Higher  multiple births in Switzerland:  neonatal outcome and evolution over the last 20 years

Mieth Arlettaz; S Ersfeld; N Douchet; S Wellmann; HU Bucher

doi:10.4414/smw.2011.13308

Original article

Vol. 141 No. 4748 (2011)

Higher multiple births in Switzerland: neonatal outcome and evolution over the last 20 years

Mieth Arlettaz
S Ersfeld
N Douchet
S Wellmann
HU Bucher

DOI: https://doi.org/10.4414/smw.2011.13308
Cite this as:: Swiss Med Wkly. 2011;141:w13308
Published: 21.11.2011

Summary

QUESTION UNDER STUDY: the study has following objectives:1) to determine the incidence of higher-order multiple births from 2005 to 2008 in Switzerland and its evolution over the last twenty years, and 2) to analyse the neonatal outcome and its change over the last two decades.

METHODS: Data on higher-order multiple births were retrospectively obtained from Swiss obstetric and neonatal hospitals and compared with results from the first two national surveys.

RESULTS: The incidence of higher-order multiple births was 35.3/100,000 live births for triplets, 0.7/100,000 for quadruplets and 0.3/100,000 for quintuplets. All newborns were premature with a median gestational age of 32 1/7 weeks for triplets, 29 2/7 weeks for quadruplets and 28 4/7 weeks for quintuplets. 94% of triplets and all quadruplets and quintuplets survived the neonatal period. Over the last two decades, the incidence of quadruplet and quintuplet births has fallen, while that of triplet births has risen by 40%. The perinatal mortality of triplets has decreased and the neonatal morbidity, mainly respiratory distress, has remained constant.

CONCLUSION: Higher-order multiple births have a high morbidity that has not improved over the last two decades. The incidence of higher-order multiple births is still increasing, which demonstrates that reproductive medicine in Switzerland is not yet sufficiently controlled and monitored.

