Project 27/28: Implications for midwives.
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Female↗
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Results for “Multiple Birth Offspring”
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Assisted reproductive technology surveillance--United States, 2000.
PROBLEM/CONDITION: In 1996, CDC initiated data collection regarding assisted reproductive technology (ART) procedures performed in the United States to determine medical center-specific pregnancy success rates, as mandated by the Fertility Clinic Success Rate and Certification Act (FCSRCA) (Public Law 102-493, October 24, 1992). ART includes fertility treatments in which both eggs and sperm are handled in the laboratory (i.e., in vitro fertilization and related procedures). Patients who undergo ART treatments are more likely to deliver multiple-birth infants than women who conceive naturally. Multiple births are associated with increased risk for mothers and infants (e.g., pregnancy complications, premature delivery, low-birthweight infants, and long-term disability among infants). REPORTING PERIOD COVERED: 2000. DESCRIPTION OF SYSTEM: CDC contracts with a professional society, the Society for Assisted Reproductive Technology (SART), to obtain data from fertility medical centers located in the United States. Since 1997, CDC has compiled data related to ART procedures. The Assisted Reproductive Technology Surveillance System was initiated by CDC in collaboration with the American Society for Reproductive Medicine, the Society for Assisted Reproductive Technology, and RESOLVE: The National Infertility Association. RESULTS: In 2000, a total of 25,228 live-birth deliveries and 35,025 infants resulting from 99,629 ART procedures were reported to CDC from 383 medical centers that performed ART in the United States and U.S. territories. Nationally, 75,516 (76%) of ART treatments were freshly fertilized embryos using the patient's eggs; 13,312 (13%) were thawed embryos using the patient's eggs; 7,919 (8%) were freshly fertilized embryos from donor eggs; and 2,882 (3%) were thawed embryos from donor eggs. The national live-birth delivery per transfer rate was 30.8%. The five states that reported the highest number of ART procedures were California (13,194), New York (11,239), Massachusetts (8,041), Illinois (7,323), and New Jersey (5,506). These five states also reported the highest number of live-birth deliveries and infants born as a result of ART. Overall, 47% of women undergoing ART-transfer procedures using freshly fertilized embryos from their own eggs were aged <35 years; 23% were aged 35-37 years; 19% were aged 38-40 years; 7% were aged 41-42 years; and 4% were aged >42 years. Among ART treatments in which freshly fertilized embryos from the patient's eggs were used, substantial variation in patient age, infertility diagnoses, history of past infertility treatment, and past births was observed. Nationally, live-birth rates were highest for women aged <35 years (38%). The risk for a multiple-birth delivery was highest for women who underwent ART-transfer procedures using freshly fertilized embryos from either donor eggs (40%) or from their own eggs (35%). Among women who underwent ART-transfer procedures using freshly fertilized embryos from their own eggs, further variation by patient age and number of embryos transferred was observed. Of the 35,025 infants born, 44% were twins, and 9% were triplet and higher order multiples, for a total multiple-infant birth rate of 53%. Patient's residing in states with the highest number of live-birth deliveries also reported the highest number of infants born in multiple-birth deliveries. INTERPRETATION: Whether an ART procedure was successful (defined as resulting in a pregnancy and live-birth delivery) varied according to different patient and treatment factors. Patient factors included the age of the woman undergoing ART, whether she had previously given birth, whether she had previously undergone ART, and the infertility diagnosis of both the female and male partners. Treatment factors included whether eggs were from the patient or a woman serving as an egg donor, whether the embryos were freshly fertilized or previously frozen and thawed, how long the embryos were kept in culture, how many embryos were transferred, and whether various specialized treatment procedures were used in conjunction with ART. ART poses a major risk for multiple births. This risk varied according to the patient's age, the type of ART procedure performed, and the number of embryos transferred. In addition, the increased risk for multiple births has a notable population impact in certain states. PUBLIC HEALTH ACTIONS: As use of ART and ART success rates continue to increase, ART-related multiple births are an increasingly important public health problem nationally and in many states. The proportion of infants born through ART in 2000 that were multiple births (53%) was substantially higher than in the general U.S. population during the same period. Data in this report indicate a need to reduce multiple births associated with ART. Efforts should be made to limit the number of embryos transferred for patients undergoing ART. In addition, continued research and surveillance is key to understanding the effect of ART on maternal and child health.
