This study assessed the trends in twin births and their survival in Bangladesh by analyzing over a quarter million live births during 1970–2018, pooled from all eight rounds of the Bangladesh Demographic and Health Survey. In these five decades, the twinning rate increased by 1.5 times, from 5.8 to 8.6 twins per 1000 maternities. The decadal twinning rates varied across maternal age, parity, body mass index, household wealth index, and geographic region. The gap in decadal neonatal, infant, and under-five cumulative survival probability between singleton and multiple births was found to be closing, using Kaplan-Meier curves. Child mortality decreased by 80% and 60% in singleton and multiple births respectively. However, the absolute size of child mortality in multiple births remained six times higher than in singletons and was concentrated in the neonatal period. The share of multiple births surged in all types of child mortality. We predict a further and faster rise in multiple births in the coming decades in the face of upward trends in maternal age overlapping with higher parities, education, career prospects, contraceptive use, and the future demand-supply of assisted reproductive technology. A particular focus on the improvement of perinatal and neonatal care with wider availability is warranted. Otherwise, increased multiple births might raise child mortality and create public health challenges.

The new West Japan Twins and Higher Order Multiple Births Registry was established by recruiting young twins and multiple births and by referrals from public health centers in the 1990s. The participants included in the survey comprised over 7800 twins and 4241 higher order multiples, and their families. Specifically, the present registry contains one of the largest triplet samples in the world. For these twins and multiples, data on year of delivery, mode of delivery, gestational age, intrapartum complications, longitudinal physical measures, motor milestones, cerebral palsy and feeding methods were obtained from records in the Maternal and Child Health Handbooks and schools. Participating mothers were asked to indicate family structure, parental educational history, maternal sleeping time, maternal health condition, maternal and paternal age at multiple delivery, complications during pregnancy, handedness of multiples and age at menarche of multiples. However, the zygosity differed among the various collaborating public health centers according to factors such as the time of investigation. Follow-up questionnaires have been mailed out every 3–4 years for longitudinal studies. This article describes the goals of this registry, recruitment of multiples and the focus of the study. The goals of this registry are not only to conduct research on human genetics and maternal and child health, but also to contribute to providing appropriate information for families with multiples.

The East Flanders Prospective Twin Survey (EFPTS) is a registry of multiple births in the province of East Flanders, Belgium. Since its start in 1964, over 10,000 twin-pairs have been registered. EFPTS has several unique features: it is population-based and prospective, with the possibility of long-term follow-up; the twins (and higher order multiple births) are recruited at birth; basic perinatal data are recorded; chorion type and zygosity are established; since 1969, placental biopsies have been taken and frozen at –20°C for future research. Since its origin, the EFPTS has included placental data and allows differentiation of three subtypes of monozygotic twins based on the time of the initial zygotic division: the dichorionic–diamniotic pairs (early, with splitting before the fourth day after fertilization), the monochorionic–diamniotic pairs (intermediate, splitting between the fourth- and the seventh-day postfertilization) and the monochorionic–monoamniotic pairs (late, splitting after the eighth day postfertilization). Studies can be initiated taking into account primary biases, those originating ‘in utero’. Such studies could throw new light on the consequences of early embryological events and the gene–environment interactions as far as periconceptional and intrauterine environment are concerned.

The East Flanders Prospective Twin Survey (EFPTS) is a prospective, population-based registry of multiple births in the province of East-Flanders, Belgium. EFPTS has several unique features: it is population-based and prospective, with the possibility of long-term follow-up; the twins (and higher order multiple births) are recruited at birth; basic perinatal data recorded; chorion type and zygosity established; and since 1969 placental biopsies have been taken and frozen at −20 °C for later determination of genetic markers. The EFPTS is the only large register that includes placental data and allows differentiation of three subtypes of monozygotic (MZ) twins based on the time of the initial zygotic division: the dichorionic–diamnionic pairs (early, with splitting before the fourth day after fertilization), the monochorionic–diamnionic pairs (intermediate, splitting between the fourth and the seventh day post-fertilization), and the monochorionic–monoamnionic pairs (late, splitting after the eighth day post-fertilization). Studies can be initiated taking into account primary biases, those originating ‘in utero’. Such studies could throw new light on the controversy over the validity of the classic twin method, the consequences of early embryological events, and the gene–environment interactions as far as periconceptional and intrauterine environment are concerned.

