Demographic analysis of the variation in the rates of multiple maternities in Sweden since 1751.

To elucidate the causes and mechanisms of twinning and higher multifetal maternities, we have taken advantage of the statistical sources of Sweden, where continuous statistics for the whole population are the oldest available. We found strong secular and regional fluctuations. The rates of multiple maternities were the highest during the last three decades of the 18th century, when the twinning rate was more than 17 per 1,000, the triplet rate was more than 3 per 10,000, and the quadruplet rate was almost 7 per 1 million maternities. During 1849-1873 the twinning rate in Sweden was 14.2 per 1,000, but this rate showed great regional differences, being 18.0 per 1,000 on the island of Gotland and 12.6 per 1,000 in the county of Alvsborg. During this period the twinning rate in the countryside in the county of Stockholm was 20.4, but in the city of Stockholm it was only 14.1 per 1,000. In Sweden after the 1930s there was a marked decrease in the twinning rate, which by the 1960s had fallen to only about half of what it had been two centuries earlier. The corresponding reductions for triplet and quadruplet rates were about 75%. The aim of this paper was to study the temporal and regional variations in multiple maternities in Sweden from 1751 to 1960 based on demographic and some socioeconomic data for the counties. We confirmed our earlier studies that maternal age and parity cannot satisfactorily explain the secular and regional differences in the twinning rates. In contrast to studies in France (1901-1968), we found no unequivocal association between the twinning rates and the crude birth rates. The correlation coefficients between the twinning rate and the crude birth rate showed statistically significant regional and temporal variations. After eliminating the temporal trends, regional differences in the correlation coefficients remained. The twinning rates for the counties seem to converge toward a common low level, 10-12 per 1,000. The observed convergence toward relatively similar levels may be caused by the increased matrimonial migration distances and decreased endogamy of the citizens as a consequence of better communications. The increased urbanization and industrialization that started in the last decades of the 19th century broke up the old static agrarian isolates and caused Sweden, within 2-3 generations, to develop from a poor nation to one of the most prosperous in the world. A more urban and affluent lifestyle, a better diet, and increased stress and sedentary occupations may have reduced the physical capacity of mothers to carry gestations with multiple embryos or fetuses to completion.