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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2012

Open Access 01-12-2012 | Research article

Temporal trends in the frequency of twins and higher-order multiple births in Canada and the United States

Authors: Deshayne B Fell, KS Joseph

Published in: BMC Pregnancy and Childbirth | Issue 1/2012

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Abstract

Background

The dramatic increase in multiple births is an important public health issue, since such births have elevated risks for adverse perinatal outcomes. Our objective was to explore the most recent temporal trends in rates of multiple births in Canada and the United States.

Methods

Live birth data from Canada (excluding Ontario) and the United States from 1991-2009 were used to calculate rates of twins, and triplet and higher-order multiples (triplet+). Temporal trends were assessed using tests for linear trend and absolute and relative changes in rates.

Results

Twin live births in the United States increased from 23.1 in 1991 to 32.2 per 1,000 live births in 2004, remained stable between 2004 and 2007, and then increased slightly to an all-time high of 33.2 per 1,000 live births in 2009. In Canada, rates also increased from 20.0 in 1991 to 28.3 per 1,000 live births in 2004, continued to increase modestly between 2004 and 2007, and rose to a high of 31.4 per 1,000 in 2009. Rates of triplet+ live births in the United States increased dramatically from 81.4 in 1991 to 193.5 per 100,000 live births in 1998, remained stable between 1998 and 2003 and then decreased to 148.9 per 100,000 in 2007. The rate declined marginally in 2008, but then rose again in 2009 to 153.5 per 100,000. Rates of triplet+ live births were much lower in Canada, although the temporal pattern of change was similar.

