Recent secular trends in dizygotic twinning rates in Europe

The author analyzes trends of declining maternal-age-specific dizygotic twinning rates in Europe for the period 1960-80. Using data from country publications on vital statistics, rates were available for most European countries; no useful data was, however, available for Albania, Romania, and Turkey. Dizygotic twinning rates declined for most countries tries through the 1970s, yet ceased their decline in the 1970s following initial drops in the 1960s were England and Wales, Scotland, Sweden, Norway, Denmark, Switzerland, Hungary, and Czechoslovakia. In the absence of concrete reasons for the observed twinning rates declines and subsequent decline cessation in several countries, the author hypothesizes potential causes. It is speculated that declining sperm quality over the period is related to the declines in European dizygotic twinning rates. Specifically, environmental pollution may have been at the root of deteriorating sperm quality, which in turn fueled the observed declines in dizygotic twinning rates. Cessation of the rate declines for selected countries in the 1970s may be related to the removal of certain polluting environmental agents from those countries. Forming 2 geographic European subregions, countries experiencing rate decline cessation or increase may have common elements to their environmental policy which foster the improvement of sperm quality. Examination of regulations regarding certain agents in these countries within a few years of 1970 may help identify agents responsible for dizygotic twinning rate trends in most European countries. The author also suggests that rate decline cessation may have stemmed from an increase in hormonally-induced twinning, counterbalancing the decline in natural twinning over the period.     

Dizygotic to monozygotic twinning ratio at The Royal Women's Hospital, Melbourne 1947-1997, compared with Australian national twinning incidence.

The incidence of dizygotic (Dz) twinning can be used as an index of natural human fertility. A retrospective study was done at The Royal Women's Hospital, Australia, to see whether the dizygotic to monozygotic (Mz) twinning ratio from one hospital can accurately reflect the national incidence of Dz twinning. The yearly twinning incidence from 1947-1997 was expressed as a Dz:Mz ratio, standardised for maternal age and plotted against previously published national statistics. The proportion of mothers born in Asia (of both singleton and multiples) between 1983-1997 was analysed to see whether different racial mixes might influence twinning trends. There were 5275 twins born of known sex and maternal age between 1947-1997. The age-standardised Dz:Mz ratio increased non-significantly from 1.39 in 1947 to 2.29 in 1953 (P = 0.08), underwent a significant decline to 0.73 in 1977, then remained stable until 1997 (P>0.05). The same trends were also apparent when the data was pooled into 2-year groups with the increase from 1947/48-1953/54 becoming highly significant (P<0.009). These trends observed in the hospital-based data were in close agreement with those found in the national statistics, with the exception of a rise in 1977-1982 only reflected in the Australia-wide data. In 1993, 2.6% of mothers were born in Asian countries; by 1997, this had risen to 10.6%. We found that the Dz:Mz ratio from one hospital closely reflects national twinning trends. Prospective studies must account for race, and would need around 200-300 twin pairs per year to minimise fluctuations of the ratio.     

Maternal smoking and twinning.

In order to investigate a possible association between maternal smoking during pregnancy and twinning, information on 1,096,330 single births and 12,342 twin births in 1983-95 was obtained from the Swedish Medical Birth Registry (MBR). All odds ratios (OR) were estimated after stratification for year of birth and maternal age, parity, and educational level. Smoking women, compared with non-smoking women, were at increased risk of having dizygotic (DZ) twins, but the risk increase was only evident among multiparas. A strong association between previous involuntary childlessness and dizygotic (DZ) twinning (especially in primiparas) was found. The strongest association between maternal smoking and DZ twinning was found among multiparas without any history of involuntary childlessness (OR: 1.35, 95%CI:1.22-1.49), whereas among women who had experienced involuntary childlessness, the opposite was seen (OR: 0.82, 95%CI:0.66-1.00, no difference between parity strata). Weinberg's differential method was used to estimate the number of monozygotic (MZ) twins, and a method of estimating stratified ORs among mothers of MZ twins was presented. No association was found between MZ twinning and maternal smoking (OR: 0.96, 95%CI:0.86-1.07), and no confounding by parity or previous involuntary childlessness was indicated. Several non-causal explanations to the positive association between DZ twinning and maternal smoking among multiparas were discussed, but homogeneity over strata indicated that maternal smoking may be a true risk factor for double ovulation.     

Overripe ova and twinning.

