Maternal and Perinatal Outcomes of Twin Pregnancy in 23 Low- and Middle-Income Countries

Background: Twin pregnancies in low- and middle-income countries (LMICs) pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources. We conducted a secondary analysis of the WHO Global Survey dataset to analyze maternal and perinatal outcomes in twin pregnancies and factors associated with perinatal morbidity and mortality in twins. Methods: We examined maternal and neonatal characteristics in twin deliveries in 23 LMICs and conducted multi-level logistic regression to determine the association between twins and adverse maternal and perinatal outcomes. Results: 279,425 mothers gave birth to 276,187 (98.8%) singletons and 6,476 (1.2%) twins. Odds of severe adverse maternal outcomes (death, blood transfusion, ICU admission or hysterectomy) (AOR 1.85, 95 % CI 1.60–2.14) and perinatal mortality (AOR 2.46, 95 % CI 1.40–4.35) in twin pregnancies were higher, however early neonatal death (AOR 2.50, 95 % CI 0.95–6.62) and stillbirth (AOR 1.22, 95 % CI 0.58–2.57) did not reach significance. Amongst twins alone, maternal age,18, poor education and antenatal care, nulliparity, vaginal bleeding, non-cephalic presentations, birth weight discordance.15%, born second, preterm birth and low birthweight were associated with perinatal mortality. Marriage and caesarean section were protective. Conclusions: Twin pregnancy is a significant risk factor for maternal and perinatal morbidity and mortality in low-resourc