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PubMed1996

What proportion of multiple births are due to ovulation induction? A register-based study in Italy.

OBJECTIVES: This study evaluated the increase in risk of multiple births associated with ovulation induction and calculated the proportion of multiple births attributable to this treatment. METHODS: Cases were 350 multiple births and controls were 737 single births enrolled from April 1993 to March 1994 in the Mercurio Project, an investigation of reproductive outcomes in Italy. RESULTS: Ovulation induction was used in 45 case births (12.9%) and 24 control births (3.3%); the adjusted odds ratio was 4.1 (95% confidence interval [CI] = 2.4, 6.9). The odds ratio for triplet or higher order births was 72.2 (95% CI = 25.7, 202.8). When unlike-sexed multiple births were considered, the odds ratio increased for twin births, but not for triplet or higher births. The highest odds ratios were found when ovulation induction was used with assisted reproduction. The proportion of multiple births attributable to ovulation induction was 9.7% overall, 5.4% for twin births, and 69.8% for triplet or higher births. CONCLUSIONS: Ovulation induction increases the risk of multiple births and has been responsible for the rise in the rate of triplet or higher order births in Italy in the last decade. Its indiscriminate and improper use should be avoided.

Adult↗
PubMed2003

Trends in multiple births conceived using assisted reproductive technology, United States, 1997-2000.

OBJECTIVE: To examine trends in multiple births conceived using assisted reproductive technology (ART) in the United States between 1997 and 2000 and to estimate the proportion of all US multiple births attributable to ART use. METHODS: We analyzed population-based data of 109 519 live-born infants who were conceived in the United States using ART and born between 1997 and 2000 and population-based data of 15 856 809 live-born infants who were delivered in the United States between 1997 and 2000. Multiple birth rates (the number of live-born infants delivered in multiple gestation pregnancies per 1000 live births) and the proportion of all US multiple births attributable to ART were evaluated. RESULTS: The twin rate for ART patients increased between 1997 and 2000, reaching 444.7 per 1000 live births in 2000, whereas the triplet/+ rate declined substantially from 134.3 to 98.7 per 1000 live births from 1997-2000. From 1997-2000, the proportion of multiple births in the United States attributable to ART increased from 11.2% to 13.6%, whereas the proportion attributable to natural conception decreased from 69.9% to 64.5%. In 2000, the proportion of triplet/+ births attributable to ART and to natural conception was 42.5% and 17.7%, respectively. The contribution of ART to multiple births increased substantially with maternal age, from 11.6% for triplet/+ infants born to women aged 20 to 24 to 92.8% for women aged 45 to 49 years. CONCLUSIONS: The contribution of ART to twin birth rates continues to increase, but the contribution of ART to triplet/+ birth rates has declined.

Adult↗
PubMed1999

Impact of multiple births on low birthweight--Massachusetts, 1989-1996.

In Massachusetts during 1989-1996, perinatal health indicators such as infant mortality, teen birth rate, and maternal smoking during pregnancy decreased steadily; however, low birthweight (LBW) (i.e., <2500 g [<5 lbs, 8 oz]) rates increased consistently. During this same period, the multiple-birth rate (i.e., number of twins and higher order multiple births per 100 live births) increased from 2.5% in 1989 to 3.5% in 1996. Massachusetts has the highest multiple-birth rate in the United States. Multiple births are more likely to result in LBW infants. To determine the effect of changes in the rate of multiple births on LBW rates and to characterize women who have multiple births, the Massachusetts Department of Public Health examined data on births in Massachusetts during 1989-1996. This report summarizes the results of this analysis, which indicate that the increase in LBW rates in Massachusetts was associated with changes in the rate of multiple births, especially among older, better educated women.

Adult↗
PubMed1995

Multiple births, sex of children and subsequent breast-cancer risk for the mothers: a prospective study in Norway.

