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PubMed1990

[Multiple births in The Netherlands, 1900-1988].

There are an estimated 120,000 twins and other multiples (all still alive) in The Netherlands. The age of this population (i.e. a quarter of a million persons, 1.6% of the total population) is slightly lower compared with The Netherlands as a whole. Alterations in the structure of mother's age and birth order can only partly explain the observed changes in multiple birth frequencies. The recent increase may be due to medical treatment of women with fertility problems. In addition dizygotic twin births appear to be largely responsible for the total development in multiple births. The changes in birth patterns which relate to the demographic variables age of mother and birth order, are hardly responsible for the decline of stillbirths, perinatal and infant mortality among twins and other multiples. This improvement can be ascribed mainly to progress in medical care. In spite of this improvement, the differences compared with singles are still considerable: the stillbirth rate for twins and other multiples is 2.5 times that for singles; the perinatal mortality rate and the infant mortality rate are about four times as high. However, in the first few years of life of twins and other multiples the age-specific mortality risk declines at such a rate that as early as the third year after birth there is hardly any difference with respect to the singles.

Adolescent↗
PubMed1978

Multiple births and visible birth defects in 13,000 consecutive deliveries in one Ghanaian hospital.

The analysis of the data from this study, though not complete, has shown the following: 1) High rates of plural births may be expected in Ghanaian populations (3.21% for twins, 0.05% for triplets). 2) Hellin's law relating to the incidence of multiple births has been found to apply to a Ghanaian population. 3) Our data show that maternal age and parity have considerable effect on twinning. 4) Multiple pregnancies may not, in themselves, constitute a risk to the mother. On the other hand, the birthweight of the babies may be the cause of hazard at childbirth.

Adolescent↗
PubMed2002

Multiple-birth infants at higher risk for development of deformational plagiocephaly: II. is one twin at greater risk?

OBJECTIVE: In part 1 of this investigation, we demonstrated that children of multiple birth pregnancies are at higher risk for development of deformational plagiocephaly. In the current investigation, we explore whether certain prenatal and postnatal risk factors predispose one twin over the other by examining the occurrence and severity of plagiocephaly in both discordant (only 1 affected) and concordant (both affected) twin pairs. METHODS: Throughout 1999, we obtained detailed medical histories on 140 sets of twins who had presented for treatment at 1 of 9 treatment centers across the United States. The study cohort consisted of 46 concordant and 94 discordant twin pairs (a total of 280 study participants). Information about prenatal and postnatal history of each infant was obtained through detailed review of the children's medical records as well as analysis of a patient database maintained on all infants who receive treatment. Follow-up interviews were performed to verify the information recorded and to obtain additional information about the child who had not received treatment (if appropriate) or use of reproductive assistance (fertility drugs, intracytoplasmic sperm injection, etc) that had not been previously recorded. Statistical analyses were performed to assess the effects of prenatal and postnatal risk factors (in utero position, in utero orientation, birth weight, neck involvement, sleeping position) with respect to which infant was affected in the discordant twin pairs and to which infant was more severely affected in the concordant twin pairs. RESULTS: Statistical analyses of both discordant and concordant twin pairs demonstrated that the lower in utero infant was significantly more likely to be affected (chi(2) = 17.391). In addition, the more severely affected infant was significantly more likely to have some form of neck involvement (torticollis, neck tightness; chi(2) = 46.380), as well as have been carried in a vertex position (chi(2) = 7.408). Conversely, neither sleeping position nor gender was found to be associated with development of plagiocephaly. CONCLUSIONS: The results of this investigation strongly support an in utero cause of plagiocephaly and demonstrate that intrauterine positioning may play a prominent role in determining both the occurrence and severity of deformational plagiocephaly in twins. These findings confirm that the lower in utero infant is at increased risk for the development of plagiocephaly, likely resulting from the more restrictive intrauterine environment encountered during the later part of the pregnancy.

Abnormalities, Multiple↗
PubMed1990

A rapid evolution mechanism may contribute to changes in sex ratio, multiple birth incidence, frequency of auto-immune disease and frequency of birth defects in Clomid conceptions.

Under conditions favourable to the horizontal transmission of genetic material, a clomiphene isomer is hypothesized to encourage an alternate ovulatory route, with consequence for the sex ratio, multiple birth incidence, incidence of auto-immune disease, and frequency of malformations.

