(901) Birth Location and Risk of Infant Death in Twin Pregnancies

To evaluate the association between birth location (birth center vs. hospital) and the risk of infant death in twin pregnancies.

Study Design:

This retrospective cohort study analyzed data from the NCHS linked multiple birth and infant death database from 2016 to 2020. Inclusion criteria were matched twin pregnancies without congenital anomalies. Infant mortality was the primary outcome. Chi-square tests and logistic regression models were used to assess the association between birth location and infant mortality, adjusting for gestational age at delivery (GA ≤ 34 weeks and GA > 34 weeks) and order of birth (Twin A and Twin B).

Results:

Among 607,355 twin births, the overall rate of neonatal death was 0.97%. Neonatal death was higher in birth centers (3.04%) compared to hospitals (0.96%) (p < 0.001). For GA > 34 weeks, neonatal death was 0.82% in birth centers vs. 0.18% in hospitals (p < 0.001, OR 4.59 [95% CI 2.75-7.67]). For GA ≤ 34 weeks, neonatal death was 13.68% in birth centers vs. 4.24% in hospitals (p < 0.001, OR 3.58 [95% CI 2.67-4.81]). In Twin A, neonatal death was 3.65% in birth centers vs. 0.93% in hospitals (p < 0.001, OR 4.06 [95% CI 3.00-5.50]), while in Twin B, neonatal death was 2.30% in birth centers vs. 1.00% in hospitals (p < 0.001, OR 2.32 [95% CI 1.53-3.52]).

Conclusion:

Birth center delivery is associated with a significantly higher risk of infant mortality in twin pregnancies compared to hospital delivery. This increased risk persists across different gestational ages and the order of birth. These findings suggest that hospital deliveries might offer safer outcomes for twins, particularly those at higher risk of neonatal complications.