Conceptive delays of twin-prone mothers: a demographic epidemiologic approach

We studied the time interval to the first birth and to the twin birth using statistical and mathematical models in two groups of mothers, those with twins and those with singletons, from the same population. We made use of a pair-matched case-control design. We treated the maternal birth cohort and parity as confounders and thus as controlled. We also investigated the sex of twin pairs as an interactive variable, employing such methods as survival curve testing and using geometric, gamma, and exponential distributions where appropriate. The expectations derived from the mathematical models yield numerical estimates of fertility components. The results suggest that unlike-sex twin-prone mothers have higher fecundity than controls when they conceive singletons. Further, fecundity appears high and unimpaired before the birth of twins. Mothers of like-sex twins experience somewhat shorter and but more variable birth intervals than corresponding controls before the birth of twins, suggesting within-group heterogeneity. Specifically, the birth of like-sex twins is preceded by low fecundity and a short period of postpartum amenorrhea. Biologically, like-sex (presumably monozygotic) twin-prone mothers have a hormonal defect related eventually to menopausal status that interferes with ovulation and perhaps with lactation. As for unlike-sex twin-bearing mothers, they probably experience a displacement of their maximum fertility potential toward early reproductive life and an extension of their menstrual life. From a methodologic standpoint, the study of the fertility of twin-prone mothers cannot proceed without estimates of the fertility components of birth intervals, as these intervals do not lend themselves to straightforward analytical interpretations by statistical analyses.     

Selection for increased brood size in historical human populations

Human twinning rates are considered to either reflect the direct fitness effects of twinning in variable environments, or to be a maladaptive by-product of selection for other maternal reproductive traits (e.g., polyovulation). We used historical data (1710-1890) of Sami populations from Northern Scandinavia to contrast these alternative hypotheses. We found that women who produced twins started their reproduction younger, ceased it later, had higher lifetime fecundity, raised more offspring to adulthood, and had higher fitness (individual lambda) than mothers of singletons in all populations studied. For example, an average of 1.2 offspring survived to adulthood from a twin delivery, irrespective of its sex ratio, whereas only 0.8 offspring survived to adulthood from a singleton delivery. Only if mothers started reproduction at very late age (> 37 yr), or had a very long reproductive life span (> 20 yr), was it more beneficial to produce only singletons. These findings suggest that twin deliveries among Sami could not be explained as a maladaptive by-product of selection for other maternal reproductive traits. In contrast, our results suggest that twinning was under natural selection, although the strength of selection was likely to have been context dependent.     

Lack of effect of maternal body mass index on anthropometric characteristics of newborns in twin gestations

We examined the correlation between maternal prepregnancy body mass index (BMI) and newborn weight, length, BMI, and gestational order, in singleton and twin births. The sample comprised 381 mothers of multiple babies (562 twins), and 7979 singleton pregnancies, used as controls. The Mann-Whitney non-parametric test was used to compare the values between the two groups, and the Spearman's correlation test (rS) was applied to the quantitative variables. A significant positive correlation was found with singleton baby variables: the higher the maternal BMI, the higher the newborn's BMI, weight, length, and gestational order. However, no significant correlation was found between maternal BMI and any of these variables in twins. Maternal weight gain, in the twin group, showed a significant positive correlation with the newborn gestational order (rS = 0.154; P = 0.002), weight (rS = 0.493; P < 0.001), length (rS = 0.469; P < 0.001), and BMI (rS = 0.418; P < 0.001). In singletons, the correlation was positive with all the variables, except for the gestational order. The newborn BMI was significantly higher in twins born by C-section than those born by vaginal birth (Z = -4.974; P < 0.001). Mothers of singletons delivered by C-section had a significantly higher BMI than those of singletons born by vaginal birth (Z = -1.642; P < 0.001); however, no significant differences were observed in mothers of twins. Prepregnancy maternal BMI in twin births would not be predictive of newborns weight, length and BMI in this population. Maternal weight gain during pregnancy proved to be the most adequate for predicting the weight, length and BMI of twins delivered by C-section.     

Stress and coping among mothers of twins in rural southwestern Nigeria.

High rates of twinning have been reported in Africa. This study sought to learn whether mothers of twins experience different stress levels than those who have only singletons. Both twin mothers (101) and singleton mothers (101) were interviewed. Using a scale of 15 stressors the researchers found that the mean stress score was significantly higher for twin mothers than singleton mothers. Higher stress scores were also associated with parity and perceptions of problems in caring for children and inversely related to perceived levels of social support. Confronting stressors or simply accepting them were the two main ways that mothers coped with their problems.     

