Medical and economic effects of twin gestations

OBJECTIVE: To determine the incidence and trends of twinning in the United States and to review the medical and economic effects of twin versus single ton gestations. METHODS: Pertinent and recent studies on twin gestations were obtained thro ugh a MEDLINE database search of the English language between December 1987 and December 1999. Data from the 1995-1996 National Center for Health Stat istics were also used to compare gestational age at delivery,fetal growth r estriction, and perinatal mortality for twin and singleton gestations. Stud ies that have evaluated perinatal risks in relation to advanced reproductiv e technology also were reviewed and summarized. The economic implications o f twinning from a societal perspective and infant quality of life issues of twins compared with singleton gestations ave reviewed. RESULTS: Due to delayed childbearing and increased use of reproductive tech nologies, the incidence of twin gestations in the United States has been in creasing. Twin pregnancies have a higher risk of complications, including p regnancy-induced hypertension, anemia, antepartum and postpartum hemorrhage , and maternal mortality. In addition, twin infants are move likely to deli ver preterm, have low birth weight and greater perinatal mortality rates. T hese outcomes influence health care costs and quality of life for both pare nts and children. CONCLUSIONS: Women carrying twin fetuses ave at increased risk for perinata l and obstetric complications. The increased perinatal risks that accompany twin fetuses may be partly due to the increasing use of advanced reproduct ive technologies. The economic burdens, us well as the potential for decrea sed quality Of life among twins, needs careful evaluation. (J Soc Gynecol I nvestig 2000;7:321-7) Copyright (C) 2000 by the Society for Gynecologic Inv estigation.