ABSTRACT
The importance of this putative association is accentuated by major and recent changes in the epidemiology of multiple gestations. First, the numbers of multiple gestations have reached epidemic dimensions in most developed countries2,4, and second, more multiple pregnancies result from infertility treatment. As one example, recent data from the East Flanders Prospective Twin Survey suggest dramatic changes in the ratio of induced/spontaneous twins, from 1 : 46 in the 1970s to 1 : 2 in the late 1990s3. Because women who require infertility treatment are more likely to be older, the current, almost universal, trend of aging of the maternal cohort has special implications for triplet mothers (see Chapter 93)3. Despite significant recent changes in the typical mother of multiples, namely increased age and decreased rate of spontaneous conceptions, for which there is much documentation, scant information exists about the potential association between GDM and the epidemic of iatrogenic multiple pregnancies.
