Less is more: The risks of multiple births

J. D.Nanette Elster, J. D.Lori Andrews, J. D.Rachel Dvorken, J. D.Robert Gatter, J. D.Terri Finesmith Horwich, J. D.Ami Jaeger, Susan Klock, M. D.Eugene Pergament, J. D.Francis Pizzulli, J. D.Robyn Shapiro, M. D.Mark Siegler, J. D.Peggie Smith

Research output: Contribution to journalReview articlepeer-review

121 Scopus citations


Objective: To review the medical, social, and financial risks caused by the birth of multiples that need to be addressed in policy and practice. Result(s): Many risks of multiple births are described in the literature. The medical risks to the offspring include death, low birth weight, deformational plagiocephaly, and other physical and mental disabilities. Risks to the women include premature labor, premature delivery, pregnancy-induced hypertension, toxemia, gestational diabetes, and vaginal-uterine hemorrhage. Children born in multiples face difficulty socializing, developmental delays, and behavioral problems, whereas their parents risk exhaustion, depression, and anxiety. In addition to personal costs faced by families, society often bears the financial costs of overburdened hospitals, caps on insurance and/or inability of parents to cover expenses. Conclusion(s): Multiple births present potential acute and long-term medical risks to the pregnant woman and her children. However, more long-term follow-up research and more research on outcomes with higher-order multiples are needed. In designing practices and policies to improve the success of IVF while reducing the risk of multiples, it is important to balance the many interests involved. At a minimum, providers and patients need to be educated about the risks of multiple gestation so that steps can be taken to prevent adverse outcomes. (C) 2000 by American Society for Reproductive Medicine.

Original languageEnglish (US)
Pages (from-to)617-623
Number of pages7
JournalFertility and Sterility
Issue number4
StatePublished - Oct 2000


  • Assisted reproductive technology
  • Fertility
  • In vitro fertilization
  • Multiple birth risks

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology


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