Woman's World

Twin Births, Up In Massachusetts, Don’t Always Double The Pleasure

By Jean Talbert, M.D.
Massachusetts has recently emerged as the state with the highest percentage of multiple births in the nation. Between 2003 and 2005, 4.5 percent of births in Massachusetts were twins compared to a national average of 3.2 percent. That’s a 40 percent difference.

More significantly, we have seen a 65 percent increase in twin deliveries and a 500 percent increase in triplets and other high order multiple pregnancies in the past 25 years.

Approximately one third of all twin births are naturally occurring, the remainder are the result of infertility treatments. And almost every high order multiple pregnancy is artificially induced. Unfortunately, multiple pregnancies are at high risk for complications both for the mother and the babies.

There are two types of twins – identical and fraternal.

Identical twins develop from a single egg and sperm and the rate of these births has not changed significantly over the years worldwide. Fraternal twins occur when two separate eggs are fertilized by two separate sperm. This rate varies by ethnic group and geographic location. In Massachusetts, infertility treatments and maternal age greater than 35 are the primary contributors to the high fraternal twin rate.

The most common serious complication of twin pregnancy is preterm birth, which significantly increases the risk of complications for the babies.

Twins, especially identicals, also have a higher rate of birth defects. Cerebral palsy, for instance, occurs four times more frequently in twins than in singletons.

Twins also are at risk of abnormal growth in-utero. They are more likely to be undersized or have discordant growth, meaning greater than 20 percent difference in size between twins. Twin-twin transfusion syndrome occurs in 10-15 percent of identical twin pregnancies. This occurs when abnormal vascular connections within a shared placenta create an imbalance of blood flow to the two fetuses. Treatment is difficult, but, if untreated, this condition carries a high risk of fetal death.

Twin pregnancies also carry an increased risk for the mother. Many twin mothers are placed on bed rest for either blood pressure abnormalities or preterm labor. Complete bed rest can increase the risk of blood clots. In addition, twin pregnancies are more likely to result in caesarean section for delivery.

Aside from medical risks, twin pregnancies can produce a tremendous strain on families. Assigned bed rest is stressful and often necessitates the assistance of family and friends. Plus, caring for more than one infant at a time is physically and emotionally draining.
Financial stresses can result from the mother being out of work for an extended period of time as well as high medical costs, especially if the babies are premature.

More than 25 percent of parents of twins suffer from postpartum depression and anxiety.
Due to the high rate of complications with multiple pregnancies, the current goal of assisted reproductive technology is to maximize healthy singleton pregnancies. Although twins are charming, pregnancy outcomes are best when we have one baby at a time.

(Dr. Talbert is a board certified OB/GYN specialist practicing with Cape Obstetrics, Midwifery & Gynecology in Falmouth and Sandwich, 508-457-0088.)