References

Nakhuda GS, Sauer MV. Addressing the growing problem of multiple gestations created by assisted reproductive therapies. Semin Perinatol. 2005;29:355–62.
Reddy UM, Wapner RJ, Rebar RW, Tasca RJ. Infertility, assisted reproductive technology, and adverse pregnancy outcomes: executive summary of a National Institute of Child Health and Human Development Workshop. Obstet Gynecol. 2007;109(4):967–77.
Shinwell ES, Haklai T, Eventov-Friedman S. Outcome of multiplets. Neonatology. 2009;95:6–14.
Wimalasundera RC, Trew G, Fisk NM. Reducing the incidence of twins and triplets. Best Pract Res Clin Obstet Gynaecol. 2003;17(2):309–29.
Imaizumi Y. Infant mortality rates in single, twin and triplet births, and influencing factors in Japan, 1995–98. Paediatr Perinat Epidemiol. 2001;15:346–51.
Shinwell ES, Blickstein I, Lusky A, Reichmann B. in collaboration with the Israel Neonatal Network. Excess risk of mortality in very low birthweight triplets: a national, population based study. Arch Dis Child Fetal Neonatal Ed. 2003;88:F36–F40.
Arlettaz R, Duc G. Triplés et quadruplés en Suisse, 1985–1988. Schweiz Med Wschr. 1992;122:511–6.
Arlettaz R, Paraskevopoulos E, Bucher HU. Triplets and quadruplets in Switzerland: comparison with singletons, and evolution over the last decade. J Perinat Med. 2003;31:242–50.
Voigt M, Fusch C, Olbertz D, Hartmann K, Rochow N, Renken C, et al. Analyse des Neugeborenenkollektivs der Bundesrepublik Deutschland: Vorstellung engmaschiger Perzentilwerte (-kurven) für die Körpermasse Neugeborener. Geburtsh Frauenheilk. 2006;66:956–70.
Bancalari E, Claure N. Definitions and diagnostic criteria for bronchopulmonary dysplasia. Semin Perinatol. 2006;30(4):164–70.
Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 gm. J Pediatr. 1978;92(4):529–34.
De Vries LS, Eken P, Dubowitz LMS. The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res. 1992;49(1):1–6.
Black M, Bhattacharya S. Epidemiology of multiple pregnancy and the effect of assisted conception. Semin Fetal Neonatal Med. 2010;15:306–12.
Blickstein I, Keith LG. The decreased rates of triplet births: temporal trends and biologic speculations. Am J Obstet Gynecol. 2005;193:327–31.
Simmons R, Doyle P, Maconochie N. Dramatic reduction in triplet and higher order births in England and Wales. BJOG. 2004;111:856–8.
Tandberg A, Bjørge T, Nygård O, Børdahl PE, Skjaerven R. Trends in incidence and mortality for triplets in Norway 1967–2006: the influence of assisted reproductive technologies. BJOG. 2010;117:667–75.
Schweizerische Gesellschaft für Reproduktionsmedizin: Fortpflanzungsmedizinverordnung des Bundes (FMedV) 4.12.2000.
Barri PN, Coroleu B, Clua E, Tur R. Prevention of prematurity by single embryo transfer. J Perinat Med. 2011;39:237–40.
De Neubourg D, Gerris J. What about the remaining twins since single-embryo transfer? How far can (should) we go? Hum Reprod. 2006;21(4):843–6.
Lüthi T. Das Problem der Mehrlingsschwangerschaften. Schweiz Ärztezeitung. 2006;87(21):943–7.
Källén B, Finnström O, Lindam A, Nilsson E, Nygren KG, Otterblad Olausson P. Trends in delivery and neonatal outcome after in vitrofertilization in Sweden: data for 25 years. Hum Reprod. 2010;25(4):1026–34.
Battin M, Wise M, DeZoete A, Stone P. Infant and perinatal outcomes of triplet pregnancy in Auckland: better than expected? N Z Med J. 2009;122(1298):39–47.
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Strauss A, Paek BW, Genzel-Boroviczény O, Schulze A, Janssen U, Hepp H. Multifetal gestation – maternal and perinatal outcome of 112 pregnancies. Fetal Diagn Ther. 2002;17:209–17.
Working group of the Swiss Society of Neonatology. Care and resuscitation of the newborn infant. Paediatrica. 2007;18(3):36–45.
Feldman R, Eidelman AI. Does a triplet birth pose a special risk for infant development? Assessing cognitive development in relation to intrauterine growth and mother-infant interaction across the first 2 years. Pediatrics. 2005;115(2):443–52.
Topp M, Huusom LD, Langhoff-Roos J, Delhumeau C, Hutton JL, Dolk H, on behalf of the SCPE collaborative group. Multiple birth and cerebral palsy in Europe: a multicenter study. Acta Obstet Gynecol Scand. 2004;83:548–53.
Wadhawan R, Oh W, Vohr BR, Wrage L, Das A, Bell EF. Neurodevelopmental outcomes of triplets or higher-order extremely low birth weight infants. Pediatrics. 2011;127:e654–60.
Adegbite AL, Ward SB, Bajoria R. Perinatal outcome of spontaneously conceived triplet pregnancies in relation to chorionicity. Am J Obstet Gynecol. 2005;193:1463–71.
Bajoria R, Ward SB, Adegbite AL. Comparative study of perinatal outcome of dichorionic and trichorionic iatrogenic triplets. Am J Obstet Gynecol. 2006;194:415–24.

How to Cite

1.

Arlettaz M, Ersfeld S, Douchet N, Wellmann S, Bucher H. Higher multiple births in Switzerland: neonatal outcome and evolution over the last 20 years. Swiss Med Wkly [Internet]. 2011 Nov. 21 [cited 2024 Apr. 25];141(4748):w13308. Available from: https://smw.ch/index.php/smw/article/view/1386

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

[1] Nakhuda GS, Sauer MV. Addressing the growing problem of multiple gestations created by assisted reproductive therapies. Semin Perinatol. 2005;29:355–62.

[2] Reddy UM, Wapner RJ, Rebar RW, Tasca RJ. Infertility, assisted reproductive technology, and adverse pregnancy outcomes: executive summary of a National Institute of Child Health and Human Development Workshop. Obstet Gynecol. 2007;109(4):967–77.

[3] Shinwell ES, Haklai T, Eventov-Friedman S. Outcome of multiplets. Neonatology. 2009;95:6–14.

[4] Wimalasundera RC, Trew G, Fisk NM. Reducing the incidence of twins and triplets. Best Pract Res Clin Obstet Gynaecol. 2003;17(2):309–29.

[5] Imaizumi Y. Infant mortality rates in single, twin and triplet births, and influencing factors in Japan, 1995–98. Paediatr Perinat Epidemiol. 2001;15:346–51.

[6] Shinwell ES, Blickstein I, Lusky A, Reichmann B. in collaboration with the Israel Neonatal Network. Excess risk of mortality in very low birthweight triplets: a national, population based study. Arch Dis Child Fetal Neonatal Ed. 2003;88:F36–F40.

[7] Arlettaz R, Duc G. Triplés et quadruplés en Suisse, 1985–1988. Schweiz Med Wschr. 1992;122:511–6.

