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Twin Pregnancy in Developing Countries

Multiple births, two or more babies born at the same time, are a relatively small percentage of all the births worldwide. Twins represent only 3.3 percent of births in the United States (CDC) and, depending on the global region looked at, the rate is even lower in the developing world.

But even with such small numbers, twin births can present a large health concern for both mother and unborn children alike. The risks are even more pronounced in the developing world.

Twins have a much higher chance of being born prematurely, and they can be underweight, which often leads to more time in the NICU. Also, twin-twin transfusion, “when identical twins share a placenta and one baby gets too much blood flow, while the other baby doesn’t get enough,” is a possibility. The most startling statistic is that in the developing world, “among stillbirths, the proportion of twins is probably somewhat higher than among live births, as fetal (and neonatal) mortality is higher among twins.”

Complications arise when mothers do not receive adequate prenatal care. Women in the developing world often do not receive enough care when they are pregnant with a single child, let alone the need for additional monitoring and ultrasounds when having a multiple birth.

A study conducted in urban Guinea-Bissau found that “sixty-five percent (245/375) of the mothers who delivered at the hospital were unaware of their twin pregnancy.” Sometimes a mother will not measure larger than average to indicate a twin pregnancy, a second heartbeat is not always discernable, and/or bloodwork is not drawn to measure hCG (pregnancy hormone). Even if any of those previous criteria were met, only an ultrasound can confirm a multiple birth.

The unborn children are not the only ones at risk; mothers also face pregnancy complications at a higher rate when carrying multiple children, like pre-term labor, anemia, gestational diabetes, preeclampsia, hyperemesis gravidarum (severe morning sickness), polyhydramnios (too much amniotic fluid), miscarriage/stillbirth, postpartum depression and postpartum hemorrhage.

While these issues have the possibility to affect all mothers experiencing a multiple birth, the complications can be exacerbated when they live in poverty. Access to a hospital for an emergency may not be possible, especially in regions that are remote. Finances to afford a hospital stay can also be an issue, especially since many multiple births are delivered through c-section.

A 2008 study done in a rural mission tertiary hospital in Nigeria found that of the twin deliveries that happened there, 60 percent of the twins were delivered c-section, 36.4 percent were vaginal deliveries and the remaining 4 percent had vacuum deliveries. C-sections are often performed due to emergencies, premature delivery and fetal malpresentation.

Even though it seems like twin pregnancy is bleak, the opposite can be true. The UN’s fifth Millennium Development Goal is to improve maternal health. While multiple births are not specifically addressed, the positive improvements to help mothers and their unborn babies will also help those pregnant with twins. Multiple births must be monitored as a high-risk pregnancy but not all (or any) complications may occur. But with improved medical care, when those complications do arise they can be addressed and the rate of stillborn twins can decline even further.

Megan Ivy

Sources: NIH 1, CDC, March of Dimes, UN, NIH 2, NIH 3
Photo: Babies Magz