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Breast Neoplasms↗
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Triplets and higher order multiple births in Japan.
Multiple birth rates in entire Japan were analyzed using vital statistics for 1951 to 1988. The triplet rate was nearly constant from 1951 to 1974, where the rate per million births was 58, then increased with the year up to 1982 (104), and decreased up to 1984, and suddenly increased thereafter (109 in 1987). The average rate of quadruplets per million births from 1951 to 1968 was 0.93, then increased with the year up to 1975 (7.5), and decreased until 1984 and suddenly increased thereafter (10.6 in 1987). The rate of quintuplets was 0.77 per million births during the period from 1975 to 1987. The higher multiple birth rate since 1975 was attributed to the higher proportion of mothers treated with ovulation-inducing hormones in Japan. Since 1985, higher multiple birth rates might be partially attributed to in vitro fertilization. The stillbirth rates for male triplets gradually decreased from 1960 to 1978 and thereafter remained constant at a little higher level except in 1988, whereas the rates for females gradually decreased with the year. The overall stillbirth rates decreased to 1/4 for triplets and to 1/5 for quadruplets during the 37-year period from 1951. The overall stillbirth rate of quintuplets was 0.60 (51/85) during the period 1975-1987.
Adult↗
Less is more: the risks of multiple births. The Institute for Science, Law, and Technology Working Group on Reproductive Technology.
OBJECTIVE: To review the medical, social, and financial risks caused by the birth of multiples that need to be addressed in policy and practice. RESULT(S): Many risks of multiple births are described in the literature. The medical risks to the offspring include death, low birth weight, deformational plagiocephaly, and other physical and mental disabilities. Risks to the women include premature labor, premature delivery, pregnancy-induced hypertension, toxemia, gestational diabetes, and vaginal-uterine hemorrhage. Children born in multiples face difficulty socializing, developmental delays, and behavioral problems, whereas their parents risk exhaustion, depression, and anxiety. In addition to personal costs faced by families, society often bears the financial costs of overburdened hospitals, caps on insurance and/or inability of parents to cover expenses. CONCLUSION(S): Multiple births present potential acute and long-term medical risks to the pregnant woman and her children. However, more long-term follow-up research and more research on outcomes with higher-order multiples are needed. In designing practices and policies to improve the success of IVF while reducing the risk of multiples, it is important to balance the many interests involved. At a minimum, providers and patients need to be educated about the risks of multiple gestation so that steps can be taken to prevent adverse outcomes.
Female↗
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.
Female↗
Current and future impact of rising multiple birth ratios on low birthweight.
Before 1980, multiple births with their increased risk of low birthweight comprised too small a proportion of births in the United States to have a significant impact on overall low birthweight levels; the recent steep rise in the multiple birth ratio has heightened their influence, however. Between 1980 and 1992 the white multiple birth ratio rose from 18.5 to 24.0 multiple births per 1,000 births. While the overall level of white low birthweight newborns increased slightly between 1980 and 1992 (from 5.7 percent to 5.8 percent), low birthweight for white singletons actually improved, declining from 4.9 to 4.7 percent. Thus, the increase in overall white low birthweight levels is a reflection of the increase in white multiple births and, to a much lesser extent, of the small increase in low birthweight among these births. Black multiple birth ratios and overall low birthweight also rose in this period. The black multiple birth ratio increased from 24.4 in 1980 to 28.2 per 1,000 births in 1992, and low birthweight rose from 12.7 to 13.3 percent. Although low birthweight for black singletons also increased (from 11.5 percent to 11.8 percent), the increase was at a slower pace than for all pluralities combined. Thus, for both white and black births, overall trends in low birthweight mask the disparate patterns of singleton and multiple births. It is, therefore, essential to examine low birthweight trends by plurality to assess accurately changes in this key indicator of infant health.
Adult↗
Trends in multiple births, 1938-1995.
Information about multiple births has been collected at birth registration in England and Wales since 1938. This article describes the changes and trends in the prevalence of multiple births since that date. Particular attention is given to the increasing incidence of multiple births since the mid-1970s. Geographical variations in multiple births and differences by social class (based on occupation) are analysed. Age at motherhood is found to be a significant factor influencing the changes since 1938.
Age Distribution↗
Multiple births in former oral contraceptive users.
