title: The association of parity with mortality outcomes among triplets.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the association of parity with stillbirth and neonatal and infant death among triplets.
  
  
  METHODS
  This was a retrospective cohort study of 15,930 triplets who were delivered in the United States between 1995 and 1997. Infants of nulliparous mothers were compared with infants of multiparous mothers. Adjusted relative risks for death by parity were computed with the use of the generalized estimating equations framework.
  
  
  RESULTS
  The likelihood for stillbirth (odds ratio, 3.40; 95% CI, 2.20-5.26) was significantly greater among nulliparous mothers. Neonatal (odds ratio, 1.17; 95% CI, 0.95-1.43) and infant mortality rates (odds ratio, 1.10; 95% CI, 0.92-1.32) were comparable, however. With an increase in parity, there was a consistent declining trend in the risk for stillbirth (P<.0001).
  
  
  CONCLUSIONS
  Nulliparity more than triples the risk for intrauterine fetal death among triplets. This parity-related disparity underscores the need for care providers to be particularly concerned about triplet gestations among nulliparous mothers.
authors.affiliation: Department of Maternal and Child Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. hsalihu@uab.edu
authors.forename: Hamisu M
authors.initials: HM
authors.lastname: Salihu
authors.forename: Muktar H
authors.initials: MH
authors.lastname: Aliyu
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: Russell S
authors.initials: RS
authors.lastname: Kirby
authors.forename: Greg R
authors.initials: GR
authors.lastname: Alexander
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D016013:Likelihood Functions; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012306:Risk; D014310:Triplets