Endocrinological changes occurring during pregnancy may influence the subsequent cancer risk of the mother. Further, the endocrinological milieu may differ according to different birth characteristics. In the present study possible relations between multiple births, sex of children and breast-cancer risk were examined in a population-based, prospective study of 802,269 parous Norwegian women aged 20-56 years. A total of 4,782 women were diagnosed with breast cancer during follow-up. Of these, 97 had ever experienced a multiple birth. We found a slightly lower risk of breast cancer among women ever having had a multiple birth than among women with singletons only (IRR = 0.89, 95% CI = 0.73-1.09). The reduction in risk was mainly observed among women with a multiple last birth. Further, the reduction in risk seemed to diminish with increasing parity, and among women with 4 or more full-term pregnancies, ever having had a multiple birth was associated with an elevated risk (IRR = 1.48, 95% CI = 0.97-2.25). The sex of the first or last child did not affect the subsequent breast-cancer risk. Further, we found no associations with the sex distribution among all children or in multiple births, despite a tendency toward a reduced risk among women with several daughters only.

Adult↗
PubMed1995

Multiple births and risk of breast cancer.

Data from a large, multicenter, population-based case-control study were analyzed to investigate the relation between multiple birth pregnancies and subsequent breast-cancer risk in the gravidas. Women less than 75 years old who had breast cancer were identified from statewide tumor registries in Wisconsin, western Massachusetts, Maine and New Hampshire. Controls aged less than 65 years were selected randomly from lists of licensed drivers, and controls aged between 65 and 74 were selected randomly from lists of Medicare beneficiaries. Information on reproductive history and other factors was obtained by means of telephone interviews. After excluding nulliparous women, 5,880 case subjects and 8,217 controls remained for analysis. Multiple birth pregnancies occurred in 146 cases and 218 controls. Adjusted for the number of full-term pregnancies and other confounders, the odds ratio (OR) for any multiple birth pregnancy was 0.94 (95% confidence interval, 0.75 to 1.17). The null association between multiple birth pregnancies and breast cancer remained if the mother's first pregnancy or last pregnancy resulted in a multiple birth. In addition, no trend in risk emerged for age at first multiple birth or time since last multiple birth. While other investigators have suggested biological mechanisms to explain both protective and detrimental effects of multiple births and subsequent development of breast cancer, this study does not support either assertion.

Adult↗
PubMed1987

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

The overall incidence of multiple births in England and Wales, which had been declining since the early 1950s, started to increase in the early 1980s in all age groups except for women under 20. This followed a rise in the incidence of triplet and higher order multiple births which had started in the late 1970s. Analyses of data for births between 1978 and 1983 showed that while stillbirth, perinatal, neonatal, and post-neonatal mortalities among multiple births fell considerably, they remained consistently higher than those for singleton births. Differences in the distribution of birth weight do not wholly explain these differences. Analyses of certified causes of stillbirth and death are difficult to interpret because a considerable proportion were attributed to 'multiple pregnancy'.

Age Factors↗
PubMed2004

On stochastic logistic population growth models with immigration and multiple births.

This paper develops a stochastic logistic population growth model with immigration and multiple births. The differential equations for the low-order cumulant functions (i.e., mean, variance, and skewness) of the single birth model are reviewed, and the corresponding equations for the multiple birth model are derived. Accurate approximate solutions for the cumulant functions are obtained using moment closure methods for two families of model parameterizations, one for badger and the other for fox population growth. For both model families, the equilibrium size distribution may be approximated well using the Normal approximation, and even more accurately using the saddlepoint approximation. It is shown that in comparison with the corresponding single birth model, the multiple birth mechanism increases the skewness and the variance of the equilibrium distribution, but slightly reduces its mean. Moreover, the type of density-dependent population control is shown to influence the sign of the skewness and the size of the variance.

Animal Migration↗
PubMed2000

Multiple births and risk of epithelial ovarian cancer.

