title: Stillbirth and infant mortality among Hispanic singletons, twins, and triplets in the United States.
abstract: OBJECTIVE
  We estimate the impact of increasing fetal number on fetal and infant mortality among Hispanic mothers.
  
  
  METHODS
  Retrospective cohort study involving singletons, twins, and triplets delivered in the United States from 1995 through 2000, except for the analysis on infant mortality in singletons (1995 through 1999). Main outcome measures were stillbirth (> or = 20 weeks) and infant mortality (< 365 days).
  
  
  RESULTS
  A total of 37,489,600 individual births were reviewed, consisting of 36,840,704 singletons, 613,930 twins, and 34,966 triplets. Hispanics accounted for 6,848,027 (18.6%) singletons, 85,887 (14.0%) individual twins, and 2,725 (7.8%) individual triplets. Among singletons, stillbirth (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.90-0.92) and infant mortality (OR 0.85, 95% CI 0.84-0.86) were both lower in Hispanics than in whites. Among twins, Hispanics had a lower risk for infant mortality (OR 0.93, 95% CI 0.88-0.97) but a comparable risk for stillbirth (OR 1.06, 95% CI 0.98-1.13). Although the risk for infant mortality in Hispanic triplets was comparable to that of whites (OR 1.20, 95% CI 0.94-1.54), Hispanic triplets had a 50% higher likelihood of dying in utero (OR 1.50, 95% CI 1.06-2.14).
  
  
  CONCLUSIONS
  Although Hispanic infants generally show better or comparable survival indices compared with whites, the risk for fetal and infant death in Hispanics increases in fetal number in a dose-dependent fashion, thereby obliterating the Hispanic advantage. The elevated risk for stillbirth among Hispanic triplets is particularly noteworthy and underscores the need for caution in making generalizations of favorable birth outcomes in Hispanics.
authors.affiliation: Department of Maternal and Child Health, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA. hsalihu@uab.edu
authors.forename: Hamisu M
authors.initials: HM
authors.lastname: Salihu
authors.forename: Isabel C
authors.initials: IC
authors.lastname: Garces
authors.forename: Puza P
authors.initials: PP
authors.lastname: Sharma
authors.forename: Sibylle
authors.initials: S
authors.lastname: Kristensen
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.forename: Russell S
authors.initials: RS
authors.lastname: Kirby
mesh_terms: D015331:Cohort Studies; D046689:Fetal Mortality; D006630:Hispanic or Latino; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D012189:Retrospective Studies; D050497:Stillbirth / Q000208:ethnology*; D014310:Triplets / Q000208:ethnology*; D014427:Twins / Q000208:ethnology*; D014481:United States / Q000453:epidemiology