Multiple births always attract attention and there is generally a great deal of fascination about the concept of more than one baby being born at the same time. But for parents of quadruplets, their initial responses can be far from what can be called exuberance, at least in the early stages. The practicalities of raising four babies to adulthood can seem utterly overwhelming, which is why experienced parents of higher order multiples (HOM) say it can help to just take things slowly at first and to allow the news to settle in, one steady day at a time.
- One fertilised egg splits into four identical embryos.
- One fertilised egg splits into three identical embryos and another separate egg is fertilised by a separate sperm. This means there are identical triplets plus one.
- One set of Identical (monozygotic) twins occurs plus another two entirely separate embryos or another set of identical twins.
- Another possibility is that a set of non identical/fraternal twins are conceived plus a monozygotic pair form making a total of four embryos.
Tell us again how lucky we are
Are quads as common as they used to be?
There is an increased likelihood of quadruplets when:
- A mother has a family history of multiple births. If she is a multiple herself or her mother and/or sisters naturally conceived multiple babies, then she is more likely to as well. This is because there is a genetic link of hyper ovulation amongst the women in some families.
- Couples have had fertility assistance. Medication which increases the number of eggs supported towards maturity will increase the chances of multiple conception.
- Women whose diet is high in dairy foods and yams/sweet potato.
- Women are of African, especially Nigerian, descent.
- Women are already breastfeeding an older baby or toddler; they are more likely to conceive with multiples. But lactation and frequent breastfeeding can also have a contraceptive effect by stopping ovulation so this is a very individual process.
- Couples have regular sex during the woman’s fertile phases. This increases the overall chances of conception occurring.
- A woman conceives in her first cycle after ceasing the contraceptive pill. This is a time when her body is going through a readjustment phase of ovulation and menstruation and it can take a few months for her body to align back to a and normal reproductive cycle.
- Women are taller and have a higher Body Mass Index (BMI). Though this can also have a reverse effect, as women who are overweight can also have problems with regular ovulation.
- Women are older when they conceive rather than in a younger age group. Research has shown that women who are over 35 years are more likely to conceive with multiples. This tendency is thought to be due to what is known as a “fertility spike”, which occurs in women just before they enter peri-menopause. From a biological perspective, this is probably due to the naturally occurring phenomenon of nature maximising the number of babies which can be born whilst women are still fertile.
- A woman has had many previous pregnancies. The more babies she has had and the more times she has ovulated the more likely she is to naturally conceive with multiples. This includes quadruplets.
Risks of quadruplet pregnancy
- Miscarrying one or all of the quadruplets. Genetic abnormalities account for a large percentage of early stage miscarriage. Even in a singleton pregnancy, the chances of miscarriage are 10-25% and these odds are increased for multiples.
- Increased risks of pregnancy complications overall including gestational diabetes, hypertension, placenta praevia, ante and post partum haemorrhage and anaemia.
- Uterine rupture and placental abruption.
- Need for caesarian section delivery. A normal vaginal delivery is not advisable for the birth of quadruplets as it is too stressful and risky for both the mother and her babies.
- Access to tertiary level neonatal services is essential. Women who are pregnant with quadruplets and who live in rural or regional areas are usually advised to relocate in their second or third trimester (at the latest) so they are close to the major city maternity hospital where their quads will be born.
- Restrictions around lifestyle, work, household and care of older children if there are any. The usual recommendations around working during pregnancy and taking maternity leave are usually different in the case of multiple pregnancy.
- Greater likelihood of having post natal depression and psychological adjustment disorders after the babies are born. Additional stress on the parent’s relationship is inevitable and the need for practical, financial and emotional support is great.
- Premature birth is always a risk factor in multiple births.
- Intra-uterine growth retardation and low birth weight. The average weight for a preterm individual quadruplet is around 1.3kgs but many weigh less than this and do not exceed 1kg when they are born.
- Cerebral palsy and jaundice. May need blood transfusions if there has been incompatibility issues or in cases of anaemia and extreme jaundice.
- Breathing difficulties, problems maintaining their temperature and blood sugar levels.
- A generalised higher risk of physiological problems including hernia.
- Greater risk of developmental problems and global delays, including gross and fine motor skills, speech and language development, social and emotional development and visual acuity.
For more support:
- 138,660 twins were born in 2008
- The twin birth rate in 2008 was 32.6 per 1,000 births.
- 138,961 twins were born in 2007
- The twin birth rate in 2007 was 32.2 per 1,000 births.
- 137,085 twins were born in 2006
- The twin birth rate in 2006 was 32.2 per 1,000 births.
Higher Order Multiples
- 5,877 triplets
- 345 quadruplets
- 46 quintuplets or higher
- 5,967 triplets
- 369 quadruplets
- 91 quintuplets
- 0 sextuplets or septuplets
Twinning Rates by Race
- Non-Hispanic White: 36.6 per 1,000
- Non-Hispanic Black: 36.8 per 1,000
- Hispanic: 22.3 per 1,000
- Non-Hispanic White (198.1 per 100,000)
- Non-Hispanic Black 91.3 per 100,000
- Hispanic 80.1 per 100,000
Impact of Fertility Treatments
- 17 percent of twins are the result of fertility treatments.
- 40 percent of triplets are the result of fertility treatments.
Maternal Age Factors
- 22 percent of births to women over age 45 were twins.
- Only 2 percent of teen mothers had twins.
Preterm Birth Rates
- Less than 40% of twins were born at 37 weeks or later.
- More than 12% were born prior to 32 weeks gestation.
- 36.33% of triplets were born prior to 32 weeks.
- About 80% of quads and higher were born befoer 32 weeks.
Highest and Lowest Multiple Birth Rates By State
|U.S. Multiple Birth Rates 1995 - 2006|
|Year||Twins||Triplets||Quadruplets||Quintuplets or More||Twin Birth Rateper 1,000 total births||Triplet Birth Rate(per 100,000 total births)||Quadruplet and Higher Birth Rate(per 100,000 total births)|