Implications of twin, triplet and quadruplet pregnancies on mothers

More women giving birth in their later years has given rise to fertility treatments which has in turn led to what can be described as an explosion in twin, triplets and quadruplet pregnancies. And while studies have been conducted to determine the impact on babies, mothers have heretofore been largely ignored.

Struck by the lack of such vital information, Dr. Mark Walker, an associate scientist in the Obstetrics and Maternal Investigations Program at the OHRI (the research arm of The Ottawa Hospital and a major partner of the Faculty of Medicine at the University of Ottawa) set out to find the data on is own. His conclusions inspire some concern.

By extracting all records for obstetric deliveries in Canada (except Quebec) from 1984 to 2000 contained in the Discharge Abstract Database collected by the Canadian Institute of Health Information, Dr. Walker has determined that multi-fetal pregnancies increase the risk of adverse outcomes for mothers. The report, which was published in BJOG: an International Journal of Obstetrics and Gynaecology, notes that heart attacks are almost 4 times more common in women who have multi-fetal pregnancies, heart failure is almost 13 times more common and venous thrombolysis - a blood clot disorder - is 2 ½ more common. All told, Dr. Walker noted that multiple gestation pregnancies are associated with an increased risk of morbidity for the mother.

Such findings indicate that mothers need to be better informed to cope with the increased risk associated with twin or multiple gestation pregnancies, according to Dr. Walker, who is also an assistant professor at the University of Ottawa.

"Individuals involved in assisted reproductive techniques need to take this information into account," said Dr. Walker, who is also a practicing physician at The Ottawa Hospital and Assistant Professor at the University of Ottawa. "Patients also need to be better informed to be vigilant for complications." One obvious example, according to Dr. Walker, is pregnant women with multiple gestation pregnancies who are ordered to bed rest. Given the increased risk of venous thrombsis (a blood clot disorder), blood thinners might also be in order.

"Dr. Walker's study fills a very important gap in obstetrics and maternal medicine," said Dr. Jeremy Grimshaw, Director of the Clinical Epidemiology Program. "This kind of information, which has been lacking for so long, is extremely useful."

"By including such a strong research component into the care of our patients, The Ottawa Hospital is ensuring that innovation in healthcare finds it's way from the bench in our Research Institute to the patient's bedside in the Hospital," noted Hospital CEO, Dr. Jack Kitts. "We are grateful to Dr. Walker and the OHRI for these important revelations."

"Mark Walker's research is going to have a marked effect on the health of women, not just in Canada, but particularly anywhere that new reproductive technology increases the rate of multi-fetal pregnancies," said Dr. Peter Walker, Dean of the Faculty of Medicine at the University of Ottawa.