BACKGROUND AND METHODS: Prevailing hypotheses about the causes of ovarian carcinogenesis predict that women with a history of multiple births (twins, triplets, etc.) should be at increased risk of epithelial ovarian cancer. However, the scant available evidence suggests that they may actually be at lower risk. To resolve this issue, we pooled data from eight studies involving 2859 parous women with epithelial ovarian cancer (case patients) and 7434 parous women without ovarian cancer (control women). In addition to assessing their history of multiple births (and the sex of the children, where available), we obtained information on age, parity, oral contraceptive use, and other reproductive factors for each woman. Details of tumor histology were available for all case patients. We estimated the relative risks of various histologic types of ovarian cancers associated with multiple births by using multivariable logistic regression analysis, adjusting for matching and confounding variables. RESULTS: Among these parous women, 73 case patients (2. 6%) and 257 control women (3.5%) had a history of multiple births. The adjusted summary odds ratio (OR) for developing all types of epithelial ovarian cancer that are associated with multiple births was 0.81 (95% confidence interval [CI] = 0.61-1.08). We found no evidence that risks associated with multiple births differed among women with borderline or invasive tumors and among women with same-sex and opposite-sex offspring from multiple births. The risk reductions appeared specific for nonmucinous tumors (n = 2453; summary adjusted OR = 0.71 [95% CI = 0.52-0.98]); in contrast, associations with mucinous tumors (n = 406) were heterogeneous across studies. CONCLUSIONS: Parous women with nonmucinous ovarian cancer are no more likely to have a history of multiple births than other parous women, counter to the predictions of current hypotheses for causes of ovarian cancer.

Adenocarcinoma, Mucinous↗
PubMed2000

Selection of patients suitable for one-embryo transfer may reduce the rate of multiple births by half without impairment of overall birth rates.

The aim of the present study was to identify a subset of patients at high risk of multiple birth after IVF and hence suitable for one-embryo transfer, which undoubtedly would reduce the multiple birth rate. This retrospective study included 2107 IVF cycles in which two embryos were transferred. Factors with possible correlation to multiple birth were studied in a multivariate analysis. The factors included background data (female age, previous pregnancies and births, previous IVF cycles, indication for IVF) and IVF cycle characteristics. The following factors were independently predictive of multiple birth: female age expressed a negative correlation while number of good quality embryos transferred was positively correlated. A subset of patients was identified as being at high risk of multiple birth by including age, cycle number and presence of tubal infertility in a model derived from a logistic regression analysis. The rate of multiple births can be reduced from 26% to 13% of all births if one-embryo transfer is performed in selected cases. The total birth rate will decrease from 29% to 25% but may be completely restored by performing one additional one-embryo freeze transfer in high risk patients who do not achieve a term pregnancy.

Adult↗
PubMed2002

Trends in the occurrence, determinants, and consequences of multiple births.

After a substantial decrease in the middle of the 20th century, multiple pregnancy rates have increased in many Western countries. Between the mid-1970s and 1998, the rate of twin pregnancies increased by 50% to 60% in England and Wales, France, and the United States. The rates of triplet or higher-order multiple pregnancies increased by 310% in France, 430% in England and Wales, and 696% in the United States. One fourth to one third of the increase in twin or triplet pregnancies are attributable to a contemporaneous increase in maternal age. Furthermore, in countries with high occurrence of multiple births, 30% to 50% of twin pregnancies and at least 75% of triplet pregnancies occur after infertility treatment. The impact of the increase in multiple births on preterm delivery rates in the overall population is mainly attributable to twin pregnancies. In Canada, France, and the United States, an increase in preterm births among multiples contributed almost as much as the increase in occurrence of multiple births to the increase or stabilization of the overall rates of preterm delivery observed in these countries.

Adult↗
PubMed1994

[Multiple births in the Netherlands, 1900-1993].

Data on multiple births in the Netherlands since 1900 are examined. It is noted that "since 1975 the number of multiple births is increasing rather strongly, partly under the influence of the application of modern medical technology (e.g. hormone treatment) to infertility problems...." Age distribution by sex among paternal and fraternal twins living in the Netherlands is also discussed. (SUMMARY IN ENG)

Age Distribution↗
PubMed2000

Cerebral palsy and multiple births in China.

