Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Trends of Multiple Births in Iran from 2014 to 2023

Authors
Milad Ahmadi Gohari 1
Maryam Chegeni 2
Firoozeh Mirzaee 3
Yunes Jahani 4
1 Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
2 Molecular and Medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran
3 Reproductive and Family Health Research Center, Kerman University of Medical Sciences, Kerman, Iran
4 Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
10.18502/jri.v26i3.20184
Abstract
Background: The aim of this study was to analyze the trends of multiple births at both national and provincial levels in Iran from 2014 to 2023. Methods: Data on the number of live births and multiple births from 2014 to 2023 at national and provincial levels were obtained from the Iran’s Bureau of Vital Statistics. The multiple birth rate (MBR), defined as the number of live births from multiple births per 1,000 live births, was calculated annually. To examine temporal trends and detect significant changes in MBR over the study period, joinpoint regression analysis was performed. Annual percent change (APC) and average annual percent change (AAPC) were calculated for the entire period. Result: The national AAPC in the MBR was estimated at 2.38% (95%CI: 1.95 to 2.76) over the entire study period. A significant shift in trend was identified in 2020. Specifically, the APC from 2014 to 2020 was 0.24%. However, from 2020 to 2023, the APC markedly increased to 6.8%, reflecting a substantial rise in MBR during this latter period. Furthermore, the study findings demonstrated that nearly all provinces across the country have exhibited an upward trend in MBR in recent years. Conclusion: The increasing trend of multiple births in Iran aligns with global patterns. Several factors may have contributed to this rise, including increased maternal age at childbirth, higher prevalence of infertility, expanded use of assisted reproductive technologies (ARTs), and shifts in population policies.
Keywords
Iran
joinpoint regression
Multiple birth
  1. Choi SH, Park YS, Shim KS, Choi YS, Chang JY, Hahn WH, et al. Recent trends in the incidence of multiple births and its consequences on perinatal problems in Korea. J Korean Med Sci. 2010;25(8):1191-6.
  2. Vlachadis N, Vrachnis D, Loukas N, Fotiou A, Maroudias G, Antonakopoulos N, et al. Temporal trends in multiple births in Greece: the evolution of an epidemic. Cureus. 2023;15(2):w35414.
  3. Wenstrom KD, Gall SA. Incidence, morbidity and mortality, and diagnosis of twin gestations. Clin Perinatol. 1988;15(1):1-11.
  4. Loos RJF, Derom C, Derom R, Vlietinck R. Determinants of birthweight and intrauterine growth in liveborn twins. paediatr Perinat Epidemiol. 2005;19 Suppl 1:15-22.
  5. Kim NO, Choi SJ, Han KH, Hyung HS, Shin SR. Birth weight distribution of twins according to gestational age. Korean J Obstet Gynecol. 2004;47:1860-4.
  6. Lee KH, Hwang SJ, Kim SH, Lee SH, Yu DK, Hwang JH, et al. Comparison of mortality and morbidity in multiple versus singleton very low birth weight infants in a neonatal intensive care unit. J Korean Med Sci. 2003;18(6):779-82.
  7. Chambers GM, Ledger W. The economic implications of multiple pregnancy following ART. Semin Fetal Neonatal Med. 2014;19(4):254-61.
  8. El-Toukhy T, Bhattacharya S, Akande V. Multiple pregnancies following assisted conception: scientific impact paper no. 22. BJOG. 2018;125(5):e12-8.
  9. Collins J. Global epidemiology of multiple birth. Reprod Biomed Online. 2007;15 Suppl 3:45-52.
  10. Vlachadis N, Vrachnis DN, Loukas N, Antonakopoulos N, Peitsidis P, Mamalis M, et al. The strong correlation between multiple births and preterm birth rates in Greece from 1991 to 2022. Cureus. 2024;16(9):e68983.
  11. Balooch Hasankhani M, Mirzaei H, Karamoozian A. Global trend analysis of diabetes mellitus incidence, mortality, and mortality-to-incidence ratio from 1990 to 2019. Sci Rep. 2023;13(1):21908.
  12. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: Final Data for 2018. Natl Vital Stat Rep. 2019;68(13):1-47.
  13. Kulkarni AD, Jamieson DJ, Jones Jr HW, Kissin DM, Gallo MF, Macaluso M, et al. Fertility treatments and multiple births in the United States. N Engl J Med. 2013;369(23):2218-25.
  14. Martin JA, Hamilton BE, Osterman MJ. Three decades of twin births in the United States, 1980-2009. NCHS Data Brief. 2012;80:1-8.
  15. Hayes E. ACOG practice bulletin No. 144: multifetal gestations: twin, triplet and higher order multifetal pregnancies. Obstet Gynecol. 2014;123(5):1118-32.
  16. Wang L, Dongarwar D, Salihu HM. Temporal trends in the rates of singletons, twins and higher-order multiple births over five decades across racial groups in the United States. Int J MCH AIDS. 2020;9(3):257-9.
  17. Tang W, Zou L. Trends and characteristics of multiple births in Baoan Shenzhen: a retrospective study over a decade. Front Public Health. 2022;10:1025867.
  18. Gebremedhin S. Multiple births in sub-Saharan Africa: epidemiology, postnatal survival, and growth pattern. Twin Res Hum Genet. 2015;18(1):100-7.
  19. Bortolus R, Parazzini F, Chatenoud L, Benzi G, Bianchi MM, Marini A. The epidemiology of multiple births. Hum Reprod Update. 1999;5(2):179-87.
  20. Kulkarni AD, Kissin DM, Adashi EY. Fertility treatments and multiple births in the United States. N Engl J Med. 2014;370(11):1070-1.
  21. Blondel B, Kaminski M. Trends in the occurrence, determinants, and consequences of multiple births. Semin Perinatol. 2002;26(4):239-49.
  22. Tandberg A, Bjørge T, Børdahl PE, Skjaerven R. Increasing twinning rates in Norway, 1967–2004: the influence of maternal age and assisted reproductive technology (ART). Acta Obstet Gynecol Scand. 2007;86(7):833-9.
  23. Cox CM, Thoma ME, Tchangalova N, Mburu G, Bornstein MJ, Johnson CL, et al. Infertility prevalence and the methods of estimation from 1990 to 2021: a systematic review and meta-analysis. Hum Reprod Open. 2022;2022(4):hoac051.
  24. Okhovati M, Zare M, Zare F, Bazrafshan MS, Bazrafshan A. Trends in global assisted reproductive technologies research: a scientometrics study. Electron Physician. 2015;7(8):1597-601.
  25. Reneker JC, Zhang Y, Young DK, Liu X, Lutz E. Use of telehealth services for prenatal care in Mississippi: comparison of pre‐COVID‐19 pandemic and pandemic obstetric management. Int J Clin Pract. 2022;2022:3535700.
  26. AlQurashi MA. Survival rate of very low birth weight infants over a quarter century (1994–2019): a single-institution experience. J Neonatal Perinatal Med. 2021;14(2):253-60.
  27. Cuestas E, Gómez-Flores ME, Charras MD, Peyrano AJ, Montenegro C, Sosa-Boye I, et al. Socioe-conomic inequalities in low birth weight risk before and during the COVID-19 pandemic in Argentina: a cross-sectional study. Lancet Reg Health Am. 2021;2:100049.
Journal of Reproduction & Infertility
Volume 26, Issue 3
Summer 2025
Pages 186-192