Adult↗
Assisted reproductive technology surveillance--United States, 2001.
PROBLEM/CONDITION: In 1996, CDC initiated data collection regarding assisted reproductive technology (ART) procedures performed in the United States to determine medical center-specific pregnancy success rates, as mandated by the Fertility Clinic Success Rate and Certification Act (FCSRCA) (Public Law 102-493, October 24, 1992). ART includes fertility treatments in which both eggs and sperm are handled in the laboratory (i.e., in vitro fertilization and related procedures). Patients who undergo ART treatments are more likely to deliver multiple-birth infants than women who conceive naturally. Multiple births are associated with increased risk for mothers and infants (e.g., pregnancy complications, premature delivery, low-birthweight infants, and long-term disability among infants). REPORTING PERIOD: 2001. DESCRIPTION OF SYSTEM: CDC contracts with a professional society, the Society for Assisted Reproductive Technology (SART), to obtain data from fertility medical centers located in the United States. Since 1997, CDC has compiled data related to ART procedures. The Assisted Reproductive Technology Surveillance System was initiated by CDC in collaboration with the American Society for Reproductive Medicine, the Society for Assisted Reproductive Technology, and RESOLVE: The National Infertility Association. RESULTS: In 2001, a total of 29,344 live-birth deliveries and 40,687 infants resulting from 107,587 ART procedures were reported from 384 medical centers in the United States and U.S. territories. Nationally, 80,864 (75%) of ART treatments used freshly fertilized embryos from the patient's eggs; 14,705 (14%) used thawed embryos from the patient's eggs; 8,592 (8%) used freshly fertilized embryos from donor eggs; and 3,426 (3%) used thawed embryos from donor eggs. Overall, 40% of ART procedures that progressed to the transfer stage resulted in a pregnancy; 33% resulted in a live-birth delivery (delivery of > or =1 infant); and 21% resulted in a singleton live birth. The highest live-birth rates were observed among ART procedures using freshly fertilized embryos from donor eggs (47%). The greatest numbers of ART procedures were performed among residents of California (13,124), New York (12,379), Massachusetts (8,151), Illinois (7,933), and New Jersey (6,011). These five states also reported the highest number of live-birth deliveries and infants born as a result of ART. The ratio of number of ART procedures per million population ranged from 74 in Idaho to 1,273 in Massachusetts, with a national average of 371 ART procedures started per million persons. Among ART treatments in which freshly fertilized embryos from the patient's eggs were used, substantial variation in live birth rates by patient (e.g., women aged < or =40 years) and treatment characteristics (e.g., ovulatory dysfunction, endometriosis, or unexplained infertility) was observed. The risk for a multiple-birth delivery was highest for women who underwent ART transfer procedures using freshly fertilized embryos from either donor eggs (42%) or from their own eggs (36%). Among ART transfer procedures in which the patient's own eggs were used, an inverse relation existed between multiple-birth risk and patient age. Number of embryos transferred and embryo availability (an indicator of embryo quality) were also strong predictors of multiple-birth risk. Of the 40,687 infants born, 46% were twins, and 8% were triplet and higher order multiples. The total multiple-infant birth rate was 53%. Approximately 1% of U.S. infants born in 2001 were conceived through ART. Those infants accounted for 16% of multiple births nationally. INTERPRETATION: Whether an ART procedure resulted in a pregnancy and live-birth delivery varied according to different patient and treatment factors. ART poses a major risk for multiple births. This risk varied according to the patient's age, the type of ART procedure performed, the number of embryos transferred, and embryo availability (an indicator of embryo quality). PUBLIC HEALTH ACTION: ART-related multiple births represent a sizable proportion of all multiple births nationally and in selected states. Efforts should be made to limit the number of embryos transferred for patients undergoing ART.
Adult↗
Preterm birth in North Carolina.
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Female↗
Newborn outcome after assisted reproductive technology: experiences and reflections from Poland.
