title: Psychosocial risks associated with multiple births resulting from assisted reproduction.
abstract: OBJECTIVE
  To determine if increased psychosocial risks are associated with each increase in birth multiplicity (i.e., singleton, twin, triplet) resulting from assisted reproduction.
  
  
  METHODS
  Stratified random sample (n = 249).
  
  
  METHODS
  An academic teaching hospital and private practice infertility center.
  
  
  METHODS
  Mothers raising 1- to 4-year-old children (n = 128 singletons, n = 111 twins, and n = 10 triplets) conceived through assisted reproduction.
  
  
  METHODS
  Self-administered, mailed survey.
  
  
  METHODS
  Scales measuring material needs, quality of life, social stigma, depression, stress, and marital satisfaction.
  
  
  RESULTS
  Using multivariate logistic regression models, for each additional multiple birth child, the odds of having difficulty meeting basic material needs more than tripled and the odds of lower quality of life and increased social stigma more than doubled. Each increase in multiplicity was also associated with increased risks of maternal depression.
  
  
  CONCLUSIONS
  To increase patients' informed decision-making, assisted reproduction providers might consider incorporating a discussion of these risks with all patients before they begin fertility treatment, and holding the discussion again if the treatment results in a multiple gestation. These data may also help providers to identify appropriate counseling, depression screening, and supports for patients with multiple births.
authors.affiliation: Reproductive Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. ellison@rand.org
authors.forename: Marcia A
authors.initials: MA
authors.lastname: Ellison
authors.forename: Selen
authors.initials: S
authors.lastname: Hotamisligil
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.forename: Janet W
authors.initials: JW
authors.lastname: Rich-Edwards
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Pang
authors.forename: Janet E
authors.initials: JE
authors.lastname: Hall
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D009099:Multiple Birth Offspring / Q000523:psychology* / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D016017:Odds Ratio; D011584:Psychology; D011788:Quality of Life / Q000523:psychology*; D027724:Reproductive Techniques, Assisted / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D012919:Social Behavior; D012959:Socioeconomic Factors