Objective To analyze the trend and perinatal outcomes of twin births in Guangzhou, Guangdong Province from 2011 to 2020, so as to provide evidence for dynamic adjustment of demand-oriented maternal and child health management strategies.

Methods In-hospital pregnant women (≥28 weeks of gestational at delivery) with locally registered residency and their perinatal newborns were recruited as study subjects between 2011 and 2020. The trend of twin pregnancies, maternal characteristics, and perinatal outcomes were analyzed retrospectively.

Results The incidence of twin births in Guangzhou increased from 2.79% to 3.32% with an overall upward trend (χ²_trend = 61.624, P < 0.001) from 2011 to 2020. The incidence of twin births among mothers aged < 35 fluctuated between 2.50% and 3.61%. The incidence of twin births among mothers aged ≥35 was higher than that of mothers aged < 35, showing an overall downward trend(χ²_trend = 54.473, P < 0.001). The average age of parturients with twin pregnancies increased from (30.21 ± 4.61) years in 2011 to (32.82 ± 4.80) years in 2020, while the percentage of multiparas was increasing(χ²_trend = 1 300.138, P < 0.001). From 2011 to 2020, the incidence of preterm birth, low birth weight and low Apgar score among live twin births were decreasing(P < 0.001), and changes of fetal loss incidence were not different (P > 0.05).

Conclusion The incidence of twin births is increasing from 2011 to 2020. Parturients with twin pregnancies are becoming older, and the percentage of multiparas is increasing significantly. Although the adverse outcomes of live twin births have been improved, quality of perinatal health care still needs to be paid close attention to ensure maternal and child safety.