In spite of much ethical uncertainty and wide variations in obstetric and neonatal outcomes reported in the literature, we have studied the outcome of Polish newborns after assisted reproductive technology (ART). In all of our patients, both obstetrics and neonatal care were performed in the Level Three Center in Poznan, Poland. A total of 45 and 82 newborns were analyzed from the ART and the control group, respectively. We analyzed gestational age, birth weight, Apgar score, duration of hospitalization, newborn mortality, and congenital malformations. We found a far higher rate of mothers over 35 years and with university education in ART compared to controls. The incidence of cesarean section and birth weight <1,500 g was much higher in ART. Newborn mortality was much higher among ART newborns compared to controls and was related to premature delivery of triplet pregnancy. The most important factor resulting in high neonatal mortality in our study group was multiple pregnancy. We consider the lack of regulation in Poland concerning the number of replaced embryos as a main factor influencing newborns' outcome after ART.
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Role of multiple births in very low birth weight and infant mortality.
OBJECTIVE: To determine the percentage of very-low-birth-weight (VLBW) infants (<1500 g) and infant deaths attributable to multiple births in the general population and in women aged 35+. STUDY DESIGN: The year 2000 Massachusetts birth certificate database with linked births-deaths was examined. Etiologic fractions (EF) for VLBW and infant mortality attributable to multiples were calculated for the general population and the 35+ age group. The percentages of multiples occurring in the 35+ age group were calculated. Infant deaths due to congenital anomalies and "perinatal conditions" were calculated. RESULTS: There were 81,582 resident births in Massachusetts in 2000. Of them 4.3% were multiples. Of the 1090 VLBW infants, 26.1% (95% CI: 23.5-28.8) were in twins and 7.7% (95% CI: 6.2-9.5) in higher-order multiples, yielding an EF of 30.8% for multiples in VLBW. In the 35+ age group, the multiple birth ratio was 6.6% (95% CI: 6.3-7.0). The EF for multiples and VLBW in this age group was 33.7%. The 35+ age group accounted for 32.4% (95% CI: 30.8-34.0) of twins and 45.5% (95% CI: 39.1-52.0) of higher-order multiples born in 2000. Of the 392 infant deaths, 57 (14.6%; 95% CI: 11.2-18.4) were attributed to congenital anomalies, and 236 (60.2%; 95% CI: 55.2-65.0) to "perinatal conditions." Multiples were responsible for 8 (14%; 95% CI: 6.3-25.8) of deaths due to anomalies, and 73 (30.9%; 95% CI: 25.1-37.3) due to "perinatal conditions." CONCLUSION: Over 30% of VLBW infants, nearly 20% of infant mortality and >30% of infant mortality due to perinatal conditions could be attributed to multiples. Multiple pregnancy is a significant public health problem.
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[Trends in multiple births in Israel].
This study examines trends in multiple births in Israel and compares the Jewish and Arab populations. Multiple births increased 150% in the last three decades. Young mothers to multiples were more frequent in the Arab population (eight times and twice the level for age <20 years and 20-24 years, respectively), whereas older mothers of multiples were more frequent in the Jewish population (twice and six times the level for age 40-44 years, and >45 years, respectively). As expected, triplets were more often represented among low birth weight infants. The incidence of multiples was higher in the Jewish population; however, the trend for Jewish triplets seems to decrease as opposed to the increasing trend in the Arab population. The skyrocketing increased incidence of multiple births is explained by the special significance attributed to motherhood in the Israeli society, which is met by the socio-political milieu and the availability of assisted reproductive technologies. Differences in the incidence of multiples between the Arab and Jewish populations are partly explained by the younger age at first delivery of Arab women.
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[Incidence and the progression of the acute-phase of the retinopathy of prematurity in infants hospitalized in Neonatology Department of University of Medical Sciences in Poznań].