Abnormalities, Drug-Induced↗
PubMed2006

Factors influencing the stillbirth rates in single and multiple births in Sweden, 1869 to 1967.

Temporal variations in the stillbirth rate among singletons, twins and triplets in Sweden between 1869 and 1967 were studied. Both among single and multiple births there were marked secular decreasing trends in the stillbirth rates. Based on our long time series since 1869, this study confirms that among twins and triplets the stillbirth rate was higher among same-sexed than among opposite-sexed sets. Comparisons between the stillbirth rates among twin births in urban and rural regions indicate higher stillbirth rates in rural areas. In addition, the stillbirth rates among twins of unmarried mothers were higher than those of twins of married mothers. These findings also hold for both same-sexed and opposite-sexed twin pairs. Analyses of the stillbirth rates for singletons and for different types of twins indicate that up to 1950 the risk of stillbirth among males was almost constantly between 15% to 20% higher than among females. After that the difference in the risk decreased. Comparisons with other populations were performed.

Female↗
PubMed1991

The very tiny baby, multiple births, and other questions about preterm deliveries.

The progressive change of the limit of viability accepted for very preterm babies has resulted in a progressive improvement of survival, but also in costs for days spent in intensive care and for numbers of severely handicapped babies. Multiple births, including twins but especially triplets and quadruplets, result in severely premature births, high death rates, high costs, and severe risk of handicap. As most supermultiple pregnancies are the result of ovulation-inducing drugs, this rise has to be limited. More than acute care, prevention is the only good solution, from both an ethical and an economical standpoint.

Female↗
PubMed1975

[Multiple birth and Down's disease].

The frequency of twinning among newborns with Down's syndrome (2,11+/-0,6%)was significantly higher than in the general populaltion (0,73+/-0,3%). The increase in the rate of multiple births of children with trisomy-21 occurred due to almost three-fold excess in the frequency of dizygotic (discordant) twin pairs over the expected level. The increase in the frequency of dizygotic twins with Down's syndrome was explained by the combined effect of two independent factors: the increase in probability of dizgotic twins natality and the enhanced rate of children birth with trisomy-21, which depended on the increase in mother's age.

Diseases in Twins↗
PubMed1995

Incidence of handicaps in multiple births and associated factors.

This study investigated the degree of risk of handicap in twins, triplets, quadruplets and quintuplets and associated factors, and examined the clustering tendency of handicaps. The sample was recruited from the Kinki University Twin and Higher Order Multiple Birth Registry. This panel consisted of 705 pairs of twins (1410 twins), 96 sets of triplets (287 triplets excluding 1 infant death), 7 sets of quadruplets (27 quadruplets excluding 1 infant death), and 2 sets of quintuplets (10 quintuplets), all of whom were born after 1977. The incidence of handicap was 3.7% in twins, 8.7% in triplets, 11.1% in quadruplets, and 10.0% in quintuplets. The risk of producing at least 1 handicapped child was approximately 1 in 13 pairs of twins (7.4%), 1 in 4 or 5 sets of triplets (21.6%), and 1 in 2 sets of quadruplet and quintuplets (50%). There was a significantly higher clustering tendency of handicaps in twins and triplets compared with the expected frequency calculated from the incidence rate of handicap. Four significant risk factors for subsequent handicap were found by logistic regression: gestation number, shortening of gestational age, premature rupture of the membrane, and toxemia during pregnancy.

Cluster Analysis↗
PubMed2000

Multiple births and outcome.

The rate of multiple-gestation pregnancies has grown exponentially over the last few decades and is responsible for the steady increase in the birth rate of low-birth weight infants. As a group, infants of multiple-gestation pregnancies have higher mortality and morbidity than singleton pregnancies. The increase in adverse outcomes is related directly to the increased risk for preterm delivery and low-birth weight, and not to the multiple gestation itself. Outcomes for multiple-gestation infants appear to be similar whether conceived spontaneously or through artificial reproductive technology. Efforts to reduce the birth rate of low-birth weight infants should target multiple-gestation pregnancies.

Birth Rate↗
PubMed1993

A community nursery nurse working with families with multiple births.

The introduction of skill mix into the health visiting services is causing debate and some concern among health visitors. Patricia Marks describes a three year project in Brighton health authority in which a community nursery nurse was introduced to work in the home with families with multiple births. The role of the community nursery nurse is different from that of the health visitor but this extra input to these families has relieved pressure on health visitors' time, as well as being of tremendous help to the families.

