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Béatrice Blondel, PhD, Michael D. Kogan, PhD, Greg R. Alexander, MPH, ScD, Nirupa Dattani, MS, MPhil, Michael S. Kramer, MD, Alison Macfarlane, CStat and Shi Wu Wen, PhD

Béatrice Blonde is with the Epidemiological Research Unit on Perinatal Health and Women’s Health, National Institute for Health and Medical Research, Villejuif, France. Michael D. Kogan is with the Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Md. Greg R. Alexander is with the Department of Maternal and Child Health, University of Alabama at Birmingham. Nirupa Dattani is with the Office for National Statistics, London, England. Michael S. Kramer is with the Department of Pediatrics and the Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec. Alison Macfarlane is with the National Perinatal Epidemiology Unit, Oxford, England. Shi Wu Wen is with the Bureau of Reproductive and Child Health, Centre for Healthy Human Development, Md. Greg R. Alexander is with the Department of Maternal and Child Health, University of Alabama at Birmingham. Nirupa Dattani is with the Office for National Statistics, London, England. Michael S. Kramer is with the Department of Pediatrics and the Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec. Alison Macfarlane is with the National Perinatal Epidemiology Unit, Oxford, England. Shi Wu Wen is with the Bureau of Reproductive and Child Health, Centre for Healthy Human Development, Ottawa, Ontario.

Correspondence: Requests for reprints should be sent to Béatrice Blondel, PhD, INSERM U149, 16 avenue Paul Vaillant-Couturier, 94807 Villejuif cedex, France (blondel{at}vjf.inserm.Fr).

Objectives. We studied the effects of twins and triplets on perinatal health indicators in the overall population in the 1980s and 1990s in Canada, England and Wales, France, and the United States.

Methods. Data were derived mostly from live birth registration. We used rates, relative risks, and population attributable risks for twins and triplets separately.

Results. In each country, the increase in multiple births, and the increase in preterm delivery among multiple births, contributed almost equally to the rise in or stabilization of the overall rates of preterm delivery. Twins contributed a much larger proportion of the preterm deliveries and low-birthweight newborns than did triplets.

Conclusions. Twins have a major population-based impact on the trends of perinatal health indicators. (Am J Public Health. 2002;92:1323–1330)

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