MULTIPLE BIRTHS AND OUTCOME
Section snippets
TRENDS IN TWINS, TRIPLETS, AND HIGHER-ORDER MULTIPLE GESTATIONS
Several investigators have reported an increase in twins, triplets, and other multiple births between the 1970s and the early 1990s.30, 35, 42, 50 In the United States and other industrialized countries, the multiple birth rate began to increase gradually in the 1970s. The rate of increase began to speed up in the late 1980s and this dramatic rise continued into the early 1990s. Most observers attributed the rise primarily to two factors: (1) therapies for infertility, including both medical
OUTCOMES OF VLBW INFANTS OF MULTIPLE GESTATIONS
As described previously, the incidence of multiple-gestation pregnancies has increased more rapidly than the incidence of singleton pregnancies in the United States. Approximately 50% of twins and greater than 90% of triplets and other higher-order multiples are low–birth weight ([LBW] <2500 g) infants.50 Among US white births in 1983, 0.7% of singletons were VLBW (<1500 g), whereas the risk of VLBW among twins was 11-fold greater (8%). In this same study, the VLBW rate among US black
ASSISTED REPRODUCTIVE TECHNOLOGY
As noted previously, the increasing use of ARTs is closely associated with the rise in multiple births.50, 66 ART includes IVF, gamete intrafallopian transfer, and ovulation-stimulating drugs. Early studies evaluating the perinatal outcome of pregnancies resulting from ARTs reported a variety of adverse outcomes.58 Much of this increase was attributed to the high rate of multiple-gestation pregnancies resulting from these techniques. Recent studies have attempted to compare the outcome of
PREVENTION
Prevention can be targeted at preventing both iatrogenic multiple gestation and preterm delivery. The most efficient way of reducing complications from higher-order multiple gestations is to reduce their frequency. This can be done through enhanced efforts to reduce the number of embryos transferred for IVF and a more controlled approach to ovulation.3, 26 Treatment with ovulation-inducing drugs alone accounts for the largest proportion of iatrogenic multiple-gestation pregnancies.26, 66
References (68)
- et al.
Aggressive perinatal care for higher order multiple gestations: Does good perinatal outcome justify aggressive assisted reproductive techniques?
Am J Obstet Gynecol
(1999) - et al.
The current status of multifetal pregnancy reduction
Am J Obstet Gynecol
(1996) - et al.
Twin pregnancies conceived by assisted reproductive techniques: Maternal and neonatal outcomes
Obstet Gynecol
(1997) - et al.
Why do small twins have a lower mortality rate than small singletons?
Am J Obstet Gynecol
(1993) - et al.
Effects of birth order, gender, and intrauterine growth retardation on the outcome of very low birth weight in twins
J Pediatr
(1993) - et al.
Preterm discordant twins: What birth weight difference is significant?
Am J Obstet Gynecol
(1995) - et al.
Multifetal pregnancy reduction: Evaluation of fetal growth in the remaining twins
Am J Obstet Gynecol
(1996) - et al.
Outcomes of very-low-birth-weight twins cared for in neonatal intensive care units
Am J Obstet Gynecol
(1998) - et al.
Selective termination: Clinical experience and residual risk
Am J Obstet Gynecol
(1990) - et al.
Very-low-birth-weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, May 1991 through December 1992
Am J Obstet Gynecol
(1995)
Perinatal and neonatal outcomes in multiple gestations: Assisted reproductive vs. spontaneous conception
Am J Obstet Gynecol
Increasing trends in plural births in the United States
Obstet Gynecol
Neonatal morbidity and mortality associated with triplet pregnancy
Obstet Gynecol
A prospective ecomparison of the outcome of triplet pregnancies managed expectantly or by multifetal pregnancy reduction to twins
Am J Obstet Gynecol
The effect of fertility drugs and in vitro methods on the outcome of 106 triplet pregnancies
Fertil Steril
Outcome of twin pregnancies reduced from triplets compared with nonreduced twin gestations
Obstet Gynecol
The ideal twin pregnancy: Patterns of weight gain, discordancy, and length of gestation
Am J Obstet Gynecol
Neonatal problems in twins
Clin Perinol
The risks confronting twins: A national perspective
Am J Obstet Gynecol
Task force report on the outcome of pregnancies and children conceived by in vitro fertilization (France: 1987 to 1989)
Fertil Steril
Prognosis for twins with birth weight <1500 gm: The impact of cesarean section in relation to fetal presentation
Am J Obstet Gynecol
Multifetal reduction increases the risk of preterm delivery and fetal growth restriction in twins: A case control study
Fertil Steril
Perinatal outcomes of a large cohort of extremely low gestational age infants (twenty-three to twenty-eight completed weeks of gestation)
J Pediatr
Is size discordancy an indication for delivery of preterm twins?
Am J Obstet Gynecol
Selective reduction of multifetal pregnancies
Lancet
Assisted reproductive technologies: Estimates of their contribution to multiple births an newborn hospital days in the U.S
Fertil Steril
No. 253: Special problems of multiple gestation
Int J Gynecol Obstet
What are the fetal growth patterns of singletons, twins, and triplets in the United States?
Clin Obstet Gynecol
Analysis of multiple births in Japan. I. Weight at birth among 12,392 pairs of twins
Jpn J Human Genet
Growth and development of twins dissimilar in size at birth
N Engl J Med
A comparison of neonatal outcomes of age-matched, growth-restricted twins and growth-restricted singletons
Am J Perinatol
Selective reduction of multifetal pregnancies in the first trimester
N Engl J Med
The growth discordant twin
Obstet Gynecol Surv
Characterization of the growth-discordant twin
Obstet Gynecol
Cited by (46)
Associations between area-level arsenic exposure and adverse birth outcomes: An Echo-wide cohort analysis
2023, Environmental ResearchMaternal, pregnancy and neonatal outcomes in triplet pregnancies in Sweden – a nationwide cohort study
2023, Upsala Journal of Medical SciencesEffect of antenatal corticosteroids on neonatal neurodevelopment: a review
2021, Chinese Journal of Perinatal Medicine
Address reprint requests to Barbara B. Warner, MD Division of Pulmonary Biology Children's Hospital Medical Center 3333 Burnet Avenue Cincinnati, OH 45229-3039