos
Anthony M
AM
D000328:Adult; D000375:Aging; D000704:Analysis of Variance; D044383:Black People; D002585:Cesarean Section; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010298:Parity; D010923:Placenta Previa / Q000453:epidemiology*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014427:Twins; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American