Number of Multiple Births Quadrupled Since 1974

The number of women giving birth to three or more babies at one time has quadrupled during the last two decades, probably because of the increasing use of fertility drugs and delayed child bearing, federal health officials reported Tuesday.

The number of births involving triplets, quadruplets and quintuplets jumped to 4,594 in 1994, up from 1,005 such births 20 years earlier, according to a report released by the National Center for Health Statistics, part of the federal Centers for Disease Control and Prevention.

The agency described the news as remarkable and noted that the increases are most pronounced among white, married, college-educated women 30 or older.

About one-third of the increase was attributable to the older age of women when their children were born, a factor that increases the chances of a woman producing two or more eggs at one time.

The remaining two-thirds was because of the growing use of ovulation-enhancing drugs and fertility techniques, such as in vitro fertilization, that are “more commonly used by older white women of higher socioeconomic status,” the report stated.

Infants born in such multiple births often arrive early, are of low birth weight and carry greater health risks than single births, although their chances of survival have improved substantially in recent years, the study said.

The findings were based on an examination of all birth certificates registered in all the states and the District of Columbia.

The report did not examine the psycho-social aspects of the births on the lives of parents, especially those who were first-time, older mothers, but experts said that they can be daunting.

“These often are women who think they are in control of their lives by the time they are ready to have a baby but didn’t plan to have two or three--and with possible health consequences,” said Victoria Jennings, an anthropologist who heads the Institute for Reproductive Health at Georgetown University in Washington.

After a multiple birth, life “is considerably more difficult,” she said. “The rules of addition and multiplication do not apply here. You’re talking geometry.”

Furthermore, the financial impact can be unexpected and overwhelming, she said.

“It may be one thing for a 35-year-old or older woman to have one baby and deal with day care, a nanny or other costs. But what if you have three? And especially if they have health problems,” Jennings said.

“Also, think of putting three or more kids through college, all at the same time, when you’re 60 years old and thinking of retiring in five years,” she said.

During the last decade, increases in multiple births averaged 11% annually. Of the 4,594 multiple births in 1994, 4,233 produced triplets, 315 produced quadruplets, and in 46 births the mother had five or more babies.

The multiple birth ratio--the number of live births per 100,000 total live births--rose 214% between 1980 and 1994. The rise in the ratio among white mothers was 252%, compared with 52% for African American mothers. White mothers accounted for 87% of all multiple births.

In comparison, the rate of births of twins rose only 30% during this period, the report said.

By state, Massachusetts reported the highest multiple birth ratio for the combined years, 1992-94, with 215.9 multiple births per 100,000 live births, more than twice as high as the nation (105.5) as a whole. The number for California was 76.6.

Multiple birth babies have a much greater health risk than single births, including lifelong health consequences, the study said.

The average birth weight of a triplet is only half that of a single birth and the gestation period is an average of seven weeks shorter. Also, caesarean section is routine for delivery of these babies.

However, “a good outcome for triplets is now almost as [common] as it is for twins,” said Dr. Michael Zinaman, associate professor and director of the division of reproductive health, endocrinology and infertility at Loyola University in Chicago. “The doctors are getting better, and the outcome of normal babies has increased dramatically.”

However, “the cost in medical dollars is enormous,” he said.

The cost of a pregnancy involving multiple fetuses is probably double the amount for a single child, and that “does not include the cost of caring for the babies in the hospital,” he said.

Zinaman said that the cost of four weeks of care in a neonatal intensive care unit could run as high as $100,000 for each baby.

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3 or More

The number of women giving birth to triplets, quadruplets or more:

Thousands of Women

‘94: 4,594 women with births of three or more

Source: National Center for Health Statistics / Centers for Disease Control and Prevention