A comparative study of zygotic twinning and triplet rates in eight countries, 1972-1999

Annual changes in twinning and triplet rates by zygosity were investigated in eight countries during the period 1972-1999 using vital statistics. The monozygotic (MZ) twinning rates in Denmark, Switzerland and the Slovak Republic remained more or less constant throughout this period, whereas those in England and Wales, the Federal Republic of Germany (Germany), the Netherlands, the Czech Republic and Japan increased significantly year by year. With the exception of the Slovak Republic, the dizygotic (DZ) twinning rate increased significantly year by year in each country. It was 2.9 times higher in Denmark and 1.5 times higher in Germany in 1999 than in 1972, and within the same range in the other countries. With two exceptions, the MZ triplet rates remained more or less constant in each country. On the other hand, the DZ and trizygotic (TZ) triplet rates increased significantly year by year in each country. The TZ rate increased 30-fold in Germany, 16.6-fold in Japan, 11.7-fold in Switzerland, 9.7-fold in the Czech Republic, 8.7-fold in the Netherlands, 6.4-fold in Denmark, 5.6-fold in England and Wales and 3.5-fold in the Slovak Republic. The higher DZ twinning rate and higher DZ and TZ triplet rates since 1983 have been attributed to the higher proportion of mothers being treated with ovulation-inducing hormones and in vitro fertilization (IVF) in Denmark, England and Wales, Germany, the Netherlands, Switzerland and Japan. After the introduction of fertility drugs and IVF, variations in the DZ twinning and triplet rates and the TZ triplet rates were not only due to biological factors, but also depended on the popularity of fertility drugs and IVF in each country. In the Slovak Republic, where human fertility might not be affected by some adverse environmental factors, the DZ:MZ ratio remained constant during the period 1972-1999.     

Epidemiological trends in multiple births in the United States, 1971-1998.

The astounding rise in multiple births in the United States continues. We analyzed live birth files from the U.S. National Center for Health Statistics. Twin, triplet, quadruplet, and quintuplet+ rates were calculated for the period 1971-1977 and for each year between 1990 and 1998. Triplet rates were also computed within categories of mother's education and age. The twin rate increased from 1.8% in 1971-77 to 2.8% in 1998. The rate of triplets increased 5.9-fold, quadruplets 11.9-fold, and quintuplets+ 5.3-fold between 1971-77 and 1998. Increases in triplet rates were much more marked among births to university-educated women and women 30 years and older. Among women 45 years and older, the triplet rate was approximately fifty times higher in 1998 than in 1971-77. This group of older women (> or = 45 years) had the highest multiple birth rate in 1998.     

Twinning rates in a rural area of Bangladesh

In this study we investigate the incidence of twin births over a period of 16 years in a rural area of Bangladesh using data from the Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research. Over the study period twinning rates fluctuated between 7.8 and 11.2 per 1000 live births. The twinning rate was strongly correlated with maternal age; the rate for mothers over 35 years of age was about 3 times higher than for mothers younger than 20 years. The variation in twinning rate with maternal age is due to the variation in dizygotic twinning; the rate of monozygotic twinning is almost constant for all ages. Twinning rates were higher in the treatment area than in the comparison area after controlling for maternal age and parity. The rates were lower for monozygotic twinning and higher for dizygotic twinning in the treatment area than in the comparison area. Seasonality was observed for both twins and singletons, but the peak for twinning precedes that for singleton births by more than a month.     

Estimated number of multiplets under 16 years using two sets of census data in Japan: 1990 and 1995.

Data for sets of multiples under 16 years of age were obtained from the population censuses of Japan in 1990 and 1995. These numbered 147,188 twin pairs, 1410 sets of triplets, 59 sets of quadruplets, and 3 sets of quintuplets in 1990, with the corresponding numbers in 1995 being 141,354, 2,211, 136 and 12, respectively. The total number of sets of multiples was 148,660 in 1990 and 143,713 in 1995. Twinning, triplet, quadruplet and quintuplet rates were estimated for each age. Rates of monozygotic twins and triplets remained constant age by age up to 15 years, while the dizygotic twinning rate, and rates of di- and tri-zygotic triplets decreased over the same period. Quadruplet and quintuplet rates also decreased. The accuracy of estimating number of multiples from census data is discussed using data on vital statistics.     