Conclusion

The rate of twin live births in the United States and Canada continues to increase, though more modestly than during the 1990s. Recent declines in rates of triplet+ live births in both countries have been followed by unstable trends.
Appendix
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Literature
1.
Public Health Agency of Canada: Canadian Perinatal Health Report. 2008, Ottawa: Minister of Health, Catalogue No HP10-12/2008E, 2008
2.
3.
Martin JA, Hamilton BE, Osterman MJK: NCHS data brief, no 80. Three Decades of Twin Births in the United States, 1980-2009. 2012, MD: National Center for Health Statistics, Hyattsville
4.
Martin JA, Park MM: Trends in twin and triplet births: 1980-97. Natl Vital Stat Rep. 1999, 47: 1-16.
5.
Ananth CV, Joseph KS, Kinzler WL: The influence of obstetric intervention on trends in twin stillbirths: United States, 1989-99. J Matern Fetal Neonatal Med. 2004, 15: 380-387. 10.1080/14767058410001727413.CrossRefPubMed
6.
Joseph KS, Marcoux S, Ohlsson A, Kramer MS, Allen AC, Liu S, Wu Wen S, Demissie K, Sauve R, Liston R, for the Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System: Preterm birth, stillbirth and infant mortality among triplet births in Canada, 1985-96. Paediatr Perinat Epidemiol. 2002, 16: 141-148. 10.1046/j.1365-3016.2002.00413.x.CrossRefPubMed
7.
Getahun D, Amre DK, Ananth CV, Demissie K, Rhoads GG: Temporal changes in rates of stillbirth, neonatal and infant mortality among triplet gestations in the United States. Am J Obstet Gynecol. 2006, 195: 1506-1511. 10.1016/j.ajog.2006.01.043.CrossRefPubMed
8.
Liu S, Allen A, Fraser W: Preterm birth rate. Canadian Perinatal Health Report. 2008, Ottawa: Public Health Agency of Canada, 123-126. 2008
9.
Blondel B, Kogan MD, Alexander GR, Dattani N, Kramer MS, Macfarlane A, Wen SW: The impact of the increasing number of multiple births on the rates of preterm birth and low birthweight: an international study. Am J Pub Health. 2002, 92: 1323-1330. 10.2105/AJPH.92.8.1323.CrossRef
10.
Mathews TJ, MacDorman MF: Infant mortality statistics from the 2007 period linked birth/infant death data set. Natl Vital Stat Rep. 2011, 59: 1-31.
11.
Rand L, Eddleman KA, Stone J: Long-term outcomes in multiple gestations. Clin Perinatol. 2005, 32: 495-513. 10.1016/j.clp.2005.03.002.CrossRefPubMed
12.
Pharoah POD: Risk of cerebral palsy in multiple pregnancies. Clin Perinatol. 2006, 33: 301-313. 10.1016/j.clp.2006.03.017.CrossRefPubMed
13.
Blickstein I: How and why are triplets disadvantaged compared to twins?. Best Pract Res Clin Obstet Gynaecol. 2004, 18: 631-644. 10.1016/j.bpobgyn.2004.04.014.CrossRefPubMed
14.
Huang L, Royle C, Boscoe M: Rate of live births to older mothers. Canadian Perinatal Health Report. 2008, Ottawa: Public Health Agency of Canada, 67-71. 2008
15.
Blondel B, Kaminski M: Trends in the occurrence, determinants, and consequences of multiple births. Semin Perinatol. 2002, 26: 239-249. 10.1053/sper.2002.34775.CrossRefPubMed
16.
Gunby J, Bissonnette F, Librach C, Cowan L, IVF Directors Group of the Canadian Fertility and Andrology Society: Assisted reproductive technologies (ART) in Canada: 2007 results from the Canadian ART register. Fertil Steril. 2011, 95: 542-547. 10.1016/j.fertnstert.2010.05.057. e1-10. Epub 2010 Jul 24CrossRefPubMed
17.
Gunby J, Bissonnette F, Librach C, Cowan L, IVF Directors Group of the Canadian Fertility and Andrology Society: Assisted reproductive technologies (ART) in Canada: 2006 results from the Canadian ART register. Fertil Steril. 2010, 93: 2189-2201. 10.1016/j.fertnstert.2009.03.102. Epub 2009 May 12CrossRefPubMed
18.
Gunby J, Bissonnette F, Librach C, Cowan L, IVF Directors Group of the Canadian Fertility and Andrology Society: Assisted reproductive technologies in Canada: 2005 results from the Canadian assisted reproductive technologies register. Fertil Steril. 2009, 91: 1721-1730. 10.1016/j.fertnstert.2008.02.125. Epub 2008 Apr 18CrossRefPubMed
19.
Gunby J, Bissonnette F, Librach C, Cowan L, IVF Directors Group of the Canadian Fertility and Andrology Society: Assisted reproductive technologies (ART) in Canada: 2004 results from the Canadian ART register. Fertil Steril. 2008, 89: 1123-1132. 10.1016/j.fertnstert.2007.05.015. Epub 2007 Aug 13CrossRefPubMed
20.
Sunderam S, Chang J, Flowers L, Kulkarni A, Sentelle G, Jeng G, Macaluso M, Centers for Disease Control and Prevention (CDC): Assisted reproductive technology surveillance – United States, 2006. MMWR Surveill Summ. 2009, 58 (SS-5): 1-25.PubMed
21.
Wright VC, Chang J, Jeng G, Macaluso M, Centers for Disease Control and Prevention (CDC): Assisted reproductive technology surveillance – United States, 2005. MMWR Surveill Summ. 2008, 57: 1-23.PubMed
22.
Wright VC, Chang J, Jeng G, Chen M, Macaluso M, Centers for Disease Control and Prevention (CDC): Assisted reproductive technology surveillance – United States, 2004. MMWR Surveill Summ. 2007, 56: 1-22.PubMed
23.
Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology: 2009 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Reports. 2011, Atlanta: Department of Health and Human Services, http://​www.​cdc.​gov/​art/​ART2009/​PDF/​ART_​2009_​Full.​pdf. Accessed February 22, 2012
24.
Blickstein I: The worldwide impact of iatrogenic pregnancy. Int J Gynaecol Obstet. 2003, 82: 307-317. 10.1016/S0020-7292(03)00219-4.CrossRefPubMed
25.
Min JK, Claman P, Hughes E, Society of Obstetricians and Gynecologists of Canada; Canadian Fertility and Andrology Society: Guidelines for the number of embryos to transfer following in vitro fertilization. Joint SOGC–CFAS guideline No. 182. J Obstet Gynaecol Can. 2006, 28: 799-813.CrossRefPubMed
26.
Min JK, Hughes E, Young D: Elective single embryo transfer following in vitro fertilization. Joint SOGC–CFAS clinical practice guideline No. 241. J Obstet Gynaecol Can. 2010, 32: 363-377.CrossRefPubMed
27.
Dickey RP: The relative contribution of assisted reproductive technologies and ovulation induction to multiple births in the United States 5 years after the society for assisted reproductive technology/American society for reproductive medicine recommendation to limit the number of embryos transferred. Fertil Steril. 2007, 88: 1554-1561. 10.1016/j.fertnstert.2007.01.112.CrossRefPubMed
28.
American society for reproductive medicine and society for assisted reproductive technology: Guidelines on number of embryos transferred. Fertil Steril. 2009, 92: 1518-1519. 10.1016/j.fertnstert.2009.08.059.CrossRef
29.
Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Kirmeyer S, Osterman MJK: Births: final data for 2007. Natl Vital Stat Rep. 2010, 58: 1-85.PubMed
30.
Blickstein I, Keith LG: The decreased rates of triplet births: temporal trends and biologic speculations. Am J Obstet Gynecol. 2005, 193: 327-331. 10.1016/j.ajog.2005.01.007.CrossRefPubMed
31.
Live births database: Canadian Vital Statistics System, 1991-2009. 2011, Ottawa: Statistics Canada
32.
Woodward GL, Bienefeld MK, Ardal S: Under-reporting of live births in Ontario: 1991-1997. Can J Public Health. 2003, 94: 463-467.PubMed
33.
National Cancer Institute: Joinpoint Regression Program, Version 3.4.3. 2010, Statistical Methodology and Applications Branch and Data Modeling Branch, Surveillance Research Program, National Cancer Institute
34.
Gunby J, Daya S, IVF Directors Group of the Canadian Fertility and Andrology Society: Assisted reproductive technologies (ART) in Canada: 2003 results from the Canadian ART register. Fertil Steril. 2007, 88: 550-559. 10.1016/j.fertnstert.2006.11.156. Epub 2007 Feb 14CrossRefPubMed
35.
Maheshwari A, Griffiths S, Bhattacharya S: Global variation in the uptake of single embryo transfer. Hum Reprod Update. 2011, 17: 107-120. 10.1093/humupd/dmq028.CrossRefPubMed
36.
Cook JL, Collins J, Buckett W, Racowsky C, Hughes E, Jarvi K: Assisted reproductive technology-related multiple births: Canada in an international context. J Obstet Gynaecol Can. 2011, 33: 159-167.CrossRefPubMed
37.
38.
Bissonnette F, Phillips SJ, Gunby J, Holzer H, Mahutte N, St-Michel P, Kadoch U: Working to eliminate multiple pregnancies: a success story in Québec. Reprod Biomed Online. 2011, 23: 500-504. 10.1016/j.rbmo.2011.05.020.CrossRefPubMed
39.
Karlstrom PO, Bergh C: Reducing the number of embryos transferred in Sweden-impact on delivery and multiple birth rates. Hum Reprod. 2007, 22: 2202-2207. 10.1093/humrep/dem120.CrossRefPubMed
40.
41.
Metadata
Title
Temporal trends in the frequency of twins and higher-order multiple births in Canada and the United States
Authors
Deshayne B Fell
KS Joseph
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2012
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-12-103

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