Mechanisms underlying effects of physical factors on twin births are unclear. The present work studied an association between monthly and yearly multiple birth rates (MBRs) in the Novosibirsk region, south-west Siberia, in relation to solar activity (sunspot numbers) and geomagnetic activity (Ap index) from 1957 to 2008. The difference was verified by comparing the yearly MBR observed in 3-year peaks (M = 7.36, SD = 0.33 per 1,000 births) and 3-year troughs (M = 8.10, SD = 0.31 per 1,000 births, p < .001) of an 11-year solar cycle. An inverse correlation (r = –.60, p < .001) was found between sunspot numbers and MBR for a lag of 1 year. Cross-spectral analysis of a 52-year time series established a common signal with the period of 10.5 years, as well as high coherence (K(2) = 0.87). The multiple regression analysis revealed a significant interaction of solar and geomagnetic effects upon the frequency of twin maternities. The results show that elevated solar activity within the 11-year cycle coinciding with the time of conception inhibits multiple births in a manner depending on geomagnetic activity. It is hypothesized that the likely mechanism underlying the association is early fetal loss induced by solar radiation/flux and its terrestrial mediators.

The purpose of this study was to estimate the number of siblings in each Japanese family with multiple birth children using two sets of census data, from 1990 and 1995. The mean number of siblings for singletons was 2.3 in 1990 (2.4 in 1995), 2.9 (2.9) for one set of twins, 4.6 (4.5) for two sets of twins, and 3.5 (3.3) for one set of triplets. For birth order of multiples, the highest mean sibling number was 4.4 for one set of twins (the middle), 7.5 for two sets of twins (the middle-middle), and 4.3 for one set of triplets (the last). The mean sibling number was slightly higher for like-sexed twins and triplets than in unlike-sexed twins and triplets. The mean sibling number was highest in the Okinawa District, among nine districts (0.4 for singletons, 0.6 for one set of twins, 1.0 for two sets of twins and 0.6 for triplets). The current study of the number of siblings in each family with multiple birth children will help provide data for designing programs to help support multiple-birth families. The method of using census data on multiple births might result in a system to analyze nationwide data on multiple birth children if there is no national registry of multiple births after live births in any country.

The twinning incidence from 1984 to 1993 was investigated in Campinas, State of São Paulo, Brazil, and the analyzed data were combined with previous series from the same population. This study has shown that the mean annual incidences and the standard deviations for DZ, MZ and DZ plus MZ twins for the period of 1984 to 1993 are estimated respectively as 4.7 ± 0.92, 4.1 ± 1.11, and 8.8 ± 0.87 per 1,000. In the same period the mean annual incidence of triplets was 0.15 ± 0.16. It was also shown that the incidence of DZ twins is steadily decreasing since 1925, while the incidence of MZ pairs, after a period of decline is increasing since the sixties, due perhaps to the widespread use of oral contraceptives. Concerning the twinning rate as a whole, it has been shown that its declining trend has disappeared over the last few years.

A randomized controlled trial of periconceptional multivitamin supplementation (including 0.8 mg folic acid – see the Materials and Methods section for the precise composition of the multivitamin and trace-element supplementation) was carried out for at least 28 days before conception. The trial was continued until at least until the second missed menstrual period to test the effectiveness of this new primary preventive method in the reduction of neural tube defects. However, other pregnancy outcomes were also evaluated. Of a total of 5,502 pregnant women, 4,846 births were analysed in the final data base. The rate of multiple births was significantly higher in the multivitamin group (3.8%) than in the placebo-like trace-element control group (2.7%), and in both groups exceeded the multiple birth rate of 2.2% in the Hungarian population at large. 7.3% of women in the multivitamin and 7.9% of women in the trace-element groups had received ovarian stimulation treatment (mainly clomiphene) for hormonal dysfunctions, eg. anovulation. Nonetheless, our study showed that periconceptional multivitamin supplementation, with or without ovarian stimulation, increases the rate of multiple births.

Over 80,000 multiple birth babies are born each year in the U.S. Their families must cope with a constellation of complex physical and psychosocial challenges, which jeopardizes their health and functioning. The demands of twin pregnancy and the parenting of twins, triplets, quadruplets, quintuplets or more puts these families at disproportionately high risk for infant mortality, birth defects, child abuse, substance abuse, financial problems and marital problems. Health and social service resources must be developed to alleviate the stresses associated with multiple birth and to empower parents to cope well. Guidelines for policies, parent education, professional training and service delivery developed for the California Department of Health Service, Maternal and Child Health Branch, are here offered for the consideration of policy makers and public health planners.