7. What is the survival rate of triplets?

MOST has worked with almost 20,000 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 complications for respiratory distress as well as complications from being a patient in the NICU. The risk of perinatal loss (loss prior to or at birth) is much higher for multiple gestation pregnancies than those with single gestation pregnancies. According to CDC data from 2003:

• The fetal mortality (death prior to or at birth) rate for twins was nearly three times that for singletons
• The fetal mortality rate for triplet or higher order multiples was almost four times that for singletons

Note that fetal loss is more prevalent at certain gestations; of all fetal deaths at 20 weeks of gestation or more, 35.2% occurred between 20–23 weeks of gestation, and 51.3% occurred between 20–27 weeks (MacDorman, et al, 2007). The risk of infant death increases with the increasing number of infants in the pregnancy. According to the CDC data from 2002:

• The infant mortality (death following a live birth) rate for triplets (60.1 per 1,000 live births) was about twice the rate for twin births (30.2 per 1000 live births) and nearly 10 times the rate for single births (6.1 per 1,000 live births)*
• The infant mortality rate for quadruplets (160.4 per 1000 live births) was more than five times the rate for twin births (30.2 per 1,000 live births) and more than 26 times the rate for single births (6.1 per 1,000 live births)*

*Note: Infant mortality rates for multiples are largely affected by prematurity and low infant birth weight. Specifically, the infant mortality rate was much higher for low-birthweight infants (birthweights weighing less than 2,500 grams - 5lbs 8oz) than for infants weighing 2,500 grams or more (59.5 versus 2.4 per 1,000 live births). Overall, the infant mortality rate for very-low-birthweight infants (those with birthweights of less than 1,500 grams - 3lbs 5oz) was 250.8 per 1,000 live births, more than 104 times the rate for infants with birthweights of 2,500 grams (5lbs 8oz) or more. Similarly, the infant mortality rate for very preterm infants (those born at less than 32 weeks of gestation) was 186.4 per 1,000 live births, nearly 75 times the rate for infants born at term (37–41 weeks of gestation) 2.5 per 1,000 live births (Mathews, et al. 2004).

The overall risk of death by age one is 20 times higher for triplets than singletons (Martin, et al, 2005).

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.

MacDorman Ph.D., M. F., Hoyert, Ph.D., D. L., Martin, M.P.H., J. A., Munson, M.S., M. L., and Hamilton,Ph.D., B. E. (2007, February 21). Centers for Disease Controls' National Vital Statistics Report: Fetal and Perinatal Mortality, United States, 2003, 55(6). Retrieved July 8, 2007 from http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_06.pdf

Martin, J.A, Hamilton, Ph.D., B.E., Sutton, Ph.D., P.D, Ventura, M.A., S. J., Menacker, Dr. P.H., F. & Munson, M.L. (2005, September 8). Centers for Disease Controls' National Vital Statistics Report: Births Final Data for 2003, 54(2). Retrieved June 27, 2007 from http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf

Mathews, M.S., T. J., Menacker, Dr. P.H., F., MacDorman, Ph.D., M. F., (2004, November 24). Centers for Disease Controls' National Vital Statistics Report: Infant Mortality Statistics from the 2002 Period Linked Birth/Infant Death Data Set, 53(10). Retrieved July 8, 2007 from http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_10.pdf

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

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

MCH Library Resources on Infant Mortality

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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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