7. What is the survival rate of triplets?

MOST has worked with almost 25,000 families since 1987. During that time the majority of expectant mothers of triplets and quadruplets who have contacted MOST have delivered healthy, albeit pre-term, babies. Even many higher order multiples of quintuplets and sextuplets have had good outcomes. Survival of higher order multiples depends on many factors.

The most important factors are the number of babies involved in the pregnancy and the level of prematurity at birth: the more babies involved the greater the risk, but the longer the gestation, the greater the chance for survival. Infants born more prematurely face a greater likelihood of respiratory distress and other complications. (See the MOST Medical Birth Survey data on infants for more details.)

Note: For morbidity and mortality data on infants born extremely premature (22-25 weeks gestation) see the National Institute of Child Health and and Human Development Neonatal Research Network online tool.

The risk of perinatal loss (loss prior to or at birth) is higher for multiple gestation pregnancies than those with single gestation pregnancies. According to CDC Fetal and Perinatal Mortality data from 2005:

• The fetal mortality rate (fetal deaths of 20 weeks of gestation or more) for twins was 16.08 per 1,000 live births: 2.7 times that for singletons
• The fetal mortality rate for triplet or higher order multiples was 27.18 per 1,000 live births: 5 times that for singletons (source #1)

"The increased risks of fetal loss for multiple pregnancies may relate in part to increased rates of preterm labor, fetal growth restriction, pre-eclampsia, anomalies, abruption, and cord accidents. Also, many multiple pregnancies are the result of assisted reproductive technologies. Studies have suggested that both the underlying infertility problem, and the use of these therapies may increase the risk of adverse outcomes." (source #2)

Additional factors, aside from a multiple gestation, that can increase fetal mortality include maternal obesity, smoking during pregnancy, severe or uncontrolled hypertension or diabetes, infections, placental and cord problems, intrauterine growth retardation, previous perinatal death, maternal race, and other factors.

The risk of infant death (death following a live birth) increases with the increasing number of infants in the pregnancy. According to the CDC data from 2007, 3% of twins and 7% of triplets compared with less than 1% of all singletons died during infancy (source #3)

*Note: Infant mortality rates for multiples are largely affected by prematurity and low infant birth weight. Multiple births are much more likely to be born preterm and at low birth weight than single births. The higher risk profile of multiple births has a substantial impact on overall infant mortality.

Despite the increased risk for loss, if the pregnancy is managed by a
perinatologist or specialist who has significant experience with higher
order multiple pregnancies, the outcome is often better than the average for these births. In addition, the quality of care in the NICU is an important
factor in survival. When choosing a primary care physician for a higher-order pregnancy, ask about the doctor's hospital associations. Inquire about hospital NICU survival statistics as well as how much experience the unit has caring for preterm multiple birth infants.

Early ultrasounds that show each baby being similar in size to that of a singleton and to each other also improves the probability of a positive outcome for these pregnancies. When a 16-18 week level II sonogram reveals that each baby is healthy and free of any obvious congenital abnormalities the odds continue to improve. Another positive indicator is if the mother does not encounter any significant challenges between 18-23 weeks gestation, such as infection or preterm labor. Of triplet pregnancies, 98% of all babies born after 28 weeks gestation survive! Of course sadly, this is not the case for every pregnancy, triplet or otherwise, and unexplained losses can occur at any time in the pregnancy. Be sure to share your questions and concerns with your medical professional so that he or she can support and advise you most appropriately.

Sources:

1. MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. National vital statistics reports; vol 57 no 8. Hyattsville, MD: National Center for Health Statistics. 2009. http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_08.pdf

2. MacDorman MF, Munson ML, Kirmeyer S. Fetal and perinatal mortality, United States, 2004. National vital statistics reports; vol 56 no 3. Hyattsville, MD: National Center for Health Statistics. 2007. ttp://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_03.pdf

3. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics reports; vol 58 no 17. Hyattsville, Maryland: National Center for Health Statistics. 2010. http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_17.pdf

For more information, see the MOST Recommendations on the Responsible Use of Fertility Treatments (PDF).

MOST also offers our book Expecting Multiples: A Comprehensive Guide covering a variety of topics related to pregnancy and delivery of higher-order multiples.

Visit the MOST Supertwins Statistics page to learn more about multiple birth complications.

MCH Library Resources on Infant Mortality

Please Note:
MOST provides these FAQs for informational purposes and cautions visitors not to use the content below to make treatment decisions without personally consulting a qualified health care provider. Reuse of this content without proper citation is a violation of copyright. To obtain permission to use Supertwins 101 content contact MOST.

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Copyright MOST 2005       Updated 8/16/10