PURPOSE: The assessment of the epidemiological data of acute-phase of retinopathy of prematurity (ROP). MATERIAL AND METHODS: Infants with birth weights less than 1500g and birth dates between April 1, 2002, and May 30, 2003, admitted to special care baby unit in Department of Neonatology in Poznan, were examined. The incidence of retinopathy of prematurity, infants sex, multiple births, the onset of acute-phase ROP (considering the day of life and postmenstrual age) and also the day of life, at which the treatment was started, were analysed. RESULTS: Among 190 infants enrolled to the study 48.9% were female and 51.1% were male. There were 20.5% infants from multiple births. In the examined group in infants with a birth weight under 1250g the incidence of ROP was 32.6% and in infants with a birth weight above 1250g--7.4%. The ROP was diagnosed earliest in 4th week of life, the latest in 12th week of life (mean time of diagnosis the 8th week of life). The earliest time of performing the treatment with diode laser was 37th day of life, the latest--97th day of life (mean time of treatment the 67.5th day of life). CONCLUSIONS: Presented epidemiological data may be helpful in foreseeing the natural history of acute-phase of ROP in population of Polish premature infants with a birth weight under 1500g.
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Breast-feeding and bottle-feeding of twins, triplets and higher order multiple births.
OBJECTIVE: This study was performed to determine the rates of breast-feeding and/or bottle-feeding in mothers of twins, triplets and higher order multiple births compared to those in mothers of singletons, and identify factors associated with decision as to breast-feed or bottle-feed. METHODS: The subjects were 1,529 mothers of twins aged 6 months-6 years and 258 mothers of triplets and higher order multiple births (higher multiples) aged 6 months-6 years (234 mothers of triplets, 20 mothers of quadruplets, 4 mothers of quintuplets). Also, 1,300 subjects were recruited as a control group from mothers of singletons aged 6 months-6 years. Information regarding feeding methods, including exclusive breast-feeding, mixed-feeding and bottle-feeding with formula milk only, and duration of breast-feeding (in months) was collected. RESULTS: There were significantly higher rates of bottle-feeding in mothers of twins and higher multiples than in mothers of singletons. Duration of breast-feeding in mothers who chose exclusive breast-feeding or mixed-feeding for twins and higher multiples was significantly shorter than those for the singletons. The feeding methods for the twins or higher multiples were not associated with prematurity or low birth weight. However, after adjusting for each associated factor using logistic regression analysis, the decision to bottle-feed was significantly associated with non-cooperation of the husband in childrearing and degree of anxiety that mothers felt when informed of a multiple pregnancy. The odds ratio indicated that mothers who received no cooperation from the husband for childrearing were 1.83 times more likely to choose bottle-feeding as those who received cooperation. Further, the odds ratio indicated that mothers who felt greater anxiety when informed of a multiple pregnancy were 1.73 times more likely to choose bottle-feeding as those who did not feel much anxiety. CONCLUSION: This study found that establishment and continuation of breast-feeding for twins, triplets and higher order multiple births are much more difficult than for singletons. Further, cooperation of the husband in childrearing and the degree of maternal anxiety when informed of a multiple pregnancy are significant factors affecting the decision to breast-feed or bottle-feed for twins, triplets or higher order multiple births.
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Trends in live births and birthweight by social class, marital status and mother's age, 1976-2000.
This article describes trends in live births between 1976 and 2000 and by birthweight from 1983 to 2000 in England and Wales. It investigates variation by mother's age, social class of father and marital status and describes trends in the percentage of births which were multiple. Changes in patterns of childbearing and cohabitation throughout the period are described.
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Inequalities in infant mortality: trends by social class, registration status, mother's age and birthweight, England and Wales, 1976-2000.
This article examines trends in inequalities in infant mortality in England and Wales between 1976 and 2000. It describes variations in neonatal, postneonatal and infant mortality by mother's age, registration status, father's social class, multiplicity and birthweight. Throughout the period, social class differences in mortality were wider in the postneonatal period than the neonatal period and there was considerable variation in infant mortality by age of mother, birthweight and multiplicity within both manual and non-manual groups.
Adolescent↗
Mortality in children aged under 8.
This article presents analyses of deaths in England and Wales of children under the age of eight by year of birth and age at death, focusing on children born between 1993 and 2001 and dying between 1993 and 2003. The analysis looks at risk factors available at birth registration including sex, birthweight, multiple birth status, mother's age, father's social class, mother's country of birth and marital status. It is the first time that ONS has been able to analyse deaths occurring up to age seven by these risk factors. The results show that many of the well established risk factors for death in infancy persist into older ages.
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Birth weight standards in the live-born population in Israel.
