How Many Is Too Many?

Not everyone is so lucky.

Marie Duncan of Dover, N.H., carried her triplets to 36 weeks before her blood pressure suddenly shot up and doctors performed an emergency cesarean. On May 14 they delivered Colby (5 pounds, 15 ounces), Hope (5 pounds, 3 ounces) and Liette (4 pounds, 3 ounces). Three days later, on a Monday, Marie went home. The babies remained in the hospital because all were receiving oxygen, and Colby was on a feeding tube.

The next Saturday, Marie and her husband, Bob, both 36, brought the two girls home. (Colby wasn't off the feeding tube yet.) Everything seemed fine. But that night, Marie awoke just after midnight, unable to breathe. She was rushed to the hospital with blood pressure of 230/140.

The problem: heart failure, brought on by peripartum cardiomyopathy, a rare disorder in which the heart muscle becomes weakened and can't pump blood efficiently. Multiple pregnancy is a risk factor for the life-threatening disorder, which can occur any time between the last month of pregnancy and five months after delivery.

Moms aren't the only ones at risk in multiple pregnancies. Most multiples are born weighing less than 5½ pounds, putting them at increased risk for health complications as newborns and for longer-term disabilities such as mental retardation, cerebral palsy and vision and hearing loss, according to the March of Dimes.

High-tech Multiples

Multiple births have risen dramatically in the United States over the past two decades.

In 2002, 31.1 out of every 1,000 deliveries yielded twins, up from 18.9 in 1980 -- a rise of 65 percent. The number of "higher-order multiples" -- meaning triplets or more -- jumped five-fold over the same period, from 37 per 100,000 to 193.5 per 100,000, according to the CDC.

Two trends explain the surge in multiple births:

• an increasing number both of women in their thirties giving birth (women in their thirties who become pregnant without fertility treatments are more likely than younger women to have multiple births); and

• advances in and greater access to fertility treatments, including in vitro fertilization (IVF), intrauterine insemination and ovulation-inducing drugs.