Incidence and short outcome in multiple pregnancies: a single center cross-sectional study in Iran 2016–2017

  • Behnaz Basiri Department of Pediatrics, Hamadan University of Medical Sciences and Health Services, Hamadan
  • Mohammad Kazem Sabzehei Department of Pediatrics, Hamadan University of Medical Sciences and Health Services, Hamadan
  • Maryam Shokouhi Department of Pediatrics, Hamadan University of Medical Sciences and Health Services, Hamadan
  • Mohammad Mahdi Sabahi Student Research Committee, Faculty of Medicine, Hamadan University of Medical Sciences and Health Services, Hamadan
Keywords: incidence, multiple pregnancy, pregnancy outcome


BACKGROUND The incidence of multiple pregnancies in industrialized countries due to the use of assisted reproductive techniques has increased over the past two decades. Multiple births are more dangerous than single pregnancies for mother and baby. This study evaluated the frequency of multiple pregnancies and its neonatal complications.

METHODS In this cross-sectional study, we assessed all multiple neonates hospitalized in Fatemieh Hospital of Hamadan, Iran from September 2016 to September 2017 in terms of gender, gestational age, birth weight, the use of assisted reproductive techniques, delivery method, cause of hospitalization, therapeutic intervention, and hospitalization outcome.

RESULTS Of 10,581 deliveries during the study period, 351 (3.3%) was multiple pregnancies and 232 neonates hospitalized. The incidence of twin, triplet, and quadruplet birth were 1.7%, 0.39%, and 0.11% respectively. In this study, 178 twin and 54 triplet and quadruplet birth were compared. The mean gestational age and mean birth weight of triplet and quadruplet were lower than that of twin births (p<0.001). A significant difference was found on the frequency of assisted reproductive techniques (p<0.001). Female sex (p=0.007), lower mean gestational age (p=0.009), lower mean birth weight (p=0.017) and need to mechanical ventilation (p<0.001) were significantly associated with early neonatal death in multiple pregnancies.

CONCLUSIONS The incidence of multiple births was high in the Hamadan province, which was often followed by infertility treatment. Moreover, multiple births cause prematurity, low birth weight, respiratory distress syndrome, and increased neonatal mortality rate.


Blondel B, Kaminski M. Trends in the occurrence, determinants, and consequences of multiple births. Semin Perinatol. 2002;26(2):239–49.

Garth E Fletcher, MD; Chief Editor: Ted Rosenkrantz, MD. Multiple birth, Medscape. Up-to-dated: Jan 13, 2015

Wei J, Wu QJ, Zhang TN, Shen ZQ, Liu H, Zheng DM, et al. Complications in multiple gestation pregnancy: a cross-sectional study of ten maternal-fetal medicine centers in China. Oncotarget. 2016;7(21):30797–803.

Collins J. Global epidemiology of multiple birth. Reprod Biomed Online 2007;15 (Suppl 3):45–52.

Pison G, D'Addato AV. Frequency of twin births in developed countries. Twin Res Hum Genet 2006;9(2):250–9.

Faraji R, Asgharnia M, Zahiri Z, Dalil Heirati SF. Assessment of the frequency of twin pregnancies and its associated complications in Rasht's Alzahra Hospital during 1997–2002. Iran Surg J. 2012:19(4);15–22.

Chowdhury S, Hussain MA. Maternal complications in twin pregnancies. Mymensingh Med J. 2011;20(1):83–7.

Qazi G. Obstetric and perinatal outcome of multiple pregnancy. J Coll Physicians Surg Pak. 2011;21(3):142–5.

Choi SH, Park YS, Shim KS, Choi YS, Chang JY, Hahn WH, et al. Recent trends in the incidence of multiple births and its consequences on perinatal problems in Korea. J Korean Med Sci. 2010;25(8):1191–6.

Riazi H, Sadri Gh, Saeedi Jam M. The study of prevalence of low birth weight newborns in Hamadan's Maternity Hospital during the first 9 month of 1974. J Hayat. 2000;6(1): 52–9.

Rezavand N, Veisi F, Malek-khosravi Sh, Zangeneh M, Kohzadi M. Assessment of frequency of twin pregnancy and neonatal outcome in deliveries of Mo'tazedi Hospital, Kermanshah in 2004–2007. J Obstet Gynaecol India. 2014;64(1):19–22.

Bodeau-Livinec F, Zeitlin J, Blondel B, Arnaud C, Fresson J, Burguet A, et al. Do very preterm twins and singletons differ in their neurodevelopment at 5 years of age? Arch Dis Child Fetal Neonatal Ed. 2013;98(6):F480–7.

