Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: A registry-based study in 14 European countries 1984-2007

B. Boyle, R. McConkey, E. Garne, M. Loane, M. C. Addor, M. K. Bakker, P. A. Boyd, M. Gatt, R. Greenlees, M. Haeusler, K. Klungsøyr, A. Latos-Bielenska, N. Lelong, R. McDonnell, J. Métneki, C. Mullaney, V. Nelen, M. O'Mahony, A. Pierini, J. RankinA. Rissmann, D. Tucker, D. Wellesley, H. Dolk*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

47 Citations (Scopus)


Objective To assess the public health consequences of the rise in multiple births with respect to congenital anomalies. Design Descriptive epidemiological analysis of data from population-based congenital anomaly registries. Setting Fourteen European countries. Population A total of 5.4 million births 1984-2007, of which 3% were multiple births. Methods Cases of congenital anomaly included live births, fetal deaths from 20 weeks of gestation and terminations of pregnancy for fetal anomaly. Main outcome measures Prevalence rates per 10 000 births and relative risk of congenital anomaly in multiple versus singleton births (1984-2007); proportion prenatally diagnosed, proportion by pregnancy outcome (2000-07). Proportion of pairs where both co-twins were cases. Results Prevalence of congenital anomalies from multiple births increased from 5.9 (1984-87) to 10.7 per 10 000 births (2004-07). Relative risk of nonchromosomal anomaly in multiple births was 1.35 (95% CI 1.31-1.39), increasing over time, and of chromosomal anomalies was 0.72 (95% CI 0.65-0.80), decreasing over time. In 11.4% of affected twin pairs both babies had congenital anomalies (2000-07). The prenatal diagnosis rate was similar for multiple and singleton pregnancies. Cases from multiple pregnancies were less likely to be terminations of pregnancy for fetal anomaly, odds ratio 0.41 (95% CI 0.35-0.48) and more likely to be stillbirths and neonatal deaths. Conclusions The increase in babies who are both from a multiple pregnancy and affected by a congenital anomaly has implications for prenatal and postnatal service provision. The contribution of assisted reproductive technologies to the increase in risk needs further research. The deficit of chromosomal anomalies among multiple births has relevance for prenatal risk counselling.

Original languageEnglish
Pages (from-to)707-716
Number of pages10
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Issue number6
Publication statusPublished - May 2013
Externally publishedYes


  • Concordance
  • congenital anomalies
  • multiple births
  • pregnancy outcomes
  • twins

ASJC Scopus subject areas

  • Obstetrics and Gynaecology


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