[8] Arlettaz R, Paraskevopoulos E, Bucher HU. Triplets and quadruplets in Switzerland: comparison with singletons, and evolution over the last decade. J Perinat Med. 2003;31:242–50.

[9] Voigt M, Fusch C, Olbertz D, Hartmann K, Rochow N, Renken C, et al. Analyse des Neugeborenenkollektivs der Bundesrepublik Deutschland: Vorstellung engmaschiger Perzentilwerte (-kurven) für die Körpermasse Neugeborener. Geburtsh Frauenheilk. 2006;66:956–70.

[10] Bancalari E, Claure N. Definitions and diagnostic criteria for bronchopulmonary dysplasia. Semin Perinatol. 2006;30(4):164–70.

[11] Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 gm. J Pediatr. 1978;92(4):529–34.

[12] De Vries LS, Eken P, Dubowitz LMS. The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res. 1992;49(1):1–6.

[13] Black M, Bhattacharya S. Epidemiology of multiple pregnancy and the effect of assisted conception. Semin Fetal Neonatal Med. 2010;15:306–12.

[14] Blickstein I, Keith LG. The decreased rates of triplet births: temporal trends and biologic speculations. Am J Obstet Gynecol. 2005;193:327–31.

[15] Simmons R, Doyle P, Maconochie N. Dramatic reduction in triplet and higher order births in England and Wales. BJOG. 2004;111:856–8.

[16] Tandberg A, Bjørge T, Nygård O, Børdahl PE, Skjaerven R. Trends in incidence and mortality for triplets in Norway 1967–2006: the influence of assisted reproductive technologies. BJOG. 2010;117:667–75.

[17] Schweizerische Gesellschaft für Reproduktionsmedizin: Fortpflanzungsmedizinverordnung des Bundes (FMedV) 4.12.2000.

[18] Barri PN, Coroleu B, Clua E, Tur R. Prevention of prematurity by single embryo transfer. J Perinat Med. 2011;39:237–40.

[19] De Neubourg D, Gerris J. What about the remaining twins since single-embryo transfer? How far can (should) we go? Hum Reprod. 2006;21(4):843–6.

[20] Lüthi T. Das Problem der Mehrlingsschwangerschaften. Schweiz Ärztezeitung. 2006;87(21):943–7.

[21] Källén B, Finnström O, Lindam A, Nilsson E, Nygren KG, Otterblad Olausson P. Trends in delivery and neonatal outcome after in vitrofertilization in Sweden: data for 25 years. Hum Reprod. 2010;25(4):1026–34.

[22] Battin M, Wise M, DeZoete A, Stone P. Infant and perinatal outcomes of triplet pregnancy in Auckland: better than expected? N Z Med J. 2009;122(1298):39–47.

[23] Min SJ, Luke B, Min L, Misiunas R, Nugent C, Van de Ven C, et al. Birth weight references for triplets. Am J Obstet Gynecol. 2004;191:809–14.

[24] Strauss A, Paek BW, Genzel-Boroviczény O, Schulze A, Janssen U, Hepp H. Multifetal gestation – maternal and perinatal outcome of 112 pregnancies. Fetal Diagn Ther. 2002;17:209–17.

[25] Working group of the Swiss Society of Neonatology. Care and resuscitation of the newborn infant. Paediatrica. 2007;18(3):36–45.

[26] Feldman R, Eidelman AI. Does a triplet birth pose a special risk for infant development? Assessing cognitive development in relation to intrauterine growth and mother-infant interaction across the first 2 years. Pediatrics. 2005;115(2):443–52.

[27] Topp M, Huusom LD, Langhoff-Roos J, Delhumeau C, Hutton JL, Dolk H, on behalf of the SCPE collaborative group. Multiple birth and cerebral palsy in Europe: a multicenter study. Acta Obstet Gynecol Scand. 2004;83:548–53.

[28] Wadhawan R, Oh W, Vohr BR, Wrage L, Das A, Bell EF. Neurodevelopmental outcomes of triplets or higher-order extremely low birth weight infants. Pediatrics. 2011;127:e654–60.

[29] Adegbite AL, Ward SB, Bajoria R. Perinatal outcome of spontaneously conceived triplet pregnancies in relation to chorionicity. Am J Obstet Gynecol. 2005;193:1463–71.

[30] Bajoria R, Ward SB, Adegbite AL. Comparative study of perinatal outcome of dichorionic and trichorionic iatrogenic triplets. Am J Obstet Gynecol. 2006;194:415–24.