Mohangoo AD, Buitendijk SE, Szamotulska K, Chalmers J, Irgens LM, Bolumar F, et al. Gestational age patterns of fetal and neonatal mortality in Europe: results from the Euro-Peristat project. PLoS One. 2011;6(11):e24727.

Su RN, Zhu WW, Wei YM, Wang C, Feng H, Lin L, et al. Maternal and neonatal outcomes in multiple pregnancy: a multicenter study in the Beijing population. Chronic Dis Transl Med. 2015;1(4):197–202.

Blondel B, Macfarlane A, Gissler M, Breart G, Zeitlin J, PERISTAT Study Group. Preterm birth and multiple pregnancy in European countries participating in the PERISTAT project. BJOG. 2006;113(5):528–35.

American College of Obstetricians and Gynecologists (College), Society for Maternal-Fetal Medicine, Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014;210(3):179–93.

Mesa EG, Peral JA. Incidence and costs of multifetal pregnancies in Andalusia (2000–2010). Twin Res Hum Genet. 2011;14(5):484– 9.

Tandberg A, Bjørge T, Børdahl PE, Skjaerven R. Increasing twinning rates in Norway, 1967-2004: the influence of maternal age and assisted reproductive technology (ART). Acta Obstet Gynecol Scand. 2007;86(7):833–9.

Russell RB, Petrini JR, Damus K, Mattison DR, Schwarz RH. The changing epidemiology of multiple births in the United States. Obstet Gynecol. 2003;101(1):129–35.

Scholten I, Chambers GM, van Loendersloot L, van der Veen F, Repping S, Gianotten J, et al. Impact of assisted reproductive technology on the incidence of multiple-gestation infants: a population perspective. Fertil steril. 2015;103(1):179–83.

Practice Committee of American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: an American society for reproductive medicine practice committee opinion. Fertil Steril. 2012;97(4):825–34.

Wright VC, Chang J, Jeng G, Macaluso M, Centers for Disease Control and Prevention (CDC). Assisted reproductive technology surveillance—United States, 2005. MMWR Surveill Summ. 2008;57(3):1–23.

Martin JA, Hamilton BE, Osterman MJ. Three decades of twin births in the United States, 1980-2009. NCHS Data Brief. 2012;(80):1–8.

Martin JA, Hamilton BE, Ventura SJ, Osterman MJ, Mathews TJ. Births: final data for 2011. Natl Vital Stat Rep. 2013;62(1):1–69,72.

Kulkarni AD, Jamieson DJ, Jones Jr HW, Kissin DM, Gallo MF, Macaluso M, et al. Fertility treatments and multiple births in the United States. N Engl J Med. 2013;369(23):2218–25.

Sabzehei MK, Basiri B, Shokouhi M, Eghbalian F. Perinatal outcome in multiple versus single pregnancies of neonates born in Fatemieh Hospital of Hamadan, Iran. Int J Pediatr. 2017;5(8):5493–500.

Kavehmanesh Z, Amirsalari S, Torkaman M, Matinzadeh ZK, Haghiri M, Javadipour M. Frequency of multiple pregnancy and its complications in three educational hospitals, Tehran. Iran J Pediatr. 2006;17(Suppl 2):261–7.

Mosayebi Z, Movahedian AH, Mir Talaei B. The prevalence of Multiple pregnancy and complications leading to hospitalization in infants born Shahidbeheshti and Shabihkhani Hospital 2000-2001 years, Kashan, Iran. Feyz, J Kashan U Med Sci. 2003;26:77– 84.

Mohangoo AD, Blondel B, Gissler M, Velebil P, Macfarlane A, Zeitlin J, et al. International comparisons of fetal and neonatal mortality rates in high-income countries: should exclusion thresholds be based on birth weight or gestational age? PLoS One. 2013;8(5):e64869.

Chaudhary S, Singh RR, Shah GS, Agrawal J, Kafle S, Shah L. Outcome of twin deliveries at a Tertiary Care Centre of Eastern Nepal. J Nepal Health Res Counc 2016;14(33):128–31.

How to Cite
Basiri B, Sabzehei MK, Shokouhi M, Sabahi MM. Incidence and short outcome in multiple pregnancies: a single center cross-sectional study in Iran 2016–2017. Med J Indones [Internet]. 2019May8 [cited 2024Feb.28];28(1):28-4. Available from:
Clinical Research