The CDC reported that triplets and higher-order birth rates in the US dropped by a 62% from 1998 to 2023. In 1998, the rate stood at approximately 194 births per 100,000, which has now decreased to around 74 per 100,000 births as of last year.
This decline is particularly among mothers aged 30 and older, a group that previously saw some of the highest increases in multiple births.
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From 1998 to 2023, the triplet and higher-order multiple birth rate dropped by approximately 62%. The rate fell from 193.5 per 100,000 total births in 1998 to 73.8 per 100,000 in 2023, with the steepest decline starting around 2009.
Between 1998 and 2009, the triplets and higher-order multiple birth rate decreased modestly by 21%, reaching 153.5 per 100,000 births in 2009. A sharper drop of 52% occurred from 2009 to 2023.
The actual number of triplet and higher-order multiple births decreased from 7,625 in 1998 to 2,653 in 2023, representing a total decline of 65%.
Most of this reduction happened after 2009, when the number dropped from 6,340 to 2,653 by 2023. The largest declines were recorded among triplet births, with quadruplet and higher-order births decreasing by an even greater percentage.
The triplets and higher-order multiple birth rate saw a decline of 71% from 1998 to 2023. The rate dropped from 262.8 per 100,000 births in 1998 to 76.1 per 100,000 in 2023.
The rate for Hispanic mothers remained relatively stable between 1998 and 2009, but then decreased by 32% from 2009 to 2023 for an overall decline of 25%.
In contrast, the triplets and higher-order multiple birth rate among Black mothers increased by 25%, rising from 87.3 per 100,000 births in 1998 to 108.9 per 100,000 in 2023.
The report shows that differences in the decline in triplets and higher-order multiple births are across racial and ethnic groups, indicating variations in access to fertility treatments and reproductive healthcare guidance.
The declines in triplets and higher-order multiple birth rates were observed in mothers aged 30 and older. Mothers aged 30–34 and 35–39 experienced declines of 77%, with rates falling from 360.4 to 82.1 per 100,000 births and 409.8 to 93.9 per 100,000, respectively.
For mothers aged 40 and older, the rate decreased by 67% from 517.6 to 168.6 per 100,000 births.
The decline was less pronounced for younger mothers, with rates for mothers under 20 experiencing no statistically change and only a 16% decline among those aged 20–24.
The most significant factor contributing to the decline in triplet and higher-order multiple births is the revised guidance for fertility treatments.
Since the 2000s, assisted reproductive technology (ART) guidelines have recommended transferring fewer embryos to minimize the risk of multiple pregnancies. This change has helped curb the rise in triplet and higher-order multiple births.
Triplets and higher-order multiple pregnancies carry greater health risks for both mothers and infants including preterm birth, low birth weight and maternal complications.
The sharp decline in these births shows a growing awareness within healthcare communities of these risks, which has led to a more cautious approach in reproductive medicine.
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As maternal age increased in previous decades, so did the use of ART, which initially contributed to the rise in triplet and higher-order births.
The triplets and higher-order multiple birth rate had reached peak in 1998, largely due to the increased use of fertility treatments beginning in the 1980s and 1990s.
Despite the declines observed from 1998 to 2023, the 2023 rate of 73.8 per 100,000 total births remains higher than the rates before the rise of ART.
ART methods including IVF, have been major contributors to the occurrence of triplet and higher-order births due to the practice of implanting multiple embryos.
Earlier, transferring multiple embryos was common to increase the likelihood of successful pregnancies. This, however, raised the probability of triplet and other multiple births.
The decline in triplets births in the US aligns with changes in guidelines recommending fewer embryo transfers to reduce health risks associated with high-order pregnancies.
Since the early 2000s, the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology have issued updated guidelines recommending a lower number of embryos to be transferred.
The goal is to tackle the risks of multiple births such as preterm birth and low birth weight, which are common in triplet pregnancies.
Improvements in embryology have allowed embryos to be cultivated longer before transfer, giving a clearer assessment of their health and viability.
Advanced embryo testing methods now help fertility specialists determine which single embryo is most likely to result in a healthy pregnancy, thus reducing the need to implant multiple embryos.
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