Published online February 1, 2005
PEDIATRICS Vol. 115 No. 2 February 2005, pp. 443-452 (doi:10.1542/peds.2004-1137)
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Does a Triplet Birth Pose a Special Risk for Infant Development? Assessing Cognitive Development in Relation to Intrauterine Growth and Mother-Infant Interaction Across the First 2 Years

Ruth Feldman, PhD* and Arthur I. Eidelman, MD{ddagger}

* Department of Psychology and the Gonda Brain Sciences Center, Bar-Ilan University, Ramat-Gan, Israel, and Child Study Center, Yale University, New Haven, Connecticut
{ddagger} Department of Neonatology, Shaare Zedek Medical Center, and Department of Pediatrics, Hebrew University School of Medicine, Jerusalem, Israel

Objective. To examine whether a triplet birth per se poses a risk to the development of infants' cognitive competencies and to the mother-infant relationship.

Methods. Twenty-three sets of triplets were matched with 23 sets of twins and 23 singleton infants (n = 138) with respect to gestational age, birth weight, and medical and demographic features. Infants with perinatal asphyxia, intraventricular hemorrhage of grade 3 or 4, periventricular leukomalacia, or central nervous system infection were excluded from the study. At 6, 12, and 24 months of age, mother-infant interaction was observed and infants' cognitive development was tested with the Bayley II test.

Results. Mothers of triplets displayed lower levels of sensitivity at 6, 12, and 24 months and infants were less socially involved at 6 and 24 months, compared with singletons and twins. Triplets scored lower than singletons and twins on the Bayley Mental Developmental Index at 6, 12, and 24 months. A weight discordance of >15% was found for 15 triplet sets (65.2%). The discordant triplets showed decreased cognitive skills at 12 and 24 months, compared with their siblings, and received the lowest scores for maternal sensitivity. Hierarchical multivariate regression analysis revealed that greater medical risk at birth, multiple-birth status, lower maternal sensitivity, and reduced infant social involvement in the first 2 years were each predictive of lower cognitive outcomes at 2 years (R2 = 0.33).

Conclusions. Triplets appear to be at higher risk for cognitive delays in the first 2 years of life, and discordant infants are at especially high risk. This delay is related in part to the difficulty of providing sensitive mothering to 3 infants at the same time. The findings may assist practitioners in guiding prenatal and postpartum parental care and management.

Key Words: triplets • twins • multiple birth • parent-infant interaction • cognitive development • Bayley II • maternal sensitivity • infant social development

Abbreviations: IUGR, intrauterine growth retardation • MDI, Mental Developmental Index • MANOVA, multivariate analysis of variance • CRIB, Clinical Risk Index for Babies • PDI, Psychomotor Developmental Index

Accepted Aug 16, 2004.


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