First-time moms who learn they've given birth to twins or triplets following assisted reproductive therapy (ART) face a higher risk of depression, according to new research.¹

The rate of multiple births in the United States has skyrocketed in the past three decades, write Marcia Ellison, PhD, in the Reproductive Endocrine Unit at Massachusetts General Hospital in Boston and her fellow researchers. This is due mainly to the use of ART, they explained, which accounts for a 49% increase in twin birth rates and a 423% gain in the triplet birth rate during that time.

Docs: Psychological Issues Get Little Attention
But while a plethora of past research has evaluated the medical risks and economic impact of multiple births associated with ART, "relatively few studies have examined the psychosocial risks (e.g., quality of life, depression, social stigma) incurred by families whose ART treatment resulted in multiple birth children," Ellison and her team wrote.

To further explain the basis for their research, the investigators pointed to other prior studies that suggested couples initially facing infertility had more stress once they became parents of multiples using ART compared to parents of multiples spontaneously conceived. "Raising two or more children of the same developmental age at the same time puts extraordinary physical, psychological, emotional, and financial stress on a family in general and the primary care taker, in particular," Ellison explained, in an interview.

Clarifying Elusive Answers
To investigate the psychosocial challenges that women using ART have after giving birth to multiples, Ellison's team surveyed 249 mothers whose children were conceived using assisted reproduction. The mothers were recruited from both a fertility clinic in Lexington, Massachusetts and an ongoing obstetrics study at Massachusetts General Hospital. Study participants were then divided into three groups: singleton, twin, or triplet birth. Multiple birth mothers were then matched to mothers of singleton babies by children's year of birth and maternal age.

The study included 128 mothers of single babies, 111 mothers of twins, and 10 women who bore triplets.

Each mother was then mailed a survey asking them about various aspects of their quality of life. These included whether material family needs were being met, whether their families experienced social stigma due to their use of ART, and their level of marital satisfaction. The researchers also asked each mother about their levels of stress and depression.

Mothers of Multiples Were More Depressed
On reviewing the survey results, Ellison's team found that mothers who had given birth to twins or triplets faced a greater likelihood of experiencing depression, stress and other psychosocial issues. "The odds of having difficulty meeting basic material needs more than tripled, while the odds of lower quality of life and increased social stigma more than doubled" for the women who had twins or triplets compared to those who bore single infants using ART, the research group wrote. The higher the number of children at birth, the greater the likelihood that the mothers were regularly depressed, as well, the study found. Ellison and her colleagues also found that mothers with multiples reported lower marital satisfaction, but this finding was not significant, they reported.

Available Support
Based on their results, Ellison and her fellow investigators stress that a support mechanism should be established for these mothers. "They would benefit greatly if physicians routinely screen multiple birth mothers for depression, and [to determine] if counseling could help women to ensure that they solicit and receive adequate social support," Ellison told Priority Healthcare.

For instance, mothers of multiples are often prescribed bed rest, but may no support to turn to while caring for these children, except for a husband who is often at work, she pointed out. Professional counseling, by contrast, could assist these mothers in not only bonding with more than one children, but developing strategies toward facing the daily physical demands of caring for these children, Ellison said. "Something as simple as taking a shower or going to the market become problematic if you have three infants and only two arms."

Parents of twins or triplets also have support mechanisms of which they can take advantage, such as peer support groups, churches, and community organizations, Ellison and her group noted. Nonetheless, the difficulties they face regularly are still very acute, they pointed out.

"These data would help shape appropriate health and social policies to ameliorate these stressors and improve quality of life in these vulnerable families," the investigators wrote. "Understanding how these needs may escalate or decrease across time would also help treatment providers ensure their patients receive appropriate and timely care."

In the meantime, it's important for couples to consider the medical risks of giving birth to multiples, independent of fertility treatment-associated risks, Ellison stressed. But, she added, there are treatment options that can minimize the risk of multiple gestations, she said. "Patients need to be aware that, although it may be tempting to think that having more than one child at a time can help a couple meet family formation needs in one fell swoop (e.g., a couple who have faced infertility and think, twins or triplets would be great, we always wanted two or three children), there are significant untoward psychosocial and health consequences," Ellison stated.

1. Ellison MA, Hotamisligil S, Lee H, Rich-Edwards JW, Pang SC, Hall JE. Psychosocial risks associated with multiple births resulting from assisted reproduction. Fertil Steril 2005 May;83(5):1422-8.

John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.