BACKGROUND: Lacking curves of "intrauterine" growth, most birthing centers in Israel use United States or Canadian based curves as standards. OBJECTIVE: To establish population-based standards of birth weight of live-born infants in Israel. METHODS: Data on birth weight and gestational age were obtained from the registries of the Israel Ministry of Health and Ministry of the Interior, During the 9 year study period there were 1,074,122 infants delivered in Israel; 787,710 (73%) were included in this analysis. RESULTS: In this study we provide data of birth weight by gestational age of live infants born in Israel between 1993 and 2001. Ranges of birth weight by gestational age are also depicted for singleton and multiple pregnancies. Fetuses in multiple pregnancies grow in a similar manner to singletons until 30 weeks of gestation, after which their growth slows down. CONCLUSIONS: Use of these data as a standard for "intrauterine" growth better represents the Israeli neonatal population than the North American standards. In addition, curves of multiple pregnancies are significantly different from those of singleton pregnancies and might be more appropriate in these pregnancies.
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Assisted reproductive technology surveillance--United States, 2002.
PROBLEM/CONDITION: In 1996, CDC initiated data collection regarding assisted reproductive technology (ART) procedures performed in the United States, as mandated by the Fertility Clinic Success Rate and Certification Act (FCSRCA) (Public Law 102-493, October 24, 1992). ART includes fertility treatments in which both eggs and sperm are handled in the laboratory (i.e., in vitro fertilization and related procedures). Patients who undergo ART treatments are more likely to deliver multiple-birth infants than women who conceive naturally. Multiple births are associated with increased risk for mothers and infants (e.g., pregnancy complications, premature delivery, low-birthweight infants, and long-term disability among infants). REPORTING PERIOD: 2002. DESCRIPTION OF SYSTEM: : CDC contracts with the Society for Assisted Reproductive Technology (SART) to obtain data from ART medical centers located in the United States. Since 1997, CDC has compiled data related to ART procedures. RESULTS: In 2002, a total of 115,392 ART procedures were reported to CDC. These procedures resulted in 33,141 live-birth deliveries and 45,751 infants. Nationally, 74% of ART procedures used freshly fertilized embryos from the patient's eggs; 14% used thawed embryos from the patient's eggs; 8% used freshly fertilized embryos from donor eggs; and 3% used thawed embryos from donor eggs. Overall, 42% of ART transfer procedures resulted in a pregnancy, and 34% resulted in a live-birth delivery (delivery of one or more live-born infants). The highest live-birth rates were observed among ART procedures using freshly fertilized embryos from donor eggs (50%). The highest numbers of ART procedures were performed among residents of California (15,117), New York (13,276), Massachusetts (8,631), New Jersey (7,744), and Illinois (7,492). These five states also reported the highest number of infants conceived through ART. Of 45,751 infants born through ART, 53% were born in multiple-birth deliveries. The multiple-birth risk was highest for women who underwent ART transfer procedures using freshly fertilized embryos from either donor eggs (42%) or their own eggs (35%). Number of embryos transferred, embryo availability (an indicator of embryo quality), and patient's age were also strong predictors of multiple-birth risk. Approximately 1% of U.S. infants born in 2002 were conceived through ART. Those infants accounted for 17% of multiple births nationally. The percentage of ART infants who were low birth rate ranged from 9% among singletons to 95% among triplets or higher order multiples. The percentage of ART infants born preterm ranged from 15% among singletons to 97% among triplets or higher order multiples. INTERPRETATION: Whether an ART procedure resulted in a pregnancy and live-birth delivery varied according to different patient and treatment factors. ART poses a major risk for multiple births. This risk varied according to the patient's age, the type of ART procedure performed, the number of embryos transferred, and embryo availability (an indicator of embryo quality). PUBLIC HEALTH ACTION: ART-related multiple births represent a sizable proportion of all multiple births nationally and in selected states. Efforts should be made to limit the number of embryos transferred for patients undergoing ART. In addition, adverse infant health outcomes (e.g., low birthweight and preterm delivery) should be considered when assessing the efficacy and safety of ART.
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Twins and more--1. Some current thinking on multiple births.