Multiple births were studied in a cohort of 2953 former oral contraceptive users and 13,630 controls, all the women were interviewed post partum. There were 238 multiple births, a rate of 14.4/1000 deliveries. Former oral contraceptive users had 13.5/1000 sets of multiple births compared to 14.5/1000 in the controls. When women who had received treatment for anovulation were excluded, these rates were 11.1 and 12.7/1000 respectively, a difference which is not statistically significant. There was, however, a significant deficit of multiple births among the small group of former pill users who were underweight in relation to their height at the time of conception. Multiple births were also increased after stopping sequential pills and preparations containing high doses of oestrogen, and there was an excess of multiple births following breakthrough pregnancies. These findings, although statistically significant, are based on small numbers, and require confirmation from other studies.
Adult↗
The analysis of the influence of birth order and other factors in multiple birth data.
We compare three methods which can be used to analyse the influence of birth order and other factors on health outcomes in multiple birth data. We consider marginal models based on generalized estimating equations (GEE) and two kinds of conditional models; conditional logistic regression (CLR) and mixed effects models (MEM). Although the models may be written similarly, there are differences in both the interpretation and the numerical values assigned to the parameters. Our main conclusion is that GEE and MEM are preferable to CLR since they provide more flexibility in dealing with missing values and covariates. The choice between GEE and MEM is less obvious and depends on the data, the parameter of interest and statistical power.
Birth Order↗
Higher multiple births: socio-economic implications in a developing nation.
A case of successful quadruplet pregnancy followed from date of diagnosis, through delivery, and to the third year of life is presented. The emotional, social, and economic problems encountered by the parents and hospital personnel are examined with a detailed analysis of the financial burden placed on all parties. Individual, voluntary donations made at the time of delivery have proved insufficient to cover the care involved before, during, and after the birth of multiples. A more concrete commitment on the part of government in the form of legislation or subvention is suggested in order to ease some of the stress on the parents of multiples.
Adult↗
[Maternal partiality in attachment with multiple birth children and the related factors].
UNLABELLED: Multiple births are associated with an increased risk of child abuse and neglect. It is reported that only one child is abused in almost cases, and most abusers are the mothers. Maternal partiality regarding attachment has been suggested as the reason for this tendency. This study investigated the prevalence of this phenomenon in families with multiple birth children and identified factors associated with increased risk. The subjects were 231 mothers of multiple birth children. The following results were obtained. 1. Overall, 10.0% of mothers with multiple birth children reported that they didn't equally attach themselves to all their offspring. 2. Mothers who didn't equally attach themselves exhibited significantly poor health conditions and a higher frequency of upper respiratory infections, compared with mothers who demonstrated no partiality. Moreover, they were more likely to complain of severe fatigue (physical and mental) and poor sleeping conditions. 3. The mothers who didn't equally attach themselves to all their multiple birth children had a higher rate of handicapped children. CONCLUSION: Mothers who do not equally attach themselves to all their multiple birth children show poor health conditions and a higher frequency of upper respiratory infections, and complain of severe fatigue and poor sleeping conditions. They also have a higher rate of handicapped children.
Adult↗
Time to pregnancy and multiple births.
BACKGROUND: Mothers of multiples are alleged to be more fecund than mothers of singletons. Some authors have suggested monitoring twinning rates for assessing temporal changes in a population's reproductive health. METHODS: Using a nested case-control design, we estimated the odds of a multiple birth in relation to fecundity in the US Collaborative Perinatal Project inclusive of 8546 pregnant women who reported a known time-to-pregnancy (TTP) upon enrolment in the cohort, 1959-1966. Case mothers comprised 81 women giving birth to twins/triplets; control mothers comprised 243 women giving birth to singletons matched to case mothers on maternal age at a ratio of 3:1. The odds ratio (OR) for a multiple birth within 6 months of trying adjusting for maternal age and prior pregnancies was estimated using logistic regression. Discrete time Cox regression analysis was also utilized to estimate the fecundability OR. RESULTS: Women with a TTP of 6 months [OR=1.95; 95% confidence interval (95% CI)=1.09-3.51]. Excluding pregnancies after 13+ months resulted in a loss of precision (OR=2.14; 95% CI=0.90-5.04). CONCLUSIONS: These data support higher fecundity among mothers of multiples than mothers of singletons.
Adult↗
Trends in multiple births.