Seasonality of birth and sex ratio in Tehran, Iran

234 218 births (1975-1983) from a hospital in Tehran have been analysed for seasonality of birth and sex ratio. The results show more births in winter and less births in fall. The sex ratio is higher in summer and lower in fall. The occurrence of multibirths shows higher twinning and triplet rates in spring and fall, respectively, whereas lower twinning and triplet rates occur in winter and summer, respectively. It could be demonstrated that geographical factors influence the rates of births and multibirths as well as the sex ratio.     

Long-term yersiniosis surveillance project in Czechoslovakia

The paper presents an epidemiological analysis of 8,232 cases of yersiniosis caused by Y. enterocolitica 03 over 1972-1988 as reported by Hygienic Stations. The steady epidemiological characteristics of yersiniosis were the prevalence of children and boys and a typical seasonal pattern with differences between the Czech and Slovak Republics. In the Czech Republic, there were several incidence peaks following, when summarized, the incidence curve of other alimentary infections, whereas in the Slovak Republic morbidity reached its peak during winter months. The numbers of isolated strains oscillated significantly between districts and by years. It appears that the number of positive findings in different districts is not only an objective value reflecting a mosaic-like pattern of incidence but also depends on the quality of microbiological diagnostics.     

The epidemiological characteristics of twinning in Northwest India

The data on twin births from four different places in Northwest India were analyzed to study epidemiological characteristics of twinning. Gujjars manifested the highest incidence of twinning (30.2 per 1000 births). The twinning rate at Amritsar for the year 1987 was 19.20. At Bathinda and Jammu, the average twinning rate over the period 1984–93 were 10.70 and 11.40 respectively. Stillbirth rate among twins was much higher in Gujjars as compared to other three samples. Regional trends of twinning rate showed the highest incidence in the state of Uttar Pradesh, while the lowest in Tamilnadu. There were no significant differences between states for MZ twinning rate, while differences in the DZ twinning rate were significant in some instances. Maternal age and parity specific twinning rate showed the highest incidence at parity 4 and in the maternal age group 30–34 years. There was evidence of both seasonality and secular trends in twin births. The highest incidence of twin births over the period 1984–93 was noted in the summer season followed by rainy season, while the lowest in autumn. The average incidence of twinning in the Jammu region decreased from 13.76 during the years 1984–89 to 9.07 during the year 1990–93.     

Complement-fixing antibodies against rotaviruses in healthy children in the Czech Socialist Republic and People's Democratic Republic of Yemen

Levels of complement-fixing antibodies against rotaviruses were evaluated in the sera of 900 healthy children aged 1-9 years 300 sera were collected in the People's Democratic Republic of Yemen in September-October 1985, 300 sera were obtained in the Czech Socialist Republic in the same period and another 300 also in the Czech Socialist Republic in September-October 1986. The latter two groups were investigated in the framework of immunological surveys. A complement-fixation antigen was prepared from a simian strain of the rotavirus type SA-11 in a tissue cell line MA-104. The sera from Yemen featured lower mean titres in the age groups and thus the lowest overall titre. As the antibody titre increased, the portion of seropositive sera from Yemen declined by far more rapidly than in the Czech children, where it remained virtually the same. The sera from Yemen showed the lowest negative rate and lowest ratio of high titres. The antibody titre of 1:64 and higher was not detected in children from Yemen, while they occurred in the two groups of Czech children. There was no correlation between antibody titres and probands' sex, nor was there linear dependence of titre magnitude on age. The mean positivity rate in each group as assessed by the antibody titres was the lowest in the sera from Yemen. The percentage of positive sera in all age groups was higher in the Czech children with the exception of children from Yemen aged 6 and 9 years. The aim of the present study was to evaluate the antibody status in infant populations and thus expand knowledge of rotavirus epidemiology.     

Seasonal variation of livebirths, stillbirths, extramarital births and twin maternities in Switzerland.

