Objective: To compare rates of preterm birth among multiple births in European countries, to estimate their contribution to overall preterm birth rates and to explore factors which could explain differences between preterm birth rates.
Design: Analyses of data from vital statistics, birth registers or national samples of births.
Setting: Eleven member states of the European Union.
Population: All live births or representative samples of births at national or regional level for the year 2000 or most recent year.
Methods: Description of rates of preterm birth before 37 and 32 weeks, estimation of population attributable risks (PAR), study of associations between preterm birth rates in multiples and singletons and nonspontaneous labour using Spearman's rank correlation coefficient.
Main outcome measures: Preterm birth rates, PAR, proportions of deliveries with nonspontaneous onset (caesarean sections before labour or induction of labour).
Results: The proportion of multiple births before 37 weeks varied from 68.4% in Austria to 42.2% in the Republic of Ireland. In half of the countries, over 20% of all preterm births were attributable to multiple births. A strong association was found between the proportions of births before 37 weeks among multiple and singleton births (r= 0.81; P < 0.001). An association was observed between the rates of preterm birth and the proportions of deliveries with nonspontaneous onset among twins.
Conclusions: Wide variations in rates of preterm births and deliveries with nonspontaneous onset were found between countries, suggesting marked differences in clinical practice which could have long-term implications for the health of children from multiple births.