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APHA Scientific Session and Event Listing

Francis A. Obuseh, MS, MPH, Department of Maternal and Child Health, University of Alabama at Birmingham, Ryals Public Health Building 320, 1530 3rd Avenue South, Birmingham, AL 35205-0022, (205) 934-7161, obuseh@uab.edu

Purpose: We investigated the impact of adolescents' pregnancy on the risk for early mortality outcomes associated with premature rupture of membranes (PROM) among twins.

Methods: Study involved the retrospective cohort of twins delivered in the United States (1995-98). Generalized estimating equations were used to compute inter and intra-cluster variation for early mortality associated with PROM among twins born to adolescents (<20 years) and mature mothers (MM) (20-30 years).

Results: We analyzed 28,826 adolescents and 186,386 MM. Bivariate analysis showed significant differences in demographic characteristics and neonatal pregnancy outcomes within adolescents and MM (p<0.0001). Adolescents had twice worse mortality outcomes compared to MM. They were 1.47 (CI: 1.34-1.61) times more likely to have neonatal deaths compared to MM. Intra-cluster sources of variation within adolescents showed that twins exposed to PROM had 2.96 (CI: 2.44-3.60), 2.85 (CI: 2.30-3.54) and 2.62 (CI: 1.77-3.86) fold risk for neonatal, early neonatal and late neonatal deaths respectively, compared to MM who had 3.55 (CI: 3.23-3.92), 3.68 (CI: 3.32-4.09) and 2.79 (CI: 2.27-3.43) fold risks for same outcomes. Gestational age appeared to modify mortality.

Conclusion: There were higher mortality risks for twins exposed to PROM. Although adolescents represent a unique high-risk obstetric entity, PROM risk was not confounded or modified by the age of the delivering mother. Higher mortality in twins from adolescents might indicate other factors peculiar to adolescents. In our study gestational age modified the risk for early mortality associated with PROM among twins.

Learning Objectives:

• At the end of this session attendees will be able to
• • Identify risk factors and prevention strategies for twin birth and neonatal mortality.
• • Identify risk factors for early mortality outcomes associated with premature rupture of membranes.
• • Identify risk factors and prevention strategies for adolescent pregnancy and twin birth.

Keywords: Pregnancy, Pregnancy Outcomes

Presenting author's disclosure statement:

Not Answered