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Multiple birth refers to a pregnancy in which two or more fetuses are present in the uterus. The rate of multiple births has increased markedly in the last 20 years due to advancements in assisted reproductive technologies (ART). Specifically, the increased use of drugs for ovulation induction and superovulation for intrauterine insemination (IUI) and in vitro fertilization (IVF).
In addition to advancements in ART other factors that impact the rate of multiple gestation include the age of the woman, the number of prior pregnancies she has had and finally, racial background.

Multiple gestation, especially triplet and higher order pregnancy, is not the desired consequence of these technologies since it increases the risk of complications for both mother and baby. The goal of any reproductive technology is the birth of a single healthy child and the conception of twins or higher is considered a complication. In an analysis of recent Society for Assisted Reproductive Technology (SART) databases and the Center for Disease Control's (CDC) National Center for Health Statistics data, the CDC has estimated that for triplets and higher-order multiple births approximately 20% were attributable to spontaneous events (related to the age of the female partner), 40% were attributable to ovulation inducing drugs without ART, and 40% were attributable to ART.

The most important maternal complications associated with multiple gestation are pre-eclampsia, preterm labor and delivery, and gestational diabetes as well as the potential risks involved with prolonged bedrest (venous thromboembolism) and cesarean delivery. Prematurity, and the complications associated with it (including increased infant mortality and increased incidence of cerebral palsy), is the greatest risk for the child.

Finally, along with the increased risk of maternal and fetal complications there is a significant associated financial impact from maternal hospitalization and neonatal intensive care to consider, as well as long term care if the babies are extremely premature. The reported hospital charges from a Boston hospital in 1991 were estimated to be $9,845 for a singleton, compared to $37,947 for twins and $109,765 for triplets.

References:
Callahan TL, Hall JE, Ettner SL, Christiansen CL, Greene MF, Crowley Jr WF. The economic impact of multiple gestation pregnancies and the contribution of assisted reproduction techniques to their incidence. N Engl J Med. 1994;331:244-249.

Multiple pregnancy associated with infertility therapy. The Practice Committee of the American Society for Reproductive Medicine. 2004 82: Supplement 1 (S153-157).

National Center for Health Statistics, CDC. Contribution of assisted reproductive technology and ovulation-inducing drugs to triplet and higher-order multiple births-United States, 1980–1997. MMWR Morb Mortal Wkly Rep 2000;49:535–8.