# The Contribution of Multiple Pregnancies in Stillbirths in Greece: A Time-Trend Analysis

## TL;DR

This study examines how multiple pregnancies in Greece have impacted stillbirth rates over 65 years, finding a significant but decreasing contribution in recent decades.

## Contribution

The study provides a long-term time-trend analysis of stillbirth rates linked to multiple pregnancies in Greece, revealing historical patterns and recent improvements.

## Key findings

- Multiple pregnancies accounted for 9.4% of stillbirths in Greece from 1957 to 2021.
- Stillbirth rates in multiple births decreased significantly from 1976 to 2021.
- The population attributable risk of stillbirths due to multiple pregnancies peaked in 2012 but dropped to 8.6% by 2021.

## Abstract

Introduction

Multiple pregnancy is an established risk factor for fetal death. This study aimed to examine the impact of multifetal pregnancies on stillbirth rates (SBRs) in the Greek population.

Methods

Data on live births and stillbirths by multiplicity were derived from the Hellenic Statistical Authority, covering a 65-year period from 1957 to 2021. The SBR for multiple and single gestations, and the population attributable risk (%) (PAR (%)) stillbirth attributable to multifetal gestations were calculated, and temporal trends were assessed using joinpoint regression analysis, with annual percentage changes (APC) and 95% confidence interval (95% CI).

Results

In the period 1957-2021, multiple pregnancies accounted for 9.4% of total stillbirths in Greece and the overall relative risk of fetal death among multifetal gestations was 3.34, in comparison with singletons. The SBR in multiple births remained unchanged from 1957 to 1976 and showed downward trends from 1976 to 2021 (APC = -3.0, 95% CI: -3.4 to -2.7, p < 0.001). PAR (%), after two decades of stability, showed an increasing trend over the period 1975-2011 (APC = 3.4, 95% CI: 2.8 to 4.0, p < 0.001), which was reversed in the more recent decade 2011-2021 (APC = -6.1, 95% CI: -9.6 to -2.5, p = 0.001), with PAR (%) decreasing from a historical high of 19.3% in 2012 to 8.6% in 2021.

Conclusion

The high incidence of multiple births has a considerable impact on stillbirth rates in the Greek population. The recent downward trends of SBR and PAR (%) of multiple gestations are encouraging, however more measures and targeted interventions are needed to improve perinatal outcomes in multifetal gestation.