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PubMed2004

The desire of infertile patients for multiple births.

OBJECTIVE: To determine the proportion of infertile women who prefer a multiple birth over a singleton, patient characteristics associated with this desire, and patient knowledge about the risks of multiple births. DESIGN: Prospective analysis. SETTING: Academic university hospital-based infertility center and private general gynecology clinic. PATIENT(S): Four hundred sixty-four female patients with infertility who presented for their initial visit. MAIN OUTCOME MEASURE(S): Demographic characteristics, infertility history, desire regarding multiple births, knowledge of the risks of multiple births, and goals of infertility evaluation and treatment were determined by using a 41-question survey. Univariate analysis was performed to assess patient characteristics associated with the desire for multiple births. Independent factors associated with this desire were assessed by multivariable logistic regression analysis. RESULT(S): 20.3% of women desired multiples over a singleton gestation. Nulliparity, lower family income, younger patient age, prior evaluation for infertility, longer duration of infertility, and lack of knowledge regarding risks of twin gestations were associated with this desire. Only nulliparity and lower family income were independently associated. CONCLUSION(S): A sizable minority of infertility patients prefers a multiple birth as their treatment outcome. Patient education may be an effective strategy to reduce the incidence of twin and higher-order multiple pregnancies.

Adult↗
PubMed1990

An agenda for meeting the special needs of multiple birth families.

Over 80,000 multiple birth babies are born each year in the U.S. Their families must cope with a constellation of complex physical and psychosocial challenges, which jeopardizes their health and functioning. The demands of twin pregnancy and the parenting of twins, triplets, quadruplets, quintuplets or more puts these families at disproportionately high risk for infant mortality, birth defects, child abuse, substance abuse, financial problems and marital problems. Health and social service resources must be developed to alleviate the stresses associated with multiple birth and to empower parents to cope well. Guidelines for policies, parent education, professional training and service delivery developed for the California Department of Health Service, Maternal and Child Health Branch, are here offered for the consideration of policy makers and public health planners.

Family↗
PubMed1988

Essential nonmedical perinatal services for multiple birth families.

Parents of multiples suffer unique stresses which can severely impair family health and welfare. Access to information, counseling, and community resources increase parents' abilities to cope, and reduce the risk of child and spousal abuse. Twinline, a social service agency in California, provides a variety of free and low-cost nonmedical perinatal services to meet the needs of a heterogeneous population of over 1,000 multiple birth families and parents expecting multiples in the urban and rural counties of the San Francisco Bay Area.

California↗
PubMed1980

Multiple births in Hausa women.

The incidence of multiple births was studied using the maternity records of 5750 Hausa women living in the savannah zone of Nigeria. There were 40 twins and 2 triplets/1000 births. Twenty six per cent of twins were monozygous. The incidence of multiple births, which was about five times higher than that observed in any western population, was significantly lower than that of other ethnic groups, who live in the hot and humid climate of the southern pat of country. The incidence of multiple births was related to maternal age but did not bear any association to the climate or prevalence of malaria.

Adult↗
PubMed1996

Maternal risk of breast cancer following multiple births: a nationwide study in Sweden.

The association between multiple births and subsequent maternal breast cancer risk was explored in a nested case-control study in Sweden encompassing 19,368 parous women with breast cancer diagnosed up to age 65 years, and 100,459 parous controls. Among cases and controls, there were 329 and 2,031 women, respectively, with a history of at least one live multiple birth. Compared with singleton mothers, breast cancer risk was 12 percent lower (odds ratio = 0.88, 95 percent confidence interval = 0.78-0.99) in women who had had a multiple birth. After stratification for age at diagnosis, evidence of a significant inverse association was found only in women aged 54 years or younger. Birth order of the multiple pregnancy had no apparent risk-modifying effect. Age at earliest multiple birth was unrelated to breast cancer risk. The inverse association between twinning and breast cancer risk may reflect protective physiological features of twin pregnancies. Further research is needed to investigate the role, if any, of increased levels of steroid hormone-binding globulins in mothers of twins and the proposed inhibitory effects of human chorionic gonadotropin and alpha-fetoprotein, both of which are increased during multiple gestations, on breast carcinogenesis. Breast feeding patterns in mothers of twins also may modify their risk of developing breast cancer.

Adult↗
PubMed2003

Breastfeeding rights of multiple birth families and guidelines for health professionals.