BACKGROUND: A population-based study on prevalence of cerebral palsy in multiple births has not been carried out in China. The purpose of this paper was to determine the prevalence of cerebral palsy in multiple births and to explore the influence of multiple pregnancy on cerebral palsy after controlling for birthweight. METHODS: A cross-sectional study of cerebral palsy was carried out among 388,192 children aged <7 years in seven cities of Jiangsu province in China. Information about birthweight and plurality was obtained from routine health care records. Pediatricians at city level diagnosed all cases. All the doctors involved had taken part in a training programme held by Beijing Medical University. Stratified analysis by birthweight and its standard normal deviate was employed to compare the prevalence of cerebral palsy in multiples and singletons. RESULTS: The prevalence of cerebral palsy for children aged <7 years in multiples was 9.7 per 1000 children (95% confidence interval [CI]: 6.5-14.0), which was 6.5 times that in singletons (95% CI: 4.4-9.3). The overall neonatal mortality rate was 60.9 per 1000 liveborn multiples, being highest (944.4 per 1000) in the 500-999 g birthweight groups. Most liveborn multiples weighing <1500 g at birth probably died from diseases related to very low birthweight prior to this study. The prevalence of cerebral palsy in multiple births was likely to be higher than that reported in developed countries for children weighing 1500-2499 g even though our data were from a cross-sectional study. When stratified by birthweight, the prevalence of cerebral palsy in multiples weighing <2500 g had tended to be lower than that of singletons in the same birthweight group. In contrast, in normal birthweight categories multiple births had a higher prevalence of cerebral palsy than singletons. When stratified by birthweight normal deviate, the prevalence of cerebral palsy in multiple births was uniformly higher than that in singletons in all birthweight strata and the prevalence of cerebral palsy among multiples appeared to be augmented as birthweight increased. CONCLUSION: The prevalence of cerebral palsy in multiples, 9.7 per 1000 children, is 6.5 times that in singletons. Survival of low birthweight infants is lower in China than in developed countries and survival quality of Chinese children weighing 1500-2499 g needs to be further improved. In terms of birthweight multiples and singletons may be heterogeneous. It might be difficult to directly use actual birthweight specific prevalence to compare the prevalence of cerebral palsy in multiples and singletons. Birthweight normal deviate specific prevalence of cerebral palsy suggests that multiple pregnancy is an independent risk factor for cerebral palsy in all birthweight groups. Multiples are in adverse circumstances very early in gestation and as the foetus matures the risk of cerebral palsy increases.

Birth Weight↗
PubMed2003

Folic acid supplements during early pregnancy and likelihood of multiple births: a population-based cohort study.

BACKGROUND: Folic acid supplements are recommended for women of childbearing age to prevent neural tube defects in their offspring. Results of some studies, however, suggest an increase in multiple births associated with use of vitamin supplements that contain folic acid during pregnancy. Our aim was to assess this association. METHODS: We used data from a population-based cohort study from which we assessed the occurrence of multiple births in women (n=242015) who had participated in a campaign to prevent neural tube defects with folic acid supplements (400 microg per day) in China. Folic acid use was ascertained before pregnancy outcome was known. We studied the relation between multiple births and any use of folic acid pills before or during early pregnancy; additionally, we investigated mechanisms by which folic acid could potentially affect the occurrence of multiple births by examining pill-taking at three time periods: before ovulation, around the time of fertilisation, and after conception. FINDINGS: 1496 (0.62%) multiple births occurred in a cohort of 242015 women who had registered with the study between October, 1993, and September, 1995, and who had a pregnancy not affected by a birth defect; the rate of multiple births in women who did and did not take folic acid before or during early pregnancy was 0.59% and 0.65%, respectively (rate ratio 0.91; 95% CI 0.82-1.00). INTERPRETATION: Our findings suggest that consumption of folic acid supplements during pregnancy is not associated with an increased occurrence of multiple births.

Adult↗
PubMedDate not supplied

The multiple birth explosion: implications for nursing practice.

