Effect of Maternal Age and Fertility Treatment on the Increase in Multiple Births in Japan: Vital Statistics, 1974–2009

BACKGROUND: The present study used vital-statistics data to estimate the effect of maternal age and fertility treatment on the number and rate of multiple live births in Japan from 1974 through 2009. METHODS: Japanese vital statistics published by the Ministry of Health, Labour and Welfare from 1974 to 2009 were gathered and reanalyzed with regard to maternal age class and plurality of live births. The numbers of spontaneous and iatrogenic multiple births during 1977–2009 were estimated, with the assumption that spontaneous multiple-birth rates according to maternal age class would be constant and equal to those of baseline values, ie, the means between 1974 and 1976. RESULTS: During the 25-year period, multiple-birth rates according to maternal age class increased after the late 1980s. This tendency was obvious in women aged 35 to 39 years. The estimated numbers of iatrogenic multiple births remained nearly constant in women aged 20 to 24 years and greatly increased in women aged 30 to 34 and 35 to 39 years. The rate (per 1000 live births) of iatrogenic multiple births gradually increased from 0.7 (1977) to 1.3 (1986), then rapidly and markedly increased from 1.3 (1986) to 11.4 (2005), and finally decreased to 8.1 (2009). The estimated maximum percentage of iatrogenic multiple births was 50.0%, in 2004 and 2005. CONCLUSIONS: The rapid increases in Japan in the number and rate of multiples born to women older than 30 years are likely due to iatrogenic rather than spontaneous multiple births.