Multiple birth pregnancies are a major public health concern in not only the United States, but the rest of the world as well, due to the significantly higher health risks for mothers and infants, in addition to the impact on healthcare costs. Investigators analyzed and compared the cost of multiple versus single-birth pregnancies and discovered that pregnancies resulting in the delivery of twins cost around five times more than singleton deliveries. Pregnancies resulting in the delivery of triplets or more cost almost 20 times as much.

Multiple birth pregnancies are increasing worldwide as increased use of reproductive technologies like ovulation induction and in vitro fertilization (IVF) occur. According to the Centers for Disease Control and Prevention (CDC), 3 percent of all infants born in the United States in 2010 were part of multiple birth deliveries. The rate of twins was 33 per 1,000 births, and the rate of triplets or more was 1.4 per 1,000 births. Experts generally agree that while about 40 percent of twin births result from assisted reproductive technologies, this increases to around 80 percent for triplet or more births.

This recent study documents and compares costs associated with multiple pregnancies versus singleton pregnancies in the United States and used the Truven Health MarketScan Commercial Claims and Encounters Database. The study population included all women between the ages of 19 and 45 who delivered at least one live born infant between January 2005 and September 2010. Investigators identified 437,924 different eligible delivery events during the investigated study period. Of these, about 97 percent (424,880) were singletons, 2.85 percent (12,482) were twins, and 0.13 percent (562) were triplets or more.

For mothers, the cost included medical expenses during the 27 weeks before and 30 days after delivery. For infants, costs contained all medical expenses up to their first birthday. This is the first study that took into account a comprehensive assessment of the incremental cost associated with multiple pregnancies by estimating all-cause medical expenses over the studied time frame.

“By taking a broad approach, we have shown that medical expenses attributable to mothers and infants varied according to birth multiplicity,” comments lead investigator Dongmu Zhang, PhD, Global Health Outcomes, Merck & Co. “For singleton pregnancy, maternal expenses accounted for about 60 percent of overall cost. whereas for twins or higher-order multiple births, expenses for infant care accounted for about 70 percent and 85 percent of total expenses, respectively.”

The adjusted total all-cause healthcare cost was about $21,000 per singleton delivery, $105,000 for twins, and over $400,000 for triplets or more.

“On average, combined all-cause healthcare expenses for mothers with twins or higher-order multiple births were about five and 20 times more expensive, respectively, than singleton delivery. The greater expenses were likely to have been due to increased maternal morbidities, significantly increased use of cesarean section and longer hospital stay for the deliveries in women with multiple pregnancies, and increased admission and longer stay in NICU for neonates of multiple gestations. We also demonstrated increased mortality for both mothers and infants associated with multiple pregnancies, although the absolute rates were small,” Dr. Zhang added.

These findings are published in the American Journal of Obstetrics & Gynecology.