What to Know About Quadruplets: Origins and Experience

One of my fall 2022 students informed me that she is a quadruplet—the only female in the set of four. She is a healthy and attractive young woman, despite her high-risk birth. However, two of her three brothers are legally blind, and they all suffer from various physical effects associated with their premature birth and very low birth weight, including cerebral palsy (CP). Research shows that male infants born before the thirtieth week of pregnancy have faster declines in mortality, and higher rates of respiratory distress syndrome and chronic lung disease than female babies (Boghossian, Geraci, Edwards, & Horbar, 2018).

I invited the student to speak with me further about her multiple birth situation. We talked about her birth history, growing up years, and present circumstances. Excerpts from this interview and my interview with the quadruplets’ mother are included in a scientific paper to be published in the journal Twin Research and Human Genetics. My conversations with mother and daughter inspired me to look more closely at the literature on higher-order multiple births.

Quadruplet Births

Higher-order multiple births come about mostly from in vitro fertilization (IVF) and ovarian stimulation, which are both assisted reproductive methods used to overcome infertility. There are downsides to these pregnancies: A recent study found that mothers face high risks of gestational complications, such as cervical incompetence, fetal growth retardation, and premature birth (Kalashnikov & Kudratova, 2021).

Some developmental outcomes are less favorable for quadruplets than triplets and less favorable for triplets than twins (Sellier, Goldsmith, McIntyre, et al., 2021). A multinational study reported that the birth prevalence of cerebral palsy was greatest for quadruplets, followed by triplets, and relatively less for twins. The prevalence of cerebral palsy among twins, but not triplets or quadruplets, decreased over time.

Support for Multiple-Birth Mothers

The need for targeted support for mothers of twins and higher-order multiples has been emphasized (Wenze, Miers, & Battle (2020). Twenty-eight women carrying twins, triplets, or quadruplets were identified online and asked to complete self-report measures and participate in telephone focus groups aimed at learning their treatment preferences. Unfavorable responses, such as anxiety, depression, and insomnia, were reported. Interest in online support was indicated, sometimes by women who had been receiving such services. The researchers proposed employing healthcare professionals familiar with multiple births and offering delivery care at home.

Despite the foregoing, many women enthusiastically embrace multiple pregnancies, so it may be that women taking part in surveys are unrepresentative of the larger population of multiple-birth mothers. Given that current assisted conceptions are more successful with single-embryo implantation, it is likely that the frequency of higher-order multiples will continue to show the recently-reported declines (Centers for Disease Control (Osterman, Hamilton, Martin, et al., 2022). As a parting word, the mother of the quadruplets said that with the challenges one faces raising special needs quadruplets, it is so important to carve out time for yourself. However, she also recognized the rewards, namely having a closely-knit family.