Multiple births were studied in a sample of orthodox Jewesses for whom an estimate could be made of the day of ovulation and the earliest possible day of conception. The overall rate of twinning was 14.5/1,000 deliveries, and of triplets, 0.40/1,000. Twinning rates varied significantly from 11.4 in the 5,976 "early" conceptions (day -1 or earlier relative to the estimated day of ovulation) to 26.9 in the 1,498 "late" conceptions (day 0 or later). Triplets varied significantly from 0 to 2.01 in early and late conceptions, respectively, and unlike-sexed multiple sets, 2.8 and 12.8, respectively. The excess of multiple births in late conceptions was seen within different ages and origin groups, in women with different menstrual characteristics, and in those with and without treatment for anovulation. While the excess of unlike-sexed sets seems to lead to the conclusion that late conceptions are associated with dizygosity, polar body twinning and uniovular dispermatic twinning should also be considered.     

Secular trends of twinning rate in Sweden.

The change in parity and maternal age in Sweden accounts for the decline in the twinning rate from the 19th century to the middle of the 20th century. The later decline in twinning rate cannot be explained by changes in maternal age and parity. Fecundity appears to be higher in mothers of twins than in other mothers.     

Coital frequency and twinning. A comment.

The author comments on Bonnelykke et al's 1990 article on the coital rates of 390 mother of dizygotic twins (DZ), and finds that the data do not support the hypothesis that coital rates of mothers of DZ are higher than those of controls. The coital rates were 9.0 and 9.3/month respectively. Questions are raised as to the strength of the evidence, the sagacity of abandoning the hypothesis, or the probability of this sample size detecting differences. Cohen in 1977 hypothesized mean coital rates of DZ and control mothers and James in 1984 estimated rates of 16 and 15/month respectively. The coefficient of variation or the standard deviation divided by the mean has been found to be 2/3 regardless of the mean when age, parity and social class are controlled for. The harmonic mean of Bonnelykke's 2 sample sizes of 390 and 1206 is 589. Using Cohens Table 2.3.2 at 600 and at d=.1, the probability of detecting the hypothesized difference is .53 at the .05 level, which is impressive but not decisive evidence. Biological evidence supports the proposition of high coital rates at the time of conception and the birth of DZ twins. In double ovulation, oocytes are released usually at different times. The corpus luteum will have an inhibitory effect on the 2nd fertilization, but this condition must occur at 1st fertilization instantaneously. A plausible situation is the 1st fertilization is with an aging spermatozoa and the 2nd from a fresh ejaculate. Also supporting this notion is the fact of superfecundation, where fertilization occurs from spermatozoa from different ejaculates.     

A twinning event in Macaca sylvanus of Gibraltar.

Linear measurements and body proportions for a set of free-ranging Macaca sylvanus twins are presented. Their measurements are compared to a full-term perinatal dead female. The twins are dizygous and probably 28 days premature.     

On the standardisation of the twinning rate.

In many studies the twinning rate, being strongly dependent on maternal age (and parity), has been standardised according to the maternal age distribution. The direct method requires very informative twinning data for the target population. The indirect method is used when the data for the target population is not sufficiently informative or when the target population is small. We have earlier introduced an alternative indirect technique for standardising the twinning rate. Our technique requires even less of the twinning data. Besides maternal age, parity is an influential factor, and should, if possible, be taken into account. In this study we present the traditional standardisation methods based on both maternal age and parity, we propose a new direct standardisation method and we develop our standardisation methods so that they take into account both maternal age and parity. We apply these standardisation methods to data from Finland, 1953-1964, from St. Petersburg, Russia, 1882-92, from Canada 1952-1967, and from Denmark, 1896-1967. These methods all give results very similar to those for the Finnish data, but the effect of parity is strongest with the direct methods. This may be due to the fact that, among extramarital maternities, parity has a strongly increasing effect on the twinning rate. This may be attributed to a higher reproduction capacity among unmarried mothers. Standardisations of the Canadian and the Danish data also give reliable results. With the St. Petersburg data, however, the different standardisations show notable discrepancies. These discrepancies are compared with Allen's findings.     

Trends in the twinning rate in Johannesburg, South Africa, 1969-1989 and estimated twinning rates for 1990.