Twinning in humans: maternal heterogeneity in reproduction and survival

While humans usually give birth to singletons, dizygotic twinning occurs at low rates in all populations worldwide. We evaluate two hypotheses that have differing expectations about the effects of bearing twins on maternal lifetime reproduction and survival. The maternal depletion hypothesis argues that mothers of twins will suffer negative outcomes owing to the higher physiological costs associated with bearing multiples. Alternatively, twinning, while costly, may indicate mothers with a greater capacity to bear that cost. Drawing from the vast natural fertility data in the Utah Population Database, we compared the reproductive and survival events of 4603 mothers who bore twins and 54 183 who had not. These mothers were born between 1807 and 1899, lived at least to the age of 50 years and married once to men who were alive when their wives were 50. Results from proportional hazards and regression analyses are consistent with the second hypothesis. Mothers of twins exhibit lower postmenopausal mortality, shorter average inter-birth intervals, later ages at last birth and higher lifetime fertility than their singleton-only bearing counterparts. From the largest historical sample of twinning mothers yet published, we conclude that bearing twins is more likely for those with a robust phenotype and is a useful index of maternal heterogeneity.     

Selection intensities in mothers of twins and in mothers of singletons

Abstract

Opportunity for selection was assessed in a group of mothers with twins and was compared with estimates obtained in mothers who gave birth to singletons only from the same population. Both groups were matched on a number of confounding variables in the framework of a case/control methodology. Two time periods involving demographic changes were studied separately. After appropriate adjustment for the increased family size of mothers of twins, results show that selection intensities are greater in twin‐bearing mothers than in controls. The fertility component of the selection index is lower than that of mortality if childless women are taken into account. However, the index of opportunity for selection is rather low by current standards but, given the methodology used, should reflect genetic rather than environmental selection. Notwithstanding, it would be difficult to explain the recent change in the twinning rates in the population by the actual level of selection indices.     

Reproductive investment in pre-industrial humans: the consequences of offspring number, gender and survival

The number and gender of offspring produced in a current reproductive event can affect a mother's future reproductive investment and success. I studied the subsequent reproductive outcome of pre-industrial (1752-1850) Finnish mothers producing twins versus singletons of differing gender. I predicted that giving birth to and raising twins instead of singletons, and males instead of females, would incur a greater reproductive effort and, hence, lead to larger future reproductive costs for mothers. I compared the mothers' likelihood of reproducing again in the future, their time to next reproduction and the gender and survival of their next offspring. I found that mothers who produced twins were more likely to stop breeding or breed unsuccessfully in the future as compared with women of a similar age and reproductive history who produced a same-gender singleton child. As predicted, the survival and gender of the offspring produced modified the costs of reproduction for the mothers. Giving birth to and raising males generally appeared to be the most expensive strategy, but this effect was only detected in mothers who produced twins and, thus, suffering from higher overall costs of reproduction.     

Comparing blood pressure of twins and their singleton siblings: being a twin does not affect adult blood pressure.

The hypothesis was tested that monozygotic (MZ) and dizygotic (DZ) twins, with their lower average birth weight, have higher adult blood pressure than their singleton brothers or sisters. From the Netherlands Twin Registry, 261 twin families were recruited from a young adult and an older adult cohort with mean ages of 26.2 and 50.4 respectively. These families yielded 204 MZ twins with 71 singleton siblings and 271 DZ twins with 103 of their singleton siblings. Anti-hypertensive medication use of these 649 participants was assessed twice with a two-year interval. Resting blood pressure was measured thrice during a standardized laboratory protocol. In spite of a significant difference in birth weight (1036 gram), no differences were found in anti-hypertensive medication use at both time points between twins and singletons nor between their resting laboratory diastolic or systolic blood pressure. These results applied to each gender and to both age cohorts. Limiting the analyses to matched twin-sibling pairs of the same families and taking current weight and height into account did not change the results; no evidence was found for a twin-singleton difference. It was concluded that estimates of genetic and environmental contributions to blood pressure deriving from twin studies do not appear to be biased and may be generalized to singletons. Our results suggest that the lower birth weight in twins does not reflect the intrauterine disadvantage described by the Barker hypothesis.     

Twin and singleton births in Ghana--a case-control study.