Since the early 1970s, the number and rate of multiple births have increased fairly steadily. Of the 4,110,907 babies born in the United States in 1991, 98,125 (2.4 percent) were twins, triplets or other higher order plural births. The 1991 rate of 23.9 multiple births per 1,000 live births--the highest recorded in this country in the last 50 years--was 1.3 percent higher than that in 1990, and 14 percent higher than the rate in 1985. The twins proportion of all multiple births has been slowly decreasing--97.6 percent in 1985, 96.9 percent in 1990 and 96.6 percent in 1991. Rates of multiple births continue to be higher among black women than white (2.8 and 2.3 per 1,000 live births, respectively, in 1991) and are more prevalent among older women. In 1991 the rates were higher through each age group to a high of 3.4 for white and 3.6 for black mothers aged 35-39 before dropping to 1.9 and 0.5, respectively, among 45- to 49-year-olds. Incidence of low birthweight (< 2,500 grams) and of very low birthweight (< 1,500 grams) babies were more frequent among multiple births than singletons and were more common among black than white infants. The median weight for white singleton births was 3,420 grams versus 2,260 grams for black plural births. The District of Columbia, Michigan and Massachusetts registered the highest percentage of multiple births in 1991 (2.9 to 2.7 percent) and the lowest rates were recorded in New Mexico and Wyoming (1.9 percent).
Black or African American↗
[Reference birthweight for multiple births in Japan].
PURPOSE: Intrauterine growth curves of twins, that is, birth weights according to gestational age, were calculated from birth certificate data. METHODS: Multiple births were identified by birthplace, ages of the parents, gestational age, and year and month of birth. There were 49,240 twin births in Japan between 1988 and 1991. Of these, 32,232 livebirth-livebirth pairs, 679 livebirth-stillbirth pairs, and 278 stillbirth-livebirth pairs were included in this analysis. There were also 1894 triplet live births from 744 sets of triplets and 206 quadruplet live births analyzed. For all, access was made to the database of birth certificates in the form of magnetic tapes giving birthweights in hundred gram categories. RESULTS: For all gestational ages, median birthweights of males were ca. 0.05 kg-0.1 kg larger than female values. Compared to singleton births in Japan, median birthweights of twins remained ca. 0.15 kg smaller until gestational age of 34 weeks, the difference then increasing to ca. 0.5 kg at 42 weeks of gestation. As for birth order, mean birthweight of the first twin was larger than that of the second and the standard deviation was larger for the second. Birthweights of twins from multiparous mothers were greater than those from primiparous mothers. Among the multiple births, median birthweight for gestational age was found to be greatest in twins, lower in triplets and lowest in quadruplets. In triplets, the 50th centile for boys was 0.08 kg larger than for girls. DISCUSSION: With regard to perinatal growth, the fetus is affected more or less by the limitation of uterine expansion in the late gestational weeks. Reference birthweights for exclusive use for multiple births are different from that for singletons.
Birth Order↗
Multiple births among adolescent women in Illinois.
OBJECTIVE: To examine the occurrence of multiple births among adolescents using birth as the unit of analysis and to examine the association between maternal race/ethnicity and parity and the occurrence of multiple births among women less than 20 years of age. STUDY DESIGN: Computerized birth certificate files without personal identifiers were obtained from the Illinois Department of Public Health totaling 1,103,333 live births from 1989 to 1994. RESULTS: A total of 13.3% of births during this time were to mothers less than 20 years of age. The overall maternal multiple birth rate was 8.2/1,000 births. There were statistically significant differences in the numbers of pregnancies resulting in live, multiple births among black, Hispanic and white teenage mothers. There was a linear increase in maternal multiple birth rates among black (P < .0001) and Hispanic (P < .001) teenage mothers by parity as well as a linear increase among black (P < .0001), Hispanic (P < .0236) and white (P < .049) populations by age of the mother. The age- and parity-specific maternal multiple birth rate ranged from 4.4 per 1,000 pregnancies for Hispanic teenage mothers less than 18 years of age to 11.9 per 1,000 pregnancies for black teenage mothers 19 years of age. At 0 and 1 parity, black women less than 20 years of age were at the highest risk for multiple births as compared to Hispanic and white mothers. CONCLUSION: This is the first study showing ethnic and racial differences in the rates of multiple births among teenage mothers. As in older women, increased age and a higher parity were associated with a higher probability of multiple birth among adolescents.
Adolescent↗
Risk of multiple birth associated with in vitro fertilization using donor eggs.
