Psychosocial impact

The psychosocial impact of the birth of multiples affects many areas of life: emotional, practical and financial. Some evidence suggests that parents of in vitro fertilisation (IVF) multiples experience greater difficulties in parenting and more problems with child behaviour than parents of naturally conceived children. One possible explanation raised in the literature is that people's often lengthy and difficult experience of infertility and its treatment impacts on their experience of raising children.

• Research in the UK suggested that mothers and families with twins sometimes experience severe parenting stress, increased maternal depression, a reduced ability to work outside the home and an increased rate of divorce.
• A study in the US of the available data on psychosocial outcomes for mothers of twins, particularly after fertility treatment, found that around 10% of mothers of twins experience depression, and that marital adjustment declined, particularly for first-time parents of twins.
• A Danish cohort study analysing health and social outcomes for all IVF children born in 1997 found that twins were a predictor of increased marital stress. First time mothers of low birthw eight twins also reported that the birth of their children had a particularly high impact on their personal and social life.
• Studies in the UK and Belgium found that mothers of IVF twins experienced significantly higher levels of stress than parents of naturally conceived twins. Significant differences were also found for fathers.
• A recent larger study in France, comparing parents of IVF twins and singletons, also found that there were no significant differences in behaviour between the children (apart from cognitive development where twins showed significantly lower levels of development) but that parents of twins reported greater difficulties in parenting and more problems with child behaviour.
• Parents of IVF twins will often be first time parents and will have a history of infertility, both factors that have been identified by a Belgian study as adding to parenting stress and having an adverse effect on psychosocial wellbeing.
• Research has shown that mothers of low birth weight infants who experienced potential loss and prolonged separation feel lower levels of attachment to their babies than mothers of full-term, healthy infants.
• The risks of adverse psychosocial outcomes increase with each additional multiple birth child. A recent US study comparing mothers of IVF conceived singletons, twins and triplets found that for each additional multiple birth child, the odds of having difficulty in meeting basic material needs more than tripled, and the odds of lower quality of life and increased social stigma more than doubled. Each additional multiple birth child was also associated with increased risk of maternal depression.