The Journal of Reproductive Medicine, 47(4), 259-265, 2002
Triplet births in the United States. An epidemic of high-risk pregnancies
Author affiliations
- Medical University of Lublin ROR
Abstract
Objective
To more precisely understand the changes in triplet births in recent years.
Study Design
Analysis of recent government and medical publications pertaining to triplets.
Results
Triplet births are at much greater risk than singletons of poor birth outcomes. More than 9 of 10 triplet births are born preterm (< 37 completed weeks of gestation) as compared with < 1 of 10 singleton infants. The average weight of a triplet newborn (1,698 g) is one-half that of a singleton newborn (3,358 g). The infant death rate for triplet and other higher-order multiple births is 12 times higher than that for singletons (93.7 as compared with 7.8 infant deaths per 1,000 live births).
Conclusion
Based on their frequency of preterm birth, low birth weight and infant death rate, it is appropriate to characterize all triplet pregnancies as high risk.
Topics
triplet births United States epidemic trends, high order multiple pregnancies birth outcomes, triplet pregnancy preterm birth low birth weight, triplet infant mortality rate versus singleton, multiple birth epidemic assisted reproduction, Keith Oleszczuk triplet pregnancy outcomes, triplet births neonatal morbidity mortality statistics, higher order multiples high risk pregnancy classification, triplet birth weight preterm delivery rates, multiple gestation pregnancy public health trends
Keith et al. 2002, Keith 2002
Cite this article
Keith, L. G., & Oleszczuk, J. J. (2002). Triplet births in the United States. An epidemic of high-risk pregnancies. The Journal of reproductive medicine, 47(4), 259-265.
Keith LG, Oleszczuk JJ. Triplet births in the United States. An epidemic of high-risk pregnancies. J Reprod Med. 2002;47(4):259-265.
Keith, Louis G., and Jaroslaw J. Oleszczuk. "Triplet births in the United States. An epidemic of high-risk pregnancies." The Journal of reproductive medicine, vol. 47, no. 4, 2002, pp. 259-265.
Keywords
Adult, Disease Outbreaks/statistics & Numerical Data, Female, Gestational Age, Humans, Infant Mortality, Infant, Low Birth Weight, Infant, Newborn, Middle Aged, Pregnancy, Pregnancy Outcome/epidemiology, Pregnancy, High-Risk, Risk Assessment, Triplets/statistics & Numerical Data, United States/epidemiology
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Open Access
Assisted Reproductive Technology Surveillance - United States, 2015
CDC, 2018 · MMWR Surveill Summ
Since the first U.S. infant conceived with assisted reproductive technology (ART) was born in 1981, both the use of ART and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which eggs or embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Although the majority of infants conceived through ART are singletons, women who undergo ART procedures are more likely than women who conceive naturally to deliver multiple-birth infants. Multiple births pose substantial risks for both mothers and infants, including obstetric complications, preterm delivery (<37 weeks), and low birthweight (<2,500 g) infants. This report provides state-specific information for the United States (including the District of Columbia and Puerto Rico) on ART procedures performed in 2015 and compares birth outcomes that occurred in 2015 (resulting from ART procedures performed in 2014 and 2015) with outcomes for all infants born in the United States in 2015. Period Covered: 2015. Description of System: In 1995, CDC began collecting data on ART procedures performed in fertility clinics in the United States as mandated by the Fertility Clinic Success Rate and Certification Act of 1992 (FCSRCA) (Public Law 102-493 [October 24, 1992]). Data are collected through the National ART Surveillance System, a web-based data collection system developed by CDC. This report includes data from 52 reporting areas (the 50 states, the District of Columbia, and Puerto Rico). 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Nationally, among ART transfer procedures in patients using fresh embryos from their own eggs, the average number of embryos transferred increased with increasing age of the woman (1.6 among women aged <35 years, 1.8 among women aged 35-37 years, and 2.3 among women aged >37 years). Among women aged <35 years, the national elective single-embryo transfer (eSET) rate was 34.7% (range: 11.3% in Puerto Rico to 88.1% in Delaware). In 2015, ART contributed to 1.7% of all infants born in the United States (range: 0.3% in Puerto Rico to 4.5% in Massachusetts). ART also contributed to 17.0% of all multiple-birth infants, 16.8% of all twin infants, and 22.2% of all triplets and higher-order infants. The percentage of multiple-birth infants was higher among infants conceived with ART (35.3%) than among all infants born in the total birth population (3.4%). Approximately 34.0% of ART-conceived infants were twins and 1.0% were triplets and higher-order infants. Nationally, infants conceived with ART contributed to 5.1% of all low birthweight infants. Among ART-conceived infants, 25.5% had low birthweight, compared with 8.1% among all infants. ART-conceived infants contributed to 5.3% of all preterm (gestational age <37 weeks) infants. The percentage of preterm births was higher among infants conceived with ART (31.2%) than among all infants born in the total birth population (9.7%). Among singletons, the percentage of ART-conceived infants who had low birthweight was 8.7% compared with 6.4% among all infants born. The percentage of ART-conceived infants who were born preterm was 13.4% among singletons compared with 7.9% among all infants. Interpretation: Multiple births from ART contributed to a substantial proportion of all twins, triplets, and higher-order infants born in the United States. For women aged <35 years, who are typically considered good candidates for eSET, the national average of 1.6 embryos was transferred per ART procedure. Of the four states (Illinois, Massachusetts, New Jersey, and Rhode Island) with comprehensive mandated health insurance coverage for ART procedures (i.e., coverage for at least four cycles of IVF), three (Illinois, Massachusetts, and New Jersey) had rates of ART use exceeding 1.5 times the national rate. This type of mandated insurance coverage has been associated with greater use of ART and likely accounts for some of the difference in per capita ART use observed among states. Public Health Action: Twins account for the majority of ART-conceived multiple births. Reducing the number of embryos transferred and increasing use of eSET when clinically appropriate could help reduce multiple births and related adverse health consequences for both mothers and infants. State-based surveillance of ART might be useful for monitoring and evaluating maternal and infant health outcomes of ART in states with high ART use.