A study was made of the seasonal variation in all births, and births according to marital status, multiplicity and birth status (live and still) in Switzerland recorded between 1876 and 1990. To obtain seasonal variation in as pure as possible form, our analyses are based on rates. When comparing the seasonality in data sets showing markedly different levels, standardised indices were used. Assuming the length of pregnancies with twins to be about one month shorter than for pregnancies with singletons, lagged twinning rates were calculated but, in comparison with actual twinning rates, the general seasonal variation remained. Therefore, this study was based on actual twinning rates. A monotonic increase in the amplitude of the seasonal variation in general births was noted for the period 1876-1930, with strong seasonal variation holding for 1921-1980. After that, a marked decline in the amplitude can be observed. Seasonality of both all births and twin maternities showed very similar pattern for the periods 1876-1930 and 1969-1990, with maxima in the spring (March-May) and troughs in late autumn (October-December). Twin maternities showed a strong seasonality for the period 1876-1930, being about 20% higher in March than in October. The twinning rate in the period 1876-1930 was about 2.6 per thousand units higher than in the period 1969-90. For twin maternities there was also a stronger seasonal variation during the earlier period than during the later one. The pattern of the seasonal variation for extramarital births, showing a maximum in February (conceptions in May-June) and a minimum in August (conceptions in November-December) with a difference of no less than 24% was more marked than for the marital births. It seems likely that this seasonality of extra-marital maternities was due mainly to seasonal variation of coital rates and multiple ovulation in the early summer months coinciding with optima of light, temperature and food supply. A strong reduction in the rate of stillbirths (gestational age more than 29 weeks) was observed during the twentieth century. The stillbirth rate declined from about 40 per 1000 in the 1870s to fewer than 5 per 1000 in the 1980s. Irrespective of this strong decline in the stillbirth rate, the same seasonal rhythm was noticed throughout the period with high stillbirth rates among births around March and low rates during the summer and autumn.     

Population increase of forest birds in the Czech Republic between 1982 and 2003

Capsule Populations of most forest bird species increased between 1982 and 2003, probably due to increased forest cover and changes in forest age-class composition.

Aims To determine population changes of forest birds in the Czech Republic and to determine their possible causes.

Methods Population data were collected via the Breeding Bird Monitoring Programme, which is based on skilled volunteers counting birds at point transects using a standardized technique. Population trends and indices for the period 1982–2003 were calculated for 47 species using log-linear models. Published data on development of forest cover and forest age composition in the Czech Republic were used to indicate environmental change over the same period.

Results Populations of most forest species increased between 1982 and 2003. There was also an increase in forest cover and an increase in the proportion of older forest age-classes. The increase in forest specialist birds was positively correlated with the average increase in forest coverage.

Conclusions The populations of Czech forest birds have increased in the last two decades. This contrasts with widely reported declines of farmland bird populations throughout Europe. The correlation between populations of specialized forest species and extent of forest habitat suggests that changes in land-use are an important factor. However, increasing cover of mature forests could have a similar effect on the populations of specialist species.     

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.     

The effects of assisted reproduction on the trends and zygosity of multiple births in England and Wales 1974-99.

Assisted reproductive techniques have led to an increase in the proportion of maternities that are multiple. Though predominantly dizygotic, they are at greater risk of monozygotic division than those spontaneously conceived. England and Wales data 1974-99 on stillbirths and livebirths were analysed for 4 periods: 1974-80 (pre-assisted reproduction; 1982-8; 1989-91 (pre-redefinition of stillbirth); 1993-9 (post-redefinition of stillbirth). For twin data, Weinberg's rule was applied to estimate the proportions that were mono- (MZ) and dizygotic (DZ). Compared with the period before assisted reproduction, the most recent period shows an increase in twin maternities of 3.81 per 1,000 comprised of 3.22 (95% CI 3.10 to 3.33; p < 0.0001) DZ and 0.60 (95% CI 0.51 to 0.68; p < 0.0001) MZ twins. It is estimated that 15.7% of assisted reproduction twins are MZ. Higher order multiple births showed an increase of 3.06 (95% CI 2.85 to 3.29; p < 0.0001) per 10,000 maternities. Stillbirth rates in MZ twins are of the same order of magnitude as those in higher order multiple births but higher than those in DZ twins. The improvement in stillbirth rates over the 26 year study period is of the same order magnitude in singletons, DZ and MZ twins and higher order multiples. Assisted reproduction has led to a significant increase in the proportion of MZ twins. These are at high risk of fetal death and this needs to be considered when local stillbirth and perinatal mortality rates are used in auditing obstetric services.     