Increasing numbers of women wish to breastfeed their multiple birth children. Breastfeeding of preterm and fullterm multiple birth infants is complex and demanding for the families and presents distinct challenges for health professionals. Families require sustained assistance from health care providers who are encouraging, knowledgeable, skilled, and committed to the breastfeeding of multiple birth children. Seven breastfeeding rights of multiple birth families are presented for the continuum of pregnancy to early childhood and are in accordance with the Declaration of Rights and Statement of Needs of Twins and Higher Order Multiples (Council of Multiple Birth Organizations of the International Society for Twin Studies, 1995). Guidelines for each of the rights have been developed to assist health professionals provide "best practices" in community and hospital settings. The guidelines are based on the existing body of breastfeeding of multiples' research, empirical findings, and consultations with parents and care providers with experience and/or expertise in breastfeeding multiples. The rights and guidelines suggest direction for providing assistance, implementing programs and services, conducting research, and evaluating the effectiveness of multiples-specific breastfeeding care during the prenatal, infancy, and toddlerhood periods.

Breast Feeding↗
PubMed1998

[Multiples births: a continuing problem with assisted reproductive techniques].

Assisted reproductive techniques (ART) such as in vitro fertilisation (IVF), ovulation induction and superovulation followed by insemination have caused a sharp increase in multiple birth prevalence rates. The perinatal morbidity of multiple birth infants is high because of the high incidence of premature birth. The social and psychological problems of multiple birth families are also considerable. In 1990 high-order multiple births were mainly the result of IVF. Although the number of IVF treatments has increased more than the number of other ART treatments, nowadays high-order multiple births are predominantly caused by superovulation. Since 1990 the number of high-order multiple births has stabilised, but the recent sharp increase in ART twins results in a further rise in births of severely preterm ART infants. More restraint should be practised in superovulation treatments to bring down the number of (high-order) multiple births.

Adult↗
PubMed2004

[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.

Adult↗
PubMed1996

Recent trends in the incidence of multiple births and associated mortality in England and Wales.

AIM: To review trends in multiple births and associated mortality in England and Wales since 1975, in the light of trends for earlier years; to assess, within the limitations of the available data, the extent of any association between multiple birth rates and assisted conception and drugs used for subfertility. METHODS: Data collected routinely in England and Wales, between 1975 and 1994, were retrospectively reviewed. These comprised Office of Population Censuses and Surveys (OPCS) data collected at the registration of live and stillbirths and deaths occurring under the age of 1 year in England and Wales from 1975 onwards. Department of Health data about NHS prescriptions dispensed outside hospitals within England for drugs which could be used in the medical management of subfertility were also included. RESULTS: The proportion of pregnancies that resulted in a registered multiple birth increased from a low of 9.9 per thousand in 1975 to 13.6 per thousand in 1994. Up to 1992, the increase was seen in all age groups except for women under 20, with the most substantial increase being in women aged 35 to 39. The rise in the rate of triplet and other higher order births was much steeper than that for all multiple births, increasing from 0.13 sets of triplets per thousand maternities in 1975, to 0.41 in 1994. Prescriptions dispensed for selected drugs that may be used for the medical management of subfertility and assisted conception became more common over this period. The fragmented nature of the data precluded direct comparison with changes in multiple birth rates, however. CONCLUSIONS: Although the causes of the rise since 1980 in multiple birth rates in general, and the dramatic rise in the triplet rate in particular, cannot be ascertained or quantified directly from routinely collected data, drugs used for subfertility and more recently, assisted conception, probably had a major role.

Adult↗
PubMed1998

Reducing the risk of multiple births by transfer of two embryos after in vitro fertilization.

BACKGROUND: In vitro fertilization is associated with a high risk of multiple births, which is a direct consequence of the number of embryos transferred. However, other factors that contribute to the risk are not well defined. METHODS: Using the data base established by the Human Fertilization and Embryology Authority in the United Kingdom, we studied the factors associated with an increased risk of multiple births in 44,236 cycles in 25,240 women. The factors included the woman's age, the cause and duration of infertility, previous attempts at in vitro fertilization, previous live births, number of eggs fertilized, and number of embryos transferred. RESULTS: Older age, tubal infertility, longer duration of infertility, and a higher number of previous attempts at in vitro fertilization were all associated with a significantly decreased chance of a birth and of multiple births. Previous live birth was associated with an increased chance of a birth but not of multiple births. The higher the number of eggs fertilized, the higher the likelihood of a live birth. When more than four eggs were fertilized, there was no increase in the birth rate for women receiving three transferred embryos as compared with those receiving two, but there was a considerable increase in the rate of multiple births when three were transferred (odds ratio, 1.6; 95 percent confidence interval, 1.5 to 1.8). CONCLUSIONS: Among women undergoing in vitro fertilization, the chances of a live birth are related to the number of eggs fertilized, presumably because of the greater selection of embryos for transfer. When more than four eggs are fertilized and available for transfer, the woman's chance of a birth is not diminished by transferring only two embryos. Transferring more embryos increases the risk of multiple births.

