© 1995 Oxford University Press
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Mortality Associated with Multiple Gestation in Malawi
*Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services 1600 Clifton Road NE, Mailstop F-22, Atlanta, GA 30333, USA.
College of Medicine Ministry of Health, Malawi.
Background. Multiple gestation is associated with increased maternal, perinatal, and infant mortality. The prevalence of multiple gestation varies widely with the highest rates reported among populations in Africa. There have been few population-based studies of the impact of multiple gestation on pregnancy outcomes in sub-Saharan Africa
Methods. Data from a 1987–1990 prospective study of the effect of malaria chemoprophylaxis among pregnant women on birthweight and mortality of their infants in a rural area of Malawi were used to estimate the prevalence of multiple gestation and to quantify the risk of mortality associated with multiple gestation compared with single gestation.
Results. There were 88 (2.2%) multiple gestations among 4049 women. Mortality was high; only 38% of mothers were known to have all their Infants survive to 1 year, compared with 74% in singleton gestations. The increased mortality associated with multiple gestation was due to two factors: a higher frequency of low birthweight and a fourfold increase in perinatal mortality among the Infants with birthweights 
2500 g and among infants with unknown birthweight. We estimated that multiple gestation contnbutes to 5.5% of the perinatal, 1.2% of the postperinatal, and 11.5% of the maternal deaths in this population.
Conclusion Multiple gestation in Malawi contributed to Increased perinatal and maternal mortality, but did not increase the risk of mortality after the perinatal period.
Received 1 September 1994
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