Birth statistics for the Johannesburg Metropolitan Region were collected for 757 151 confinements from 1969 to 1989 (467513 Black, 194375 White, 67250 Coloured and 28013 Indian confinements). From 1969 to 1978 data on the sexes of twins were also collected for 375 203 of the confinements (203 504 Black, 129 631 White, 28 253 Coloured and 13 815 Indian confinements). A twin confinement was defined as two deliveries during one confinement. Twinning rates (TRs), defined as the number of twin confinements per 1000 total confinements, were calculated per year for each population group and from 1969-1978 estimates of the relative proportions of dizygotic (DZ) and monozygotic (MZ) twins were calculated and thus the relative DZTRs and MZTRs. A significant decline in Black and Coloured TRs was observed between 1969 and 1989. A significant decline in Black DZTR but not Black MZTR was observed between 1969 and 1978, the Coloured twin sample was too small to show significant trends over this period. It is probable that the overall decline in Black twinning may be explained by a decline in the DZTR. An analysis of birth statistics for 159 748 confinements (134 504 Black and 25 244 White confinements) collected as part of a prospective study of TRs in the Johannesburg Metropolitan Region from 1988 to 1990, indicated that the Black TR continued to decline at least until the end of 1990. TRs in the Johannesburg Metropolitan Region calculated from City Health Department birth statistics collected from 1988 to 1990 were: 13.8 and 10.77 for the Black and White populations, respectively. TRs for this period calculated from the combined birth statistics of 14 hospitals, nursing homes and maternity clinics across the region were: 12.4 and 10.88 for the Black and White populations, respectively.     

Insurance ovulation, embryo mortality and twinning.

The 'insurance ova' hypothesis (Anderson, 1990) views dizygotic twinning as a by-product of selection for multiple ovulation which sometimes--in error--results in the birth of twins. From this viewpoint, polyovulation is a mechanism which reduces the risks of fertilization failure or embryo defect/mortality. If DZ twin births are a 'side-effect' of a mechanism which compensates for defective embryos one might predict that embryo defect rates and twinning rates will covary. This prediction is tested using national-level data on twinning rates and rates of trisomy-21 (Down's syndrome), and a strong positive correlation is found, even when controlling for maternal age. One suggestion that follows from this finding is that intra- and interpopulation variation in both twinning rates and Down's syndrome rates may result, in part, from individual variation in pre-implantation rejection of embryos in the very early stages of pregnancy. In this paper it is proposed that the 'insurance ova' explanation for twinning in humans could be expanded to incorporate a model of rejection of anomalous embryos, be they anomalies of number or type. Variation in the efficiency of an embryo rejection mechanism, combined with variation in frequency of polyovulation, would have consequences for individual reproductive success.     

Secular trends in twinning rates

Based on national data from civil birth registration systems, this paper provides an overview of trends in the twinning birth rates in fifteen developed countries. Patterns and differentials in such rates across populations are described, and trends over time are given. The evolution of the twinning rate in industrialized countries over the last century follows broadly the same pattern. One exception is the period around World War I, with a peak in the twinning rate being observed during the war, or just after it, although this was not registered in all countries. Since the mid-1970s twinning rates have increased in many developed countries in response to a growing use of fertility-stimulating treatments such as in vitro fertilization.     

Temporal differences in the regional twinning rates in Sweden after 1750.

When twinning rates are studied, maternal age and parity should be considered. Data on parity are seldom available. We studied information about the mean parity, using the gross reproduction rate, the total fertility rate and the crude birth rate. These are strongly correlated with the mean parity. The crude birth rate is more readily available than the gross reproduction rate or the total fertility rate. Earlier studies have shown that it is difficult to model variations in the twinning rate with data for the macrolevel. In this study these findings are explained by theoretical analyses and illustrated by empirical data. Sweden, having the oldest continuous population statistics and high twinning rates, offers excellent possibilities for analyses of the twinning rate. We considered data for the counties of Gotland, Alvsborg and Stockholm and the city of Stockholm from 1749 to 1960 and for Sweden until 1996. For Alvsborg, the twinning rate was low for the whole period, showing no statistically significant decreasing trend. It is mainly about 11-14 per thousand, which is only 50-60% of the twinning rate in Gotland in the 18th century. In Gotland, in the county of Stockholm, in the city of Stockholm and in Sweden as a whole, the decreasing trends in the twinning rate were statistically significant. The decreasing twinning rates converge towards the low twinning rate of Alvsborg. After standardization of the twinning rate, the differences remained and the low rate in Alvsborg could not be explained by maternal age.