Adult↗
PubMed1997

Infertility treatment and multiple birth rates in Britain, 1938-94.

Trends in multiple birth rates are thought to have been substantially affected by subfertility treatments in the last 25 years, but there are few quantitative assessments of this. This paper examines trends in twin and higher multiple birth rates separately in Scotland, England and Wales and compares their course with corresponding multiple birth rates in the Oxford Record Linkage Study area, where the proportions following subfertility treatment are documented. National data on prescriptions for subfertility treatments reinforce the view that they have had a major effect on the trends, and currently perhaps 60% of triplet and higher order births and 15% of twins follow their use in Britain.

Birth Rate↗
PubMed1992

Multiple births: trends and patterns in Canada, 1974-1990.

This paper examines Canadian trends and patterns in multiple births in relation to total confinements, singleton births, maternal age, parity, gestational age and birth weight using vital statistics from 1974 to 1990. Multiple-birth rates in Canada increased from 912.8 to 1,058.9 per 100,000 confinements between 1974 and 1990. The increase is especially noticeable for women over 30. The rate of triplet and higher-order births increased from 8.3 to 21.7 per 100,000 confinements between 1974 and 1990. The proportion of multiple-birth babies that were pre-term (< 37 weeks gestation period) increased from 32.8% in 1974 to 45.8% in 1990. Factors associated with the increase in multiple births may include the use of assisted pregnancy techniques, and the fact that women aged 30 and older, who are at higher risk of a multiple birth, and who postponed their child bearing, have increased their fertility. The sharp increase in multiple-birth rates has implications for maternal and child health and health care costs.

Adolescent↗
PubMed2005

Reference birth-length range for multiple-birth neonates in Japan.

AIM: To clarify the birth length of twins according to gestational age. METHODS: We studied a total of 51,910 live-birth-live-birth pairs of twins, 4,561 triplet live births and 256 quadruplet live births, using data obtained from corresponding birth certificates. The birth length of twins was analyzed according to gestational age. RESULTS: Compared to singleton neonates, the median birth length of twins was approximately 0.5 cm smaller after the gestational age of 34 weeks, increasing to approximately 2.0 cm at 42 weeks of gestation. The median birth length according to gestational age was found to be the greatest in twins, lower in triplets and the lowest in quadruplets, in which the difference was <2.0 cm. CONCLUSION: The birth length of twins was smaller than that of singletons, but the difference was smaller than the difference in birthweight between twins and singletons.

Birth Order↗
PubMed1989

The frequency of multiple births in Gondar Hospital northwestern Ethiopia.

The frequency of multiple births was analysed using data on 12287 deliveries conducted at the Gondar College of Medical Sciences Teaching Hospital in Northwestern Ethiopia, between 1977 and 1985. There were a total of 183 multiple births giving a frequency of 14.9 per thousand deliveries. The prevalence rates of twins and triplets were 14.4 and 0.49 per thousand deliveries respectively. Increasing rates of twinning by maternal age and parity were observed, the peak prevalence was seen after the sixth parity and in mothers 40-44 years old. Using Weinberg's differential method, the monozygous and dizygous twinning rates per thousand deliveries were 4.8 and 11.7 respectively. The latter rate tended to increase with both parity and maternal age. The findings of this study suggest a lower frequency of multiple births than in previous reports from Ethiopia and other African countries and hence are not characteristic of the continent. The rates found occupy an intermediate position between those for Caucasians and Africans. Multicentre data should, therefore, be analysed to confirm the findings of this and other reports concerning multiple births in Ethiopia.

Adolescent↗
PubMed1988

[[Analysis of multiple birth rates in Japan]].

The author analyzes multiple birth rates in Japan based on data from published vital statistics for the years 1951-1968 and from computer files for 1974-1985. "The higher multiple birth rate since 1974 was attributed to the higher proportion of mothers treated with ovulation-inducing hormones in Japan." (SUMMARY IN ENG)

Asia↗
PubMed1991

Trends in multiple births in Italy: 1955-1983.