Multiple birth, which is associated with adverse fetal, infant, and maternal outcomes, is increasingly related to the use of in vitro fertilization (IVF). Among women undergoing IVF who use their own eggs, greater maternal age is associated with decreased risk of multiple birth; using donor eggs from younger women may negate this age effect. Data from 6,936 IVF procedures performed in the United States in 1996-1997 on women aged 35-54 years who used donor eggs were analyzed to assess the effect of maternal age, number of embryos transferred, and cryopreservation of extra, nontransferred embryos (an indicator of higher embryo quality) on risk of multiple birth. Greater maternal age did not decrease multiple-birth risk. Rates of multiple birth were related to number of embryos transferred and whether extra embryos had been cryopreserved, and they were high compared with those of IVF patients the same age who had used their own eggs. Among women who had extra embryos cryopreserved, transferring more than two embryos increased multiple-birth risk, with no corresponding increase in the chance for a livebirth. These results highlight the need to consider the age of the donor and embryo quality when making embryo transfer decisions involving use of donor eggs.
Adult↗
The changing epidemiology of multiple births in the United States.
OBJECTIVE: To describe changes in the epidemiology of multiple births in the United States from 1980 to 1999 by race, maternal age, and region; and to examine the impact of these changes on birth weight-specific infant mortality rates for singleton and multiple births. METHODS: Retrospective univariate and multivariable analyses were conducted using vital statistics data from the National Center for Health Statistics. RESULTS: Between 1980 and 1999, the overall multiple birth ratio increased 59% (from 19.3 to 30.7 multiple births per 1000 live births, P <.001), with rates among whites increasing more rapidly than among blacks. Women of advanced maternal age, especially those aged 30-34, 35-39, and 40-44 experienced the greatest increases (62%, 81%, and 110%, respectively). Although all regions of the United States experienced increases in multiple birth ratios between 1991 and 1999, the Northeast had the highest twin (33.9 per 1000 live births) and higher order birth ratios (280.5 per 100,000 live births), even after adjusting for maternal age and race. Between 1989 and 1999, multiple births experienced greater declines in infant mortality than singletons in all birth weight categories. Consequently, very low birth weight and moderately low birth weight infant mortality rates among multiples were lower than among singletons. CONCLUSION: It is important to understand the changing epidemiology of multiple births, especially for women at highest risk (advanced maternal age, white race, Northeast residents). The attribution of infertility management requires further study. The differential birth weight-specific infant mortality for singletons and multiples demonstrates the importance of stratifying by plurality when assessing perinatal outcomes.
Adult↗
Comparison of feeding among multiple birth infants.
Mothers of multiples who choose to feed their infants breast milk are faced with a seemingly overwhelming set of circumstances. Since mothers of multiples could potentially feed their infants differing proportions of breast milk, current methods of obtaining breastfeeding data for mothers of singletons may not adequately describe the breastfeeding behaviors of mothers of twins and triplets. The goal of our study was to determine the proportion of breast milk each infant of a multiple set was fed over a six-month period and compare the feeding regimens of sibling infants. Results of this retrospective study based on maternal reports indicated that there was almost complete agreement in the proportion of breast milk fed to siblings born from the same pregnancy, regardless of stratification based on gestational age, plurality, or location of the infants (hospital vs. home). The Pearson correlation coefficient for duration of breast-milk feeding between sibling twins was 0.99 (p < .0001); among sibling triplets the values were .97, .98 and .99 (p < .0001). A better understanding of the process by which twins and triplets are fed breast milk sets the stage for future research and can ultimately lead to the development of strategies to increase breast-milk feeding rates for multiple birth children.
Age Factors↗
Assisted reproductive interventions and multiple birth.
OBJECTIVE: To investigate the contributions of ovulation-inducing drugs and assisted reproductive technologies to multiple birth. METHODS: This historic prospective study was conducted in a cohort of 13,151 women who delivered after 20 weeks' gestation between October 1996 and December 1999. The study setting was a Colorado health maintenance organization. Cases were women who were pregnant as a result of exposure to treatment with either assisted reproductive technologies or ovulation induction in the absence of assisted reproductive technologies. The main outcome measure was multiple birth. RESULTS: There was a significant association between assisted conception and multiple birth. Compared with women with naturally conceived pregnancies, there was a 25-fold likelihood (95% confidence interval 18, 35, P <.001) of multiple birth among women exposed to any of those treatments. In the total cohort the proportion of multiple births attributable to those treatments was 33%. After adjusting for the use of assisted conception and other covariates, we found no association between advanced maternal age and multiple birth. CONCLUSION: In this cohort, assisted reproductive interventions were strongly associated with multiple birth. Although a higher proportion of older women sought assisted reproductive technologies, we did not find an independent relationship between advanced maternal age and multiple birth. The increasing number of multiple births attributable to assisted conception raises public health concerns regarding multiple gestation-related maternal and infant morbidities.
Adolescent↗