Community Health Nursing↗
PubMed2000

Birthweight percentiles by gestational age in multiple births. A population-based study of Norwegian twins and triplets.

OBJECTIVE: To assess secular trends for birthweight by gestational age in twins in Norway and to develop current national birthweight standards by gestational age for twin and triplet births using population-based data. MATERIAL AND METHODS: The analysis of secular trends for birthweight and gestational age in twins was based on 32,379 twin livebirths (1967-95). Taking into account the observed secular trends in birthweight for 35-40 weeks of gestation, data on twins born during 1987-95 only were included in the calculation of birthweight percentiles for 35-40 weeks, while for lower and upper weeks, data on twins born during 1967-95 were used. The construction of birthweight-for-gestation curves for triplets was based on the data on 690 triplets. RESULTS: Whereas the overall mean birthweight and gestational age decreased in 1987-95 compared with the previous years, the mean birthweights by gestational age for the 35-40 weeks of gestation was significantly higher in 1987-95. Male twins weighed more than female twins throughout the gestation with consistent and significant differences from 27 to 42 weeks of gestation. Smoothed curves for birthweight-by-gestational-age percentiles of male and female twins are plotted. The birthweight-by-gestational-age curves of triplets were almost identical with twin curves before 30 weeks of gestation, starting to diverge from them progressively thereafter. The intrauterine growth of twin births also starts to differ markedly from singletons at approximately 30 weeks of gestation. CONCLUSION: This study shows that plurality-specific birthweight-by-gestation standards should be used for assessment of fetal growth in multiple births rather than singleton standards.

Birth Weight↗
PubMed1998

Assisted reproduction technology, multiple births, and adverse perinatal outcome.

The increase in the rate of multiple pregnancies in Australia in recent years is primarily due to the use of assisted reproduction technology. Compared to singleton births, fetal, neonatal, and perinatal mortality rates are 3-6 times higher in twins and 5-15 times higher in multiple births of a higher order. Cerebral palsy rates among survivors are six times higher in twins and twenty times higher in triplets. The increased risks in multiple pregnancies are not entirely explained by their higher prematurity and low birthweight rates. In Australia, the practice of transferring more than three embryos in any one assisted reproduction technology cycle has declined in recent years and, as a result, the number of multiple pregnancies from assisted reproduction technology has also declined. Nevertheless, assisted reproduction technology pregnancies remain to have poorer than normal outcome with regards to spontaneous abortion, ectopic pregnancy, preterm birth, low birthweight, and perinatal mortality. Infants born after assisted reproduction technology have a higher neonatal morbidity rate, including a greater requirement for assisted ventilation, and a higher long-term neurodevelopmental disability rate. These adverse outcomes following assisted reproduction technology are partly due to the increased risk of multiple pregnancy and partly due to preterm and low birthweight. This fact and the lack of evidence that the transfer of more than two embryos improves pregnancy rates, make it advisable to limit the number of embryos transferred to no more than one or two per cycle.

Australia↗
PubMed1996

Assisted reproductive technologies: estimates of their contribution to multiple births and newborn hospital days in the United States.

OBJECTIVE: Estimate the contribution of assisted reproductive technology (ART) in the United States to multiple gestation births and newborn hospital days. DESIGN: Analysis of successful ART conceptions occurring during 1990 to 1991 compared with vital statistics. Newborn hospital days are estimated from the 1990 National Hospital Discharge Survey. SETTING: The American Fertility Society and the Society for Assisted Reproductive Technology registry. PATIENTS: Infants delivered from ART. INTERVENTIONS: Assisted reproductive technology. MAIN OUTCOME MEASURES: Number of multiple gestation infants and newborn hospital days. RESULTS: Approximately 12,327 live-born infants were delivered from ART conceptions during 1990 to 1991, representing 22.2% of all live-born triplet, 17.3% of quadruplet, and 11.4% of quintuplet infants born in the United States. The number of newborn hospital days attributed to ART infants was 87,135 days. Between the periods 1972 through 1974 and 1990 through 1991, the rate of triplet and higher order multiple gestation infants per 100,000 white live births increased by 191%, with 38% due to ART conceptions and 30% to increased childbearing among older women. CONCLUSIONS: Assisted reproductive technology contributed 22% of U.S. triplet and higher order multiple births during 1990 to 1991.

Female↗