Skip to main content Accessibility help
×
Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-28T03:40:54.907Z Has data issue: false hasContentIssue false

Chapter 1 - Epidemiology of Multiple Pregnancy

Published online by Cambridge University Press:  11 October 2022

Leanne Bricker
Affiliation:
Corniche Hospital, Abu Dhabi
Julian N. Robinson
Affiliation:
Brigham & Women's Hospital, Boston
Baskaran Thilaganathan
Affiliation:
St George's Hospital Medical School, University of London
Get access

Summary

The incidence of twin and higher order multiple pregnancies increased dramatically with the advent of Assisted Reproductive Technology (ART) in the 1970s, but practice guidelines have led to decreasing numbers from 2014 onwards. All types of twins have increased in incidence, but dizygous much more so than monozygous. Monochorionic placentation is peculiar to monozygotic pregnancies. Higher orders of chorionicity can occur in monozgotic pregnancies, but are much more common in gestations of plural zygosity. There are many factors that affect the incidence of multiple gestation: individual, genetic, and environmental. However, prudent ART management is the simplest and most effective way of reducing the incidence. Multifetal pregnancy reduction is an operative intervention that can reduce the unwanted medical and social sequelae of multiple pregnancy, counseling about such an intervention should be non-directional and carried out by a specialist.

Type
Chapter
Information
Management of Multiple Pregnancies
A Practical Guide
, pp. 1 - 10
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American College of Obstetricians and Gynecologists. Multifetal pregnancy reduction. ACOG Committee Opinion No. 719. Obstet Gynecol 2017;130(3):670–1. https://doi.org/10.1097/aog.0000000000002302Google Scholar
Martin, JA, Hamilton, BE, Osterman, MJK. Three decades of twin births in the United States, 1980–2009. NCHS Data Brief. 2012;80:18.Google Scholar
Martin, JA, Hamilton, BE, Osterman, MJK, Driscoll, AK. Births: final data for 2018. Natl Vital Stat Rep 2019;68(13):155.Google Scholar
Martin, JA, Osterman, MJK. Is twin childbearing on the decline? Twin births in the United States, 2014–2018. NCHS Data Brief 2019;351:18.Google Scholar
Martin, JA, Osterman, MJK, Thoma, ME. Declines in triple and higher-order multiple births in the United States, 1998–2014. NCHS Data Brief 2016;243:108.Google Scholar
Norwitz, ER. Multiple pregnancies: trends past, present and future. In The Infertility and Reproductive Medicine Clinics of North America, Diamond, M, DeCherney, A (eds.). Philadelphia: W. B. Saunders, 1998;chapter 9, pp. 351–69.Google Scholar
Lee, YM, Wylie, BJ, Simpson, LL, D’Alton, ME. Twin chorionicity and the risk of stillbirth. Obstet Gynecol 2008;111(1):301–8. https://doi.org/10.1097/AOG.0b013e318160d65dCrossRefGoogle ScholarPubMed
Ein-Mor, E, Mankuta, D, Hochner-Celnikier, D, Hurwitz, A, Haimov-Kochman, R. Sex ratio is remarkably constant. Fertil Steril 2010;93(6):1961–5. https://doi.org/10.1016/j.fertnstert.2008.12.036CrossRefGoogle ScholarPubMed
Mcnamara, HC, Kane, SC, Craig, JM, Short, RV, Umstad, MP. A review of the mechanisms and evidence for typical and atypical twinning. Am J Obstet Gynecol 2016;214(2):172–91. https://doi.org/10.1016/j.ajog.2015.10.930Google Scholar
Gee, RE, Dickey, RP, Xiong, X, Clark, LS, Pridjian, G. Impact of monozygotic twinning on multiple births resulting from in vitro fertilization in the United States, 2006–2010. Am J Obstet Gynecol 2014;210(5):468.e16. https://doi.org/10.1016/j.ajog.2013.12.034Google Scholar
Adashi, EY, Gutman, R. Delayed childbearing as a growing, previously unrecognized contributor to the national plural birth excess. Obstet Gynecol 2018;132(4):9991006. https://doi.org/10.1097/aog.0000000000002853Google Scholar
American College of Obstetricians and Gynecologists. Multifetal gestations: twin, triplet and higher-order multifetal pregnancies. ACOG Practice Bulletin No. 169. Obstet Gynecol 2016;128(4):926–8. https://doi.org/10.1097/aog.0000000000001709Google Scholar
Hoekstra, C, Zhao, ZZ, Lambalk, CB, Willemsen, G, Martin, NG, Boomsma, DI, Montgomery, GW. Dizygotic twinning. Hum Reprod Update 2008;14(1):3747. https://doi.org/10.1093/humupd/dmm036CrossRefGoogle ScholarPubMed
Reddy, U, Branum, A, Klebanoff, M. Relationship of maternal body mass index and height to twinning. Obstet Gynecol 2005;105(3):593–7. https://doi.org/10.1097/01.aog.0000169607.78155.7fCrossRefGoogle ScholarPubMed
American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: an American Society of Reproductive Medicine Practice Committee Opinion. Fertil Steril 2012;97(4):825–34. https://doi.org/10.1016/j.fertnstert.2011.11.048Google Scholar
American College of Obstetricians and Gynecologists. Perinatal risks associated with assisted reproductive technology. ACOG Committee Opinion No 671. Obstet Gynecol 2016;128(3).e61–8. https://doi.org/10.1097/aog.0000000000001643Google Scholar
American Society for Reproductive Medicine and Society for Assisted Reproductive Technology. Criteria for number of embryos to transfer: a committee opinion. Practice Committees of ASRM and SART. Fertil Steril 2013; 99(1):44–6. https://doi.org/10.1016/j.fertnstert.2012.09.038Google Scholar
Callahan, TL, Hall, JE, Ettner, SL, Christiansen, CL, Greene, MF, Crowley, WF Jr. The economic impact of multiple-gestation pregnancies and the contribution of assisted-reproduction techniques to their incidence. N Engl J Med 1994;331(4):244–9. https://doi.org/10.1056/NEJM199407283310407CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×