A retrospective study involving 623 twin and 1246 singleton births was conducted to compare the two groups with regard to selected maternal, fetal and labor and delivery characteristics and outcomes. Maternal age and parity were significantly higher for twins. The risks of preterm delivery, arrival in the labor ward in second stage of labor, cesarean births and postpartum haemorrhage were significantly higher in twin than in singleton births. In vaginal deliveries twin mothers were significantly less likely to have had episiotomies or perineal lacerations. There was no difference in the duration of the third stage of labor or in the incidence of retained placentae. Antepartum haemorrhage was a less likely indication for cesarean delivery among twins, while there was no significant difference in the likelihood of severe pre-eclampsia/eclampsia being an indication. Singleton babies were significantly heavier than twins. The incidences of malpresentation, low birth weight, stillbirths and of admission of live births to the neonatal intensive care unit were significantly higher in twins. There was no difference in the rate of instrumental vaginal delivery, or in the route of delivery of fetuses presenting by the breech. There is the need for detailed study of the incidences of antepartum haemorrhage and hypertensive diseases in twin and singleton pregnancies and of the factors determining the mode of delivery when such complications arise. Labor and delivery should also be examined to determine any differences between the two groups, especially in the first and second stages.     

Sex differences in birth defects: a study of opposite-sex twins

BACKGROUND: Sex differences in structural birth defects are often confounded by environmental risk factors. Opposite-sex twins provide a unique model for detecting sex differences in birth defects while maximally controlling environmental risk factors in a natural setting. METHODS: Population data from the Florida Birth Defects Registry were analyzed. A total of 4,768 pairs of twins who were discordant for sex and born between 1996 and 2001 were analyzed. The McNemar test was used to compare the differences between a male twin and his twin sister for the risk of developing specific defects and organ-system defects. RESULTS: Of 4,768 twin pairs, 225 males (4.72%) and 175 females (3.67%) had birth defects. Among opposite-sex twin pairs, males had a 29% higher risk for birth defects than their twin sisters. Compared to their twin sisters, males had a 5.4 times higher risk for pyloric stenosis and a 2.4 times higher risk for obstructive genitourinary defect, but only one-tenth the risk for congenital hip dislocation. CONCLUSIONS: Sex differences in birth defects exist between opposite-sex twins.     

Perinatal mortality in term and preterm twin and singleton births.

Although, in general, twins have higher perinatal mortality rates than singletons, preterm twins have lower perinatal mortality rates than singletons of the same birth weight or gestational age. This study investigated the hypotheses that this paradoxical twin advantage: 1) is due to gestational age distribution differences between the singleton and twin populations, and 2) is due to increased likelihood of birth having occurred in a tertiary perinatal center. A pre-existing, time-limited data set of all births in the province of Ontario in odd years between 1979 and 1985 was chosen for this study because of the large sample size (n = 618,579). Multivariable logistic regression of the relationship between perinatal mortality and twin status was controlled for mother's age, hospital level and gestational age. Findings confirm the lower mortality of preterm twins. After controlling for level of hospital of birth this difference remained, suggesting that level of hospital of birth was not a major factor responsible for the twin advantage. Analyses in which gestational age was standardized indicate that, for those whose gestational age was less than 2 SD below the mean for their particular group (twin or singleton), twins were actually at higher risk than singletons. These results support hypothesis 1 and do not strongly support hypothesis 2. The results also support earlier authors' suggestions that the definition of term birth should be different for twins and singletons     

Twin-singleton differences in intelligence?

The twin method has been criticised for its alleged non-generalisability. When population parameters of intellectual abilities are estimated from a twin sample, critics point to the twin-singleton differences in intrauterine and family environments. These differences are suggested to lead to suboptimal cognitive development in twins. Although previous studies have reported twin-singleton differences in intelligence, these studies had two major drawbacks: they tested young twins, and twins were compared with (genetically) unrelated singletons. To test accurately whether twin-singleton differences in intelligence exist, a group of adult twins and their non-twin siblings were administered the Dutch WAIS-III. The group was large enough to detect twin-singleton differences of magnitudes reported in earlier investigations. The data were analysed using maximum likelihood model fitting. No evidence of differences between adult twins and their non-twin siblings on cognitive performance was found. It is concluded that twin studies provide reliable estimates of heritabilities of intellectual abilities which can be generalised to the singleton population.     

Menstrual characteristics of mothers of twins

The menarcheal age and frequency of menstrual disorders in mothers of dizygotic (DZ) and monozygotic (MZ) twins born in Denmark in 1984 or 1985 were compared with a control sample of mothers of singleton infants born in the same period. Compared to control mothers, mothers of DZ twins had a lower menarcheal age and a lower frequency of menstrual irregularities--menstrual cycles exceeding 5 weeks duration, varying length of menstrual cycles and episodes of menostasia. Mothers of MZ twins had a higher frequency of intermenstrual bleeding compared to mothers of singletons. All results were adjusted for maternal age and parity. The findings are relevant to the interpretation of aetiological factors leading to twin births and support the hypothesis of differences in sex hormone activity of the mothers of DZ twins in comparison with other women.     

