This study assessed the trends in twin births and their survival in Bangladesh by analyzing over a quarter million live births during 1970–2018, pooled from all eight rounds of the Bangladesh Demographic and Health Survey. In these five decades, the twinning rate increased by 1.5 times, from 5.8 to 8.6 twins per 1000 maternities. The decadal twinning rates varied across maternal age, parity, body mass index, household wealth index, and geographic region. The gap in decadal neonatal, infant, and under-five cumulative survival probability between singleton and multiple births was found to be closing, using Kaplan-Meier curves. Child mortality decreased by 80% and 60% in singleton and multiple births respectively. However, the absolute size of child mortality in multiple births remained six times higher than in singletons and was concentrated in the neonatal period. The share of multiple births surged in all types of child mortality. We predict a further and faster rise in multiple births in the coming decades in the face of upward trends in maternal age overlapping with higher parities, education, career prospects, contraceptive use, and the future demand-supply of assisted reproductive technology. A particular focus on the improvement of perinatal and neonatal care with wider availability is warranted. Otherwise, increased multiple births might raise child mortality and create public health challenges.

中文翻译：

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孟加拉国双胞胎出生和生存的趋势：半个世纪证据的分析

这项研究通过分析 1970 年至 2018 年期间超过 25 万的活产（来自所有八轮孟加拉国人口和健康调查），评估了孟加拉国双胞胎出生及其生存的趋势。在这50年里，双胞胎率增加了1.5倍，从每1000名产妇中有5.8对增加到8.6对。十年双胞胎率因母亲年龄、胎次、体重指数、家庭财富指数和地理区域而异。使用卡普兰-迈耶曲线发现，单胎和多胎之间十年新生儿、婴儿和五岁以下儿童累积生存概率的差距正在缩小。单胎和多胎儿童死亡率分别下降 80% 和 60%。然而，多胞胎儿童死亡率的绝对规模仍然是单胞胎的六倍，并且集中在新生儿期。多胞胎在所有类型的儿童死亡率中所占的比例激增。我们预测，由于孕产妇年龄的上升趋势与生育次数的增加、教育、职业前景、避孕药具的使用以及辅助生殖技术的未来供需重叠，未来几十年多胞胎的数量将进一步更快地增加。有必要特别关注改善围产期和新生儿护理并提供更广泛的服务。否则，多胞胎的增加可能会提高儿童死亡率并带来公共卫生挑战。