Infant mortality among twins born to teenagers in the United States. Black-white disparity.

OBJECTIVE: To determine the magnitude of the disparity in infant mortality between twins born to black and white teenagers in the United States. STUDY DESIGN: Analysis was performed on twins born to adolescents in the United States within the period 1995-1997. The generalized estimating equations framework was used to generate relative risks after capturing the effects of sibling correlations within twin pairs. RESULTS: Infant mortality was 20% higher among black twins as compared to their white counterparts (adjusted OR = 1.20, 95% CI = 1.04-1.39). The black-white disparity in infant mortality occurred exclusively in the neonatal period (adjusted OR = 1.31, 95% CI = 1.11-1.54), with postneonatal estimates comparable (adjusted OR = 0.86, 95% CI = .63-1.17). The higher proportion of low-birth-weight infants--more specifically, those small for gestational age as opposed to preterm--among black twins was the most likely explanation for the lower survival probability among twins born to black teenagers. CONCLUSION: Black-white disparity in infant mortality among twins occurred exclusively during the first 28 days of life rather than throughout infancy. Efforts to bridge the gap should be focused on this critical period and should preferentially target those twins who are small for gestational age.

Survival of triplets who are born to teen mothers in the United States.

OBJECTIVE: The purposes of this study were to assess survival among triplets who are born to teen mothers and to determine whether fetal number influences the mortality rates of the offspring of teen mothers when compared with the offspring of older women. STUDY DESIGN: A retrospective cohort study of 354 triplet births to teenage mothers and 6858 to young mature mothers (20-29 years) who were delivered from 1995 through 1998. We compared the occurrence of stillbirth and neonatal and infant mortality rates between the 2 categories by means of the generalized estimating equation. Similar analyses were conducted for singleton pregnancies and twin pregnancies. RESULTS: Triplets of teenage mothers experienced a higher level of stillbirth (odds ratio, 3.24; 95% CI, 1.44-7.24), neonatal mortality (odds ratio, 2.00; 95% CI, 1.11-3.61), and infant death (odds ratio, 1.66; 95% CI, 1.01-2.87). Moreover, as the plurality increased from singleton infant to triplet, the offspring of teenagers fared progressively worse ( P < .0001). CONCLUSION: This study confirms the association between teenage motherhood and feto-infant death and indicates that this mortality relationship varies in a dose-dependent fashion.

Stillbirths and infant deaths associated with maternal smoking among mothers aged > or =40 years: a population study.

We set out to estimate the association between smoking among pregnant women aged at least 40 years and pregnancy outcome by analyzing singleton live births in the United States between 1995 and 1997. The study group consisted of deliveries to mothers aged 40 years and older with two maternal age categories (20 to 29 and 30 to 39 years) as control. Although risks varied with maternal age, smoking was associated with a higher-than-expected risk for infant mortality in all maternal age categories. The highest rate of infant mortality associated with smoking after adjusting for confounding was among mothers aged 20 to 29 (hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.28 to 1.75), while the lowest was among pregnant mothers in the 40 and above age category (HR, 1.03; 95% CI, 0.87 to 1.23). In utero fetal demise was highest among older smoking mothers (>/=40 years) and declined with decreasing age (p for trend <0.0001). In conclusion, the relationship between maternal smoking and pregnancy outcomes is modified by the age of the mother.