On the twin risk in autism

Autism is considered by many to be the most strongly genetically influenced multifactorial childhood psychiatric disorder. In the absence of any known gene or genes, the main support for this is derived from family and twin studies. Two recent studies (Greenberg et al. 2001; Betancur et al. 2002) suggested that the twinning process itself is an important risk factor in the development of autism. If true, this would have major consequences for the interpretation of twin studies. Both studies compared the number of affected twin pairs among affected sib pairs to expected values in two separate samples of multiplex families and reported a substantial and significant excess of twin pairs. Using data from our epidemiological study in Western Australia, we investigated the possibility of an increased rate of autism in twins. All children born between 1980 and 1995 with autism, Asperger syndrome, or pervasive developmental disorder not otherwise specified (PDD-NOS) were ascertained. Of the 465 children with a diagnosis, 14 were twin births (rate 30.0/1,000) compared to 9,640 children of multiple births out of a total of 386,637 births in Western Australia between 1980 and 1995 (twin rate weighted to number of children with autism or PDD per year 26.3/1,000). These data clearly do not support twinning as a substantial risk factor in the etiology of autism. We demonstrate that the high proportion of twins found in affected-sib-pair studies can be adequately explained by the high ratio of concordance rates in monozygotic (MZ) twins versus siblings and the distribution of family size in the population studied. Our results are in agreement with those of two similar studies by Croen et al. (2002) in California and Hultman et al. (2002) in Sweden.     

Influenza epidemics in the USSR and Czechoslovakia in 1979-1984

In this work materials characterizing the appearance and development of influenza epidemic at the territories of the USSR and the Czech Socialist Republic are presented, the common features and differences of the epidemic process in both countries are recorded. The work shows that in both countries the appearance of this epidemic is caused by the same virus. In most cases the epidemic started earlier and lasted longer in the USSR, but morbidity rate during the epidemic was, on the whole, higher in the Czech Socialist Republic. Similarity in the course of the primary period of the epidemic processes from their appearance to their maximum rise was observed. In both countries the maximum rise of morbidity rate was registered on weeks 3-4 from the beginning of the epidemic.     

Twinning across the Developing World

Background

Until now, little was known about the variation in incidence of twin births across developing countries, because national representative data was lacking. This study provides the first comprehensive overview of national twinning rates across the developing world on the basis of reliable survey data.

Methods

Data on incidence of twinning was extracted from birth histories of women aged 15–49 interviewed in 150 Demographic and Health Surveys, held between 1987 and 2010 in 75 low and middle income countries. During the interview, information on all live births experienced by the women was recorded, including whether it was a singleton or multiple birth. Information was available for 2.47 million births experienced by 1.38 million women in a period of ten years before the interview. Twinning incidence was measured as the number of twin births per thousand births. Data for China were computed on the basis of published figures from the 1990 census. Both natural and age-standardized twinning rates are presented.

Results/Conclusions

The very low natural twinning rates of 6–9 per thousand births previously observed in some East Asian countries turn out to be the dominant pattern in the whole South and South-East Asian region. Very high twinning rates of above 18 per thousand are not restricted to Nigeria (until now seen as the world''s twinning champion) but found in most Central-African countries. Twinning rates in Latin America turn out to be as low as those in Asia. Changes over time are small and not in a specific direction.

Significance

We provide the most complete and comparable overview of twinning rates across the developing world currently possible.     

Radiocesium in mushrooms from selected locations in the Czech Republic and the Slovak Republic

In this paper, activity concentrations of radiocesium in mushrooms from various locations in the Czech Republic and the Slovak Republic in the years 2000–2004 are presented. Summary reports of Czech regulatory bodies have judged the average activity concentrations in mushrooms to be remarkably below the maximum permissible level of contamination. However, there are certain regions where radiocesium activities have approached the maximum permissible level for contamination of basic foodstuff. For example, the highest activity concentration of ¹³⁷Cs measured by gamma-spectrometry was 2,263 Bq kg⁻¹ (on a dry mass basis), in Xerocomus badius from Staré Ransko (a locality in the Czech-Moravian Highlands, Czech Republic). The highest activity concentration of ¹³⁷Cs measured in Slovakia was 966 Bq kg⁻¹ (on a dry mass basis), for Suillus luteus from Senica. For comparison, the corresponding activity concentration in a sample taken within the 30 km zone around Chernobyl was measured to be 6,000 Bq kg⁻¹ (on a dry mass basis). Our results have also demonstrated remarkably lower activity concentrations of ¹³⁷Cs in Slovakia compared to those in the Czech Republic.     