Are twins and singletons comparable? A study of disease-related and lifestyle characteristics in adult women.

The classic twin study is sometimes described as "the perfect natural experiment" for the investigation of the aetiology of complex disease, but assumptions of the twin design need to be empirically tested if their results are to be considered unbiased and representative of singleton populations. In this study comparisons of disease and prevalence of lifestyle characteristics have been made between twin participants in the St Thomas' Hospital UK adult twin registry, the largest twin volunteer register in the UK for the study of diseases of ageing, and a parallel population-based study of singleton women. The only differences found were for weight, where monozygotic (MZ) twins were lighter and had a smaller variance than dizygotic (DZ) twins and singletons. For the other variables studied, volunteer twins were not found to differ from age-matched singleton women in distribution or prevalence of: bone mineral density, osteoarthritis, blood pressure, hypertensive drug use, height, history of hysterectomy and ovariectomy, menopausal status and current alcohol and overall tobacco consumption. We conclude that the results of twin studies can be generalised to singleton populations for these measures and disease outcomes.     

Maternal age and birth weight characteristics of twins born to nulliparous mothers: a population study.

In order to examine birth weight characteristics of twins delivered to nulliparous mothers in relation to maternal age, we used a population-based cohort of Israeli twins delivered between 1993-98 to select all 4793 (37.6%) nulliparas who delivered twins. Maternal age was subdivided as less than 20 years, 20-24, 25-29, 30-34, 35-39, and 40 years or more. We counted the frequencies of each total twin birth weight (twin A + twin B) in each of three categories (less than 3000, 3000-4999, and more than 5000 g) and the frequency of very low birth weight (VLBW, less than 1500 g) neonates in each of the six maternal age categories. There were significantly more nulliparas in the twin population at age groups less 30 years and significantly less at ages 30 years or more. We found a highly significant inverse correlation between the proportion of nulliparas and maternal age group, decreasing from 71.8% at less than 20 years to 18.6% at age 35-39 years (% nulliparas = 85 - 13.7 x age group, Pearson R2 = 0.98). However, this trend changed abruptly to the observed figure of 25.9% nulliparas aged 40 years or more instead of the expected 2.8%. We failed to reveal any significant difference in birth weight characteristics between the maternal age groups (all p > 0.05, all confidence intervals included 1.0). The more than tenfold deviation of the observed from the predicted frequency of nulliparas aged 40 years or more suggests that a different relationship between parity and age occurs at this age group. Maternal age of nulliparas is not associated with different birth weight characteristics of their twins.     

Iron stocks and risk of anemia in twins

This study aims to compare the risk of anemia by iron deficiency in mothers and infants of twin and single pregnancy. It concerned 33 couples of twins and 31 control, all 97 being term newborns. At birth, ferritinemia is significantly lower in twins, and reticulocytes count is significantly higher; their mothers have a significantly lower hemoglobin level and higher reticulocytes percentage and count. At 3 and 6 months, hemoglobin level and mean corpuscular hemoglobin are significantly lower in twins, as at 6 months ferritinemia is significantly lower in twins. Iron stocks constituted in utero are significantly lower in twin pregnancy, and this study support the early preventive iron treatment in twins.     

Potential bias regarding birth weight in historical and contemporary twin data bases.

In this study we examine the hypothesis that monozygotic (MZ) twins in historical databases are less discordant for birth weight due to negative selection of severely discordant MZ twins. Furthermore, we test the hypothesis that MZ twins are less discordant for birth weight when comparing a volunteer based twin registry with a population based twin registry, due to selective registration. Data were available on 3927 twin pairs from the volunteer Australian Twin Registry born before 1964, 3059 volunteer twin pairs from the Netherlands Twin Register born 1987-1989 and 454 Belgian twin pairs from The East Flanders Prospective Twin Survey born 1987-1989. Intrapair relative birth weight differences (RBWD) were computed for MZ and dizygotic (DZ) twins from each twin registry. Comparing birth weight differences between MZ and DZ twins provides support for the hypothesis that MZ twins are subject to a negative selection in historical databases. Furthermore, Australian MZ twins have a lower RBWD compared to Dutch MZ twins when corrected for the RBWD of Australian and Dutch DZ twins, indicating circumstances which only affect MZ twins. Our hypothesis that MZ twins are less discordant for birth weight in a volunteer based twin registry compared to a population based twin registry had to be rejected. We suggest that investigators using historical databases to test the fetal origins hypothesis should be aware of this increased likelihood of selective exclusion of individuals with extreme morphometric parameters at time of birth.     