The incidence of multiple births is rising in many countries including the U.K., mainly as a result of treatment for infertility. Parents of twins, triplets or more require specific information, advice and support at all stages of parenting from diagnosis of a multiple pregnancy onwards. Specialist midwives have an important role to play in this, as do voluntary organisations such as the Multiple Births Foundation. The first part of this two-part article provides an update of some current thinking on multiple births, including twin-twin transfusion syndrome. Part two will provide information about the needs of families with a multiple birth in the early years.
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Twins and more--2. Practical aspects of parenting in the early years.
Caring for twin, triplets or more can be a daunting prospect for parents, however much the children are wanted and loved. Multiple birth babies are more likely to be born preterm and of low birth weight, adding to the practical, financial and emotional pressures of coping with two or more babies. Good preparation and advice before the babies are born, as described in Part 1 of this article (Journal of Family Health Care 2005; 15151: 143-146) is essential. After the birth, parents need continuing support and access to care from professionals who understand their different and special needs. Bereavement counselling and support may also be required, as the mortality rate is higher for multiple births. Part Two looks at the care commonly needed for multiple birth families during the first five years.
Adaptation, Psychological↗
Assisted reproductive technology surveillance--United States, 2003.
PROBLEM/CONDITION: In 1996, CDC initiated data collection regarding assisted reproductive technology (ART) procedures performed in the United States, as mandated by the Fertility Clinic Success Rate and Certification Act (FCSRCA) (Public Law 102-493, October 24, 1992). ART includes fertility treatments in which both eggs and sperm are handled in the laboratory (i.e., in vitro fertilization and related procedures). Patients who undergo ART treatments are more likely to deliver multiple-birth infants than women who conceive naturally. Multiple births are associated with increased risk for mothers and infants (e.g., pregnancy complications, premature delivery, low-birthweight infants, and long-term disability among infants). REPORTING PERIOD COVERED: 2003. DESCRIPTION OF SYSTEM: CDC contracted with the Society for Assisted Reproductive Technology (SART) to obtain data from ART medical centers located in the United States. Since 1997, CDC has compiled data related to ART procedures. RESULTS: In 2003, a total of 122,872 ART procedures were reported to CDC. These procedures resulted in 35,785 live-birth deliveries and 48,756 infants. Nationwide, 74% of ART procedures used freshly fertilized embryos from the patient's eggs; 14% used thawed embryos from the patient's eggs; 8% used freshly fertilized embryos from donor eggs; and 4% used thawed embryos from donor eggs. Overall, 42% of ART transfer procedures resulted in a pregnancy, and 35% resulted in a live-birth delivery (delivery of one or more live-born infants). The highest live-birth rates were observed among ART procedures using freshly fertilized embryos from donor eggs (51%). The highest numbers of ART procedures were performed among residents of California (15,911), New York (15,534), Massachusetts (8,813), Illinois (8,676), and New Jersey (8,299). These five states also reported the highest number of infants conceived through ART. Of 48,756 infants born through ART, 51% were born in multiple-birth deliveries. The multiple-birth risk was highest for women who underwent ART transfer procedures using freshly fertilized embryos from either donor eggs (40%) or their own eggs (34%). Number of embryos transferred, embryo availability (an indicator of embryo quality), and patient's age were also strong predictors of multiple-birth risk. Approximately 1% of U.S. infants born in 2003 were conceived through ART. Those infants accounted for 18% of multiple births nationwide. The percentage of ART infants who were low birthweight ranged from 9% among singletons to 94% among triplets or higher order multiples. The percentage of ART infants born preterm ranged from 15% among singletons to 97% among triplets or higher order multiples. INTERPRETATION: Whether an ART procedure resulted in a pregnancy and live-birth delivery varied according to different patient and treatment factors. ART poses a major risk for multiple births. This risk varied according to the patient's age, the type of ART procedure performed, the number of embryos transferred, and embryo availability (an indicator of embryo quality). PUBLIC HEALTH ACTIONS: ART-related multiple births represent a sizable proportion of all multiple births nationwide and in selected states. Efforts should be made to limit the number of embryos transferred for patients undergoing ART. In addition, adverse infant health outcomes (e.g., low birthweight and preterm delivery) should be considered when assessing the efficacy and safety of ART.
Adult↗
The children of ART (assisted reproductive technology): should the law protect them from harm?
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Child↗