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Twin Deliveries in the United States Over Three Decades: An Age-Period-Cohort Analysis

John C. Smulian, MD, MPH^*, Cande V. Ananth, PhD, MPH, Wendy L. Kinzler, MD^*, Eftichia Kontopoulos, MD^* and Anthony M. Vintzileos, MD^*

From the *Division of Maternal–Fetal Medicine and Section of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School/Robert Wood Johnson University Hospital, New Brunswick, New Jersey.

Address reprint requests to: John C. Smulian, MD, MPH, UMDNJ–Robert Wood Johnson Medical School, 125 Paterson Street, CAB-2140, New Brunswick, NJ 08901-1977; e-mail: smuliajc{at}umdnj.edu.

OBJECTIVE: Time is an important variable in understanding the recent increase in twin deliveries in the United States. Therefore, this study was designed to estimate the influences of maternal age, period (year) of delivery, and maternal-birth-year cohort on trends in rates of twin deliveries.

METHODS: United States natality data were used to assess trends in twin pregnancies resulting in live births. This age-period-cohort analysis included 7, 5-year maternal-age groups (15–19 through 45–49 years), 6 twin delivery periods (1975, 1980, 1985, 1990, 1995, and 2000), and 12, 5-year maternal birth cohorts (1926–1930 through 1981–1985). The independent effects of maternal age, twin delivery period, and maternal birth cohort on twin delivery rates for blacks and whites were modeled using Poisson regression techniques.

RESULTS: Our study assessed 95,042 blacks and 401,989 whites with twin deliveries. Twin deliveries increased by 46% for blacks and 62% for whites from 1975 to 2000, with the largest increase occurring in the year 2000. For blacks, maternal age had the strongest impact on the increasing twin delivery rates, followed by period of delivery. For whites, the greatest effect was due to period of delivery, followed by maternal birth year cohort and, lastly, maternal age.

CONCLUSION: Our data confirm the importance of nature's biologic contribution of maternal aging to twin delivery rates, but suggest that recent changes in the environment surrounding pregnancy (nurture) also influence twin delivery rates. The relative contributions of biologic versus environmental influences appear to differ among blacks and whites.

LEVEL OF EVIDENCE: II-2

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