On the basis of the numbers of single and multiple births routinely collected by the Central Institute of Statistics, trends in multiple births in Italy over the period 1955-1983 were analyzed. Between 1955 and 1983 the frequency of multiple births declined by about 25% (from 12.6/1000 deliveries to 9.6/1000 deliveries). The downward trend was constant until the early 1970s when rates tended to level off and increase slightly. This finding was largely attributable to trends in dizygotic rates, monozygotic births being approximately constant over the period considered. Multiple birth rates rose till age 35-39, being more than two times higher in this age group than in teenagers, but flattened off in the subsequent strata of age: this finding was constant over the period considered. Despite the general decreasing trend, the regional differences persisted largely unchanged, multiple birth rates being about 30% higher in Southern (and less developed areas) of the country than in the North of Italy. Geographic differences were limited to dizygotic pregnancies, monozygotic rates being constant (about 4/1000 pregnancies) in various areas.

Adolescent↗
PubMed2003

Social stigma and compounded losses: quality-of-life issues for multiple-birth families.

OBJECTIVE: To determine the quality-of-life domains most impacted by multiple births. DESIGN: Focus groups, qualitative research. SETTING: Human volunteers in a medical research environment.Forty-three mothers, 29 raising multiple-birth children, 13 raising singletons, identified from random and convenience samples. INTERVENTION: None. MAIN OUTCOME MEASURE(S): Maternal self-reports of the psychosocial sequelae of multiple or singleton births, based on qualitative data analysis of transcribed group discussions. RESULT(S): The quality-of-life domains that were most impacted by raising multiple birth children were social stigma, pregnancy loss, marital satisfaction, children's health, unmet family needs, parenting stress, maternal depression, and the infertility experience. CONCLUSION(S): Qualitative methods identified two novel quality-of-life domains in iatrogenic multiple birth families: social stigma and compounded losses. An unexpected finding was the potential for increased marital solidification as parents coped with the inordinate stresses of multiple births. As anticipated, children's health, unmet family needs, maternal depression, and parental stress were key areas of concern. In addition, the infertility experience had a lasting impact. These findings are significant, given that at least 38% of all assisted conceptions result in a multiple birth. This study lays the groundwork for further research on the impact of iatrogenic multiple births.

Abortion, Spontaneous↗
PubMed1992

Triplets and higher-order multiple births. Time trends and infant mortality.

OBJECTIVES: To describe changes in rates of higher-order multiple births (triplets and higher) between 1972 and 1989, to compare infant mortality rates in infants of higher-order multiple births and singletons born from 1983 through 1985, and to compare infant mortality rates among higher-order multiples born from 1983 through 1985 with rates among those born in 1960. RESEARCH DESIGN: Population-based analysis of live births (1972 through 1989) and infant deaths (1960 and 1983 through 1985) in the United States. The rate of higher-order multiple births was calculated per 100,000 live births. DATA SOURCE: Computerized national natality files for 1972 through 1989 and national linked birth/infant death data sets for 1960 and 1983 through 1985 from the National Center for Health Statistics, Centers for Disease Control. POPULATION: Live births to white and black women in the United States. INTERVENTIONS: None. MAIN RESULTS: Between 1972 through 1974 and 1985 through 1989 the rate of higher-order multiple births increased by 113% among infants of white mothers and by 22% among infants of black mothers. In whites the increase was mostly age specific and was not due to the upward shift in the maternal age distribution. The increase was particularly large in white women aged 30 through 34 years (152%) and 35 through 39 years (165%) and in more highly educated mothers. In blacks the modest increase in the rate of higher-order multiple births was mostly due to an upward shift in the maternal age distribution. From 1983 through 1985, mortality of infants of higher-order multiple births was about 15 times that of singletons. This was due almost entirely to the lower birth weight distribution of infants of higher-order multiple births. Their weight-specific mortality compared favorably with that of singletons. At 500 through 999 g, mortality was about the same. In weight categories between 1000 and 1999 g, mortality rates in higher-order multiple births were much lower: weight-specific relative risks ranged from 0.30 to 0.73. Between 1960 and 1983 through 1985 infant mortality in higher-order multiple births declined by about 50%. CONCLUSIONS: It is likely that much of the increase in the incidence of higher-order multiple births is due to the rise in the use of ovulation-inducing drugs for the treatment of infertility. This increase and the decline in mortality risk have created a much greater need for medical and social services for infants of higher-order multiple births and their families.

Black or African American↗