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The incidence of triplet and higher-order multiple births rose fourfold during the 1980s and 1990s (1-3). Since 1998, however, this trend has edged downward (3). This rise was associated with older maternal age and the increased use of fertility-enhancing therapies (4,5) and was of concern because of the greater risk of adverse outcome of triplet and higher-order births compared with white women, with death rates decreasing faster among white women.

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