This paper is only available as a PDF. To read, Please Download here.
Abstract
Multiple births, which account for approximately 3% of births and 14% of infant deaths,
are increasing in frequency. Multiple birth rates began to decline in the 1950s, reaching
a minimum in the 1970s and rising since then. Both twin and triplet rates followed
the same rising trend until 1998, after which triplet birth rates began to decline
while twin birth rates continued to rise. Rising maternal age is associated with rising
frequency of dizygotic twinning up to 37 years of age. Older maternal age, associated
with the social trend to delayed child bearing, accounts for 25–30% of the rise in
multiple birth rates since 1970. The resulting rise in the prevalence of infertility
has given rise to unprecedented use of ovarian stimulation treatments that stimulate
the development of multiple oocytes. Assisted reproduction technology and ovulation
stimulation with clomiphene citrate or gonadotrophins without assisted reproduction
account for similar proportions of both twin births (20–30%) and triplet births (30–40%).
The fall in triplet rates since 2000 is reassuring, but fetal reduction of high order
pregnancies may be a factor in rising twin rates. Continuing attention is needed to
all possible means of minimizing triplet pregnancies.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Reproductive BioMedicine OnlineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Obstetric outcome of natural and assisted conception twin pregnancies is similar.Acta Obstetricia et Gynecologica Scandinavica. 1997; 76: 45-49
- Deliveries and children born after in-vitro fertilisation in Sweden 1982–95: a prospective cohort study.Lancet. 1999; 354: 1579-1585
- The decreased rates of triplet births: temporal trends and biologic speculations.American Journal of Obstetrics and Gynecology. 2005; 193: 327-331
Blondel B 1996 L'épidémiologie des grosses multiples: évolution, facteurs favorisants et issue de la grossesse. XI èmes Journées de Techniques Avancées en Gynécologies, Obstétrique, PMA et Pédiatrie. Paris, AGPA, 333 pp.
- Trends in the occurrence, determinants, and consequences of multiple births.Seminars in perinatology. 2002; 26: 239-249
- Trends in perinatal health in metropolitan France between 1995 and 2003: results from the National Perinatal Surveys.Journal de Gynécologie Obstétrique et Biologie de la Reproduction (Paris). 2006; 35: 373-387
- The economic impact of multiple-gestation pregnancies and the contribution of assisted-reproduction techniques to their incidence.New England Journal of Medicine. 1994; 331: 244-249
- Contribution of assisted reproductive technology and ovulation-inducing drugs to triplet and higher-order multiple births–United States, 1980–1997.Morbidity and Mortality Weekly Report. 2000; 49: 535-538
- Pregnancy outcomes in a randomised controlled trial of periconceptional multivitamin supplementation. Final report.Archives of Gynecology and Obstetrics. 1994; 255: 131-139
- Iatrogenic multiple pregnancies in East Flanders, Belgium.Fertility and Sterility. 1993; 60: 493-496
- Perinatal outcome of pregnancies after assisted reproduction: a case control study.American Journal of Obstetrics and Gynecology. 1999; 181: 688-695
- The danger of overmatching in studies of the perinatal mortality and birthweight of infants born after assisted conception.European Journal of Obstetrics and Gynecology and Reproductive Biology. 1996; 69: 73-75
Guitteny MA 2000. Impact des traitements de l'infertilité sur l'état de santé des enfants à la naissance. Dissertation, Paris.
- Factors influencing twins and zygosity.Paediatric and Perinatal Epidemiology. 2005; 19: 8-9
- A comparative study of zygotic twinning and triplet rates in eight countries, 1972–1999.Journal of Biosocial Science. 2003; 35: 287-302
- Triplets and quadruplets born in Victoria between 1982 and 1990.Medical Journal of Australia. 1993; 158: 659-663
- A randomised trial of low dose folic acid to prevent neural tube defects. The Irish Vitamin Study Group.Archives of Diseases in Childhood. 1992; 67: 1442-1446
- Higher multiple births and the modern management of infertility in Britain.British Journal of Obstetrics and Gynaecology. 1992; 99: 607-613
- The East Flanders Prospective Twin Survey (Belgium): a population-based register.Twin Research. 1998; 1: 167-175
Lumley J, Watson L, Watson M et al. 2001 Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects. Cochrane Database Systematic Review. CD001056.
- Assisted reproductive interventions and multiple birth.Obstetrics and Gynecology. 2001; 97: 195-200
- Prevention of neural tube defects: results of the medical research council vitamin study.Lancet. 1991; 338: 131-137
- The changing epidemiology of multiple births in the United States.Obstetrics and Gynecology. 2003; 101: 129-135
- Trends in multiple deliveries and infertiflity treatments in France.British Journal of Obstetrics and Gynaecology. 1993; 100: 383-385
- Assisted reproductive technologies: estimates of their contribution to multiple births and newborn hospital days in the United States.Fertility and Sterility. 1996; 65: 361-366
Biography
John Collins trained in Obstetrics and Gynecology at the University of Western Ontario, followed by post-residency training in London and Edinburgh. He is Professor Emeritus at McMaster University and Adjunct Professor at Dalhousie University. He is the Editor-in-Chief of Human Reproduction Update, a member of the ESHRE Capri Workshop Group and consultant to the Practice Committee of the American Society for Reproductive Medicine. His research involves the evaluation of outcomes such as the effectiveness, safety and cost of interventions for reproductive health disorders, and the long-term cardiovascular and cancer outcomes associated with use of oral contraception and hormone treatment.
Article info
Publication history
Accepted:
April 3,
2007
Received:
January 19,
2007
Identification
Copyright
© 2007 Reproductive Healthcare Ltd, Duck End Farm, Dry Drayton, Cambridge CB23 8DB, UK. Published by Elsevier Inc. All rights reserved.