Population based study of rates of multiple pregnancies in Denmark, 1980-94.

OBJECTIVE: To study trends in multiple pregnancies not explained by changes in maternal age and parity patterns. DESIGN: Trends in population based figures for multiple pregnancies in Denmark studied from complete national records on parity history and vital status. POPULATION: 497,979 Danish women and 803,019 pregnancies, 1980-94. MAIN OUTCOME MEASURES: National rates of multiple pregnancies, infant mortality, and stillbirths controlled for maternal age and parity. Special emphasis on primiparous women > or = 30 years of age, who are most likely to undergo fertility treatment. RESULTS: The national incidence of multiple pregnancies increased 1.7-fold during 1980-94, the increase primarily in 1989-94 and almost exclusively in primiparous women aged > or = 30 years, for whom the adjusted population based twinning rate increased 2.7-fold and the triplet rate 9.1-fold. During 1989-94, the adjusted yearly increase in multiple pregnancies for these women was 19% (95% confidence interval 16% to 21%) and in dizygotic twin pregnancies 25% (21% to 28%). The proportion of multiple births among infant deaths in primiparous women > or = 30 years increased from 11.5% to 26.9% during the study period. The total infant mortality, however, did not increase for these women because of a simultaneous significant decrease in infant mortality among singletons. CONCLUSIONS: A relatively small group of women has drastically changed the overall national rates of multiple pregnancies. The introduction of new treatments to enhance fertility has probably caused these changes and has also affected the otherwise decreasing trend in infant mortality. Consequently, the resources, both economical and otherwise, associated with these treatments go well beyond those invested in specific fertility enhancing treatments.     

Twinning and heteropaternity in chimpanzees (Pan troglodytes)

Unlike monozygotic (MZ) twins, dizygotic (DZ) twins develop from separate ova. The resulting twins can have different sires if the fertilizing sperm comes from different males. Routine paternity testing of a pair of same-sexed chimpanzee twins born to a female housed with two males indicated that the twins were sired by two different males. DNA typing of 22 short-tandem repeat (STR) loci demonstrated that these twins were not MZ twins but heteropaternal DZ twins. Reproductive data from 1926-2002 at five domestic chimpanzee colonies, including 52 twins and two triplets in 1,865 maternities, were used to estimate total twinning rates and the MZ and DZ components. The average chimpanzee MZ twinning rate (0.43%) equaled the average human MZ rate (0.48%). However, the chimpanzee DZ twinning rate (2.36%) was over twice the human average, and higher than all but the fertility-enhanced human populations of Nigeria. Similarly high twinning rates among African chimpanzees indicated that these estimates were not artifacts of captivity. Log-linear analyses of maternal and paternal effects on recurrent twinning indicated that females who twinned previously had recurrence risks five times greater than average, while evidence for a paternal twinning effect was weak. Chimpanzee twinning rates appear to be elevated relative to corresponding estimated human rates, making twinning and possibly heteropaternity more important features of chimpanzee reproductive biology than previously recognized.     

Echinococcus multilocularis in the red fox Vulpes vulpes from the East Carpathian region of Poland and the Slovak Republic

The occurrence of Echinococcus multilocularis in the Poland-Slovak frontier zone of the East Carpathian region was assessed, for comparison with that in adjacent regions in both countries. A total of 392 red foxes from Poland and 427 red foxes from the Slovak Republic were examined from 2001 to 2004. Significant differences in prevalences were observed in foxes captured from the borderland and adjacent zones in both countries. The mean prevalence of E. multilocularis in the Polish borderland reached 45.7+/-18.6% and in the Slovak border 35.0+/-10.7%. In both countries, the prevalence of E. multilocularis in red foxes from adjacent districts, outside the frontier Carpathian region, was considerably lower (18.9+/-9.2% in Poland and 20.8+/-9.0% in Slovakia). These differences are probably due to geomorphological and ecological factors, which contribute to the survival of the tapeworm eggs and the subsequent spread of infection. The Carpathian regions of northeast Slovakia and southeast Poland are characterized by specific climatic conditions such as low mean annual air temperatures, low temperatures in active soil surfaces, high soil humidities and a high mean annual rainfall.     

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.