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Specialized prenatal care and maternal and infant outcomes in twin pregnancy

  • Barbara Luke
    Correspondence
    Reprints not available from the authors.
    Affiliations
    From the Department of Epidemiology and Public Health, University of Miami School of Medicine,a and the Departments of Obstetrics and Gynecologyb and Rehabilitation and Physical Medicine,c University of Michigan Medical School, and the Department of Biostatistics, School of Public Health, University of Michigand USA
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  • Morton B Brown
    Affiliations
    From the Department of Epidemiology and Public Health, University of Miami School of Medicine,a and the Departments of Obstetrics and Gynecologyb and Rehabilitation and Physical Medicine,c University of Michigan Medical School, and the Department of Biostatistics, School of Public Health, University of Michigand USA
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  • Ruta Misiunas
    Affiliations
    From the Department of Epidemiology and Public Health, University of Miami School of Medicine,a and the Departments of Obstetrics and Gynecologyb and Rehabilitation and Physical Medicine,c University of Michigan Medical School, and the Department of Biostatistics, School of Public Health, University of Michigand USA
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  • Elaine Anderson
    Affiliations
    From the Department of Epidemiology and Public Health, University of Miami School of Medicine,a and the Departments of Obstetrics and Gynecologyb and Rehabilitation and Physical Medicine,c University of Michigan Medical School, and the Department of Biostatistics, School of Public Health, University of Michigand USA
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  • Clark Nugent
    Affiliations
    From the Department of Epidemiology and Public Health, University of Miami School of Medicine,a and the Departments of Obstetrics and Gynecologyb and Rehabilitation and Physical Medicine,c University of Michigan Medical School, and the Department of Biostatistics, School of Public Health, University of Michigand USA
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  • Cosmas van de Ven
    Affiliations
    From the Department of Epidemiology and Public Health, University of Miami School of Medicine,a and the Departments of Obstetrics and Gynecologyb and Rehabilitation and Physical Medicine,c University of Michigan Medical School, and the Department of Biostatistics, School of Public Health, University of Michigand USA
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  • Barbara Burpee
    Affiliations
    From the Department of Epidemiology and Public Health, University of Miami School of Medicine,a and the Departments of Obstetrics and Gynecologyb and Rehabilitation and Physical Medicine,c University of Michigan Medical School, and the Department of Biostatistics, School of Public Health, University of Michigand USA
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  • Shirley Gogliotti
    Affiliations
    From the Department of Epidemiology and Public Health, University of Miami School of Medicine,a and the Departments of Obstetrics and Gynecologyb and Rehabilitation and Physical Medicine,c University of Michigan Medical School, and the Department of Biostatistics, School of Public Health, University of Michigand USA
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      Abstract

      Objective

      This study was undertaken to evaluate the effect of a prenatal nutrition and education program on twin pregnancy, neonatal, and early childhood outcomes.

      Study design

      This prospective intervention study of women who participated in a specialized program (Program Pregnancies) versus nonparticipants included twice-monthly visits, dietary prescription of 3000 to 4000 kcal per day, multimineral supplementation, and patient education.

      Results

      Program Pregnancies were associated with improved pregnancy outcomes (preeclampsia, adjusted odds ratio [AOR] 0.41, 95% CI, 0.23-0.75; preterm premature rupture of membranes, AOR 0.35, 95% CI, 0.20-0.60; delivery <36 weeks, AOR 0.62, 95% CI, 0.43-0.89; low birth weight, AOR 0.42, 95% CI, 0.29-0.61), significantly longer gestations (+7.6 days), higher birth weights (+220 g), lower neonatal morbidity (retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, or ventilator support, AOR 0.44, 95% CI, 0.31-0.62), length of stay (–5.3 days), and cost per twin (–$14,023). Through 3 years of age, program children were significantly less likely to be rehospitalized (AOR 0.31, 95% CI, 0.11-0.91) or to be developmentally delayed (AOR 0.65, 95% CI, 0.44-0.96).

      Conclusion

      Program participation was associated with improved outcomes at birth and through age 3 years.

      Keywords

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