An explosion in multiple birth rates has generated record numbers of multiple pregnancies and infants. Obstetric and neonatal nurses and those in related practice areas, such as reproductive endocrinology, perinatal education, home health, and lactation services, need special knowledge and resources to provide optimal care for these high-risk families. Multiple birth families have a number of unique health care problems that require directed nursing interventions throughout the perinatal continuum.

Directories as Topic↗
PubMed1990

Familial incidence of multiple births in a colony of chimpanzees (Pan troglodytes).

This paper describes the incidence of multiple births in the Yerkes Chimpanzee colony for a period of about 63 years. Pedigrees are presented for all multiple births. They demonstrate the recurrence of twins in relatively few family lines which can be traced back to a small number of ancestors. The findings suggest that twinning is a family trait in chimpanzees and they support the hypothesis that the incidence of multiple births is genetically influenced in this colony. In addition, a relatively high level of inbreeding may have enhanced the incidence of multiple births in these family lines. Similar findings are known from human populations.

Animals↗
PubMed1997

Multiple births in Nigerian Igbo women: incidence and outcomes.

The rate of multiple births varies amongst races and ethnic groups. This study shows that the incidence of multiple births among the Nigerian Igbo women is one in 35.5 or 28.2 per 1000 births. A significant difference in Apgar scores at 1 minute between the first and second twins suggests a greater risk for the second twin following the delivery of the first twin. Significantly lower Apgar scores and higher perinatal mortality rate in the twins compared with the singleton controls also indicate greater hazard for the multiple births in general. Successful management of multiple pregnancy can occur following early diagnosis and confirmation of fetal presentations, adequate antepartum fetal surveillance and prompt management of pregnancy complications; appropriate referrals to specialised centres when indicated; and prompt decisions as to timing and mode of delivery.

Journal Article↗
PubMed1999

Multiple-birth infants at higher risk for development of deformational plagiocephaly.

OBJECTIVE: Deformational plagiocephaly refers to the development of an abnormal head shape in infants resulting from externally applied molding forces, which may occur either prenatally or postnatally. We have observed that an unexpectedly high number of multiple-birth infants have presented to our center with this condition. The purposes of this investigation were to: 1) determine the significance of this observation; and 2) examine the risk factors that may make this population more susceptible to the development of plagiocephaly. MATERIALS AND METHODS: A retrospective review of our database was performed to identify those infants who were of multiple-birth origin. The parents of these infants were contacted by phone to complete a survey regarding the prenatal and postnatal history of their child. Similar information was obtained for the state of Arizona from the Office of Vital Statistics. A chi2 analysis was used to compare the incidence of multiple births in Arizona with the incidence of multiple births in our treatment population. RESULTS: Between 1993 and 1996, 69 (8.6%) of the 801 infants treated for deformational plagiocephaly at our Phoenix center were of multiple-birth origin. Four infants who had been treated postoperatively after surgery for craniosynostosis, as well as 5 patients who had been referred from out of state, were excluded from further study. The chi2 analysis of the remaining 60 patients confirmed that a statistically significant number of plural-birth infants had presented with deformational plagiocephaly. Four risk factors were identified as having occurred at high frequency in this population: in utero constraint, supine sleeping position, torticollis, and prematurity. CONCLUSIONS: The current findings of this investigation confirm that a significant number of multiple-birth infants have presented to our clinic with deformational plagiocephaly. Compared with their singleton counterparts, plural infants seem to be at higher risk for the development of deformational plagiocephaly, because they are more likely to be exposed to multiple risk factors.deformational plagiocephaly, multiple birth, plurality.

Female↗
PubMed1997

Services for families with multiple births. The United Kingdom model.

Families with multiple births have special needs that are insufficiently recognized by many of their professional care givers. The Multiple Births Foundation is the first organization to provide professional services to these families through twins clinics, a telephone service, meetings for parents and literature. Its aim now is to provide an educational program for professionals so that the special needs of these families can be more widely recognized and provided for.

Family↗