Abstract
Multiple pregnancy rates in the Maltese Islands have increased significantly in the last forty years from 1.04% during the period 1960–1969 to 1.30% during 1990–1999. This increase has in part been influenced by changes which have occurred in maternal age distribution which alone would have increased the twin pregnancy rate to only 1.07%. The difference must be attributable to other factors, the most likely being the increasing use of pharmacological and technological reproductive aids. The occurrence of a multiple pregnancy remains fraught with adverse outcomes and in spite of the advances in obstetric antenatal surveillance and easier recourse to early delivery, the stillbirth rates in multiple maternities has remained markedly elevated contrasting with the fall in the singleton stillbirth rate. The early neonatal mortality also remains markedly greater than that registered for singleton births, but has shown a proportional decrease.