title: The decreased rates of triplet births: temporal trends and biologic speculations.
abstract: Recent data from the US and from England and Wales demonstrate decreasing rates of higher-order multiple births and represent, for the first time, a striking change in trend when compared with the previous steep 4-fold increase since the early 1980s. However, the incidence of other multiples--twins--continued to escalate. The most probable reasons for this change are new embryo transfer guidelines and availability of multi-fetal pregnancy reduction procedures. Because actual numbers of higher-order multiples are by far lower than the number of twins, and because twins are predictably associated with significant perinatal morbidity and mortality, the implications of the ever-increasing multiple birth rates are no less alarming. As long as the incidence of twins is not reduced, the decreasing incidence of higher-order multiples, per se, does not herald the end of the epidemic of multiple births.
authors.affiliation: Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Isaac
authors.initials: I
authors.lastname: Blickstein
authors.forename: Louis G
authors.initials: LG
authors.lastname: Keith
mesh_terms: D004624:Embryo Transfer; D005260:Female; D006801:Humans; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D014310:Triplets; D014427:Twins; D006113:United Kingdom / Q000453:epidemiology