Study Shows Improved Outlook for Triplets

From the WebMD Archives

Sept. 20, 2000 -- The number of women giving birth to more than one baby at a time has risen by more than 100% in the last 20 years. Although big births like those of the Dilley sextuplets and the McCaughey septuplets make headlines, most multiple births are triplets or twins.

Often, women who conceive three or more babies at once through fertility treatments are advised to undergo a "selective reduction" -- a procedure in which doctors inject a toxic substance into one or more of the fetuses early in the pregnancy. This reduces the number of babies, with the hope of giving the remaining fetus or fetuses a better chance of survival and good health, but it can also raise medical, ethical, and psychological issues for both parents and physicians.

But as technology has improved and doctors have gained more experience working with multiple pregnancies, survival rates for triplets appear to be good enough that many couples who want to keep all three can be safely counseled to do so.

In a new study published in The American Journal of Obstetrics and Gynecology, researchers evaluated 127 triplet pregnancies. Of those, 46 chose to have the reduction procedure (95% of whom chose twins and 5% of whom chose to carry just one baby). Eleven of the women lost one or two babies spontaneously after nine weeks without undergoing the procedure.

The study showed that triplets had the same survival rates as the babies of mothers who selectively reduced, and were delivered about the same time. Although the triplets were smaller, on average, than the other babies, their weights were not so low as to cause them to be kept in the hospital significantly longer. The length of the pregnancies averaged 32 weeks for the triplets and 33 weeks for the group reduced to twins; a full-term pregnancy is 38-42 weeks after the last menstrual period.

The study shows that there have been substantial improvements in the outcome of triplets, says study author Mark P. Leondires, MD.

"Most patients I see just want to have a baby, and they want to know if they are going to have a baby at about the same rate if they go ahead with triplets or not," says Leondires, of the Walter Reed Army Medical Center in Washington. "What the study says is, whether they have a reduction or go on with triplets, you can't say there is a significant difference in the take-home baby rate for one, two, or three [babies]."

Leondires says patients should be given this information along with all the other facts about triplet pregnancies, including the potential problems. He says, specifically, that there is a 10-15% chance one triplet will have cerebral palsy; that triplets may have to spend more than two months in the hospital nursery before they can go home; that the parents will need outside help in the form of family, friends, or paid workers to care for the babies; and that the family dynamic will change dramatically.

"You're talking about 50 bottles a day, 25 diapers a day, a 30-40% risk of depression in the mother, and a 20% incidence of divorce among the couples," he says. "It's very hard for patients to look down the line at the implications, but I tell people that they have to look within themselves and decide whether they themselves, their family structure, and their resources will be OK with going ahead with triplets."

Still, the decision whether to have triplets, twins, or just one baby is a personal one that depends on many different factors, Leondires says.

Gabriella Pridjian, MD, a maternal-fetal medicine specialist at Tulane University Medical Center in New Orleans, agrees.

She tells WebMD that the best advice for couples faced with a multiple birth is to gather as much information as possible from maternal-fetal medicine specialists, fertility specialists, and neonatologists and make an informed decision based on their own situation.

The study, she says, "is good news in the sense that [for those who choose] not having a reduction, the outcome may be equal; and for couples that are concerned that fetal reduction may not be appropriate for them for social and religious reasons, they can rest somewhat assured that carrying a triplet pregnancy is likely about the same as having a reduction."