Economic and social correlates of infant mortality: A cross‐sectional and longitudinal analysis of 63 selected countries

Abstract

Genealogical records containing birth and death dates for completed families have been analyzed to compare the longevity of twins, sibs and parents. The data are restricted to twins and sibs who survived to adulthood and married. The findings, similar to those found with respect to fertility (Wyshak and White, 1969), show that twins, especially male twins, are disadvantaged in comparison with their male sibs. Sib‐sib and parent‐offspring correlation analysis confirmed that there is a genetic component in the determination of life span, but environmental factors contribute more to the total variation. No evidence of a stronger maternal than paternal effect was found. Twin bearers also lived longer than nontwin bearers. Even among persons who survived to age SO or more, parents of twins had more children and lived slightly longer than their twin and nontwin offspring. Regression analysis for persons who survived to SO or longer indicated that, in addition to life span of parents, secularity (year of death) and fertility (number of children borne) were the best predictors of longevity, though only a small proportion of the variation could be accounted for by these and other demographic variables. Life span has shown a consistent increase over time from the seventeenth century through the nineteenth century, while fertility has tended to decline. However, among persons surviving to age SO, when the relation between secularity and fertility and secularity and longevity is controlled, a significant correlation between fertility and longevity remains. This relation, observed in populations that did not practice voluntary family size limitation, would not be found in contemporary data. Maternal mortality accounted for the shorter life span of women than for men; eliminating its effect gives women a slight advantage. The fertility and longevity experience of migrants who survived to age SO is more favorable than that of persons who did not migrate.     

The risk of birth defects in dichorionic twins conceived by assisted reproductive technology.

The purpose of this study was to examine whether dichorionic twins conceived by assisted reproductive technology (ART; intracytoplasmic sperm injection [ICSI], in vitro fertilization [IVF], gamete-intrafallopian tube transfer [GIFT]) have a higher risk of birth defects compared to dichorionic twins conceived naturally. We reviewed the medical records of 406 mothers with dichorionic twin pregnancies, who received continuous antenatal care from < or = 20 weeks of gestation and gave birth to infants after > or = 24 weeks of gestation in our institute. Birth defects were diagnosed at the time of hospital discharge according to the International Classification of Diseases, 10th Revision. Occurrence of birth defects was compared between twins conceived by ART and those conceived naturally using logistic regression analysis. Overall, 51 of 812 infants (51/812 = 6.2%) had birth defects. The incidence of birth defects in ART-conceived twins was significantly higher than that of naturally conceived twins with an odds ratio of 6.9 (95% confidence interval [CI] 2.1, 22.5), 3.7 (95% CI 1.2, 12.0), and 4.3 (95% CI 1.4, 14.3) for ICSI, IVF, and GIFT, respectively. The higher frequency of birth defects in ART-conceived twins was still significant after adjusting for higher maternal age in the ART group, with an adjusted odds ratio of 6.7 (95% CI 2.1, 21.9), 3.6 (95% CI 1.1, 11.5), and 3.7 (95% CI 1.2-11.8) for ICSI, IVF, and GIFT, respectively. Dichorionic twins conceived by ART, compared to dichorionic twins conceived naturally, had a much higher risk for birth defects diagnosed at hospital discharge.     

A Conversation with Bakhtin : On Inquiry and Dialogic Thinking

Two different traditions in psychology emphasize the study of twin-twin and mother-twin relationships. One line of research, the twin development approach, has compared parenting styles and sibling relationships in families with twin and singleton offspring. This research tradition is based on the assumption that twins, relative to singletons, may be at risk for developmental delays in motor, cognitive [1-3], linguistic [1,4,5], and social-emotional functioning [6,7] because of their increased rate of prematurity, lower birth weight [8-11], increased parenting demands that result in less interactive maternal speech [12-18], shared peer time [19], and other experiences that distinguish twins from singletons [7,8,19-21]. Although recent studies have not replicated the developmental concerns [22-26] or concerns about specific birth defects [27] that emerged from earlier studies comparing twins and singletons, there continues to be interest in the relational differences that may be present in twin and singleton families and in the need to address educational and social policies that promote twin development [28,29]. Within the framework of this approach, distinctions between twins and singletons have received more attention than distinctions between fraternal, dizygotic (DZ) and identical, monozygotic (MZ) twins.