Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-25T20:09:43.189Z Has data issue: false hasContentIssue false
  • English
  • Français

Zygosity as a Risk Factor for Complications and Outcomes of Twin Pregnancy

Published online by Cambridge University Press:  01 August 2014

R.E. Hoskins
R.E. Hoskins*
Affiliation:
Department of Epidemiology, University of Washington, and the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
*
Department of Health/Epidemiology, 1102 SE Quince St, P.O. Box 47812, Olympia, WA 98504-7812, U.S.A.

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

All of the recorded twin live births in Washington State birth certificates between 1984 and 1988 were used a retrospective cohort study to determine the risk of zygosity on pregnancy complications and birth outcomes (n = 3458). Relative risks comparing different sex (DS) twins to same sex (SS) twins were corrected to relative risks relating dizygotic (DZ) to monozygotic (MZ) twins, using the Weinberg rule. A higher proportion of DS twin pregnancies (3.5%) than SS pregnancies (1.6%) were complicated by gestational diabetes, resulting in an estimated risk for DZ twin pregnancies relative to MZ pregnancies of 8.6 (95% CI = 3.5-21.0). DZ twin pregnancies were at a lower risk for complications of polyhydraminios (RRDZ∣MZ = 0.2, 95% CI = 0.1-0.4) and of pyelonephritis, (RRDZ∣MZ = 0.3, 95% 0 = 0.1-0.8). MZ twins were more likely to have low birthweight and to have shorter gestations. The proportion of first-born babies of MZ twin pairs who died during their first year was similar to that of first twins of DZ pairs; however, the second-born of MZ twins were more likely to die in infancy than were second-born DZ pairs. First twins of DZ pairs were more likely to die of SIDS (sudden infant death syndrome) than the first of MZ twins (RRDZ∣MZ = 1.5, 95% CI = 0.4-5.1). In contrast, DZ second-born were less likely to die of SIDS than were MZ second-born twins (RRDZ∣MZ = 0.1, 95%CI = 0.1-0.7). DZ twins were less likely to have adverse newborn conditions or malformations. The high risk for gestational diabetes for DZ twin mothers is possibly due to the presence of two placentas which may support the development of greater insulin antagonism than the single placenta in the mother of MZ twins. The reduced risk of DZ relative to MZ twins for selected adverse birth outcomes may result from the increased tendency of MZ twins to be premature.

Keywords

ZygosityTwinsPerinatal complicationsMonozygoticDizygotic
Type
Research Article
Information
Acta geneticae medicae et gemellologiae: twin research , Volume 44 , Issue 1 , January 1995 , pp. 11 - 23
Copyright
Copyright © The International Society for Twin Studies 1995

References

REFERENCES

1.Bulmer, MG (1970): The Biology of Twinning in Man. Oxford: Clarendon Press.Google Scholar
2.Campbell, DM, MacGillivray, I (1988): Outcome of twin pregnancies. Twinning and Twins. MacGillivray, I, Campbell, DM, Thompson, B (eds): Chichester: John Wiley & Sons Ltd.Google Scholar
3.Chaurasia, AR (1980): Perinatal mortality in twins. Acta Genet Med Gemellol 29:237–239.Google Scholar
4.Chescheir, NC, Seeds, JW (1988): Polyhydramnios and oligohydramnios in twin gestations. Obstet and Gynecol 71:882–884.Google Scholar
5.Coustan, DR, Felig, P (1988): Diabetes mellitus. In Burrow, GN, Ferrus, TF (eds): Medical Complications During Pregnancy. Philadelphia: W.B. Saunders Company, pp 34–64.Google Scholar
6.Dwyer, PL, Oats, JN, Walstab, JE, Beischer, NA (1982): Glucose tolerance in twin pregnancy. Aust NZJ Obstet Gynaecol 22:131–134.Google Scholar
7.Fleiss, JL (1981): Statistical Methods for Rates and Proportions. New York: John Wiley and Sons, p 205.Google Scholar
8.Fraser, C, Nylander, PPS (1988): The relationship of birthweight to later growth and intelligence in twins. In MacGillivray, I, Campbell, DM, Thompson, B (eds): Twining and Twins. Chichester: John Wiley & Sons Ltd.Google Scholar
9.Frost, F, Starzyk, P, George, S, et al (1984): Birth complications reporting: the effect of birth certificate design. Am J Public Health 74:505–506.Google Scholar
10.Gaehtens, G (1936): Klinscher Beitrag zur Pathogenese des akuten Hydramnions. Monatsschr Geburtschilfe Gynaekol 103:40–48.Google Scholar
11.Gedda, L, Segni, G, Andreani, D, Casa, D, DiMarco, G (1970): Diabete e gemellogenesi. Acta Genet Med Gemellol 19:98–99.Google Scholar
12.Getts, A (1981): SIDS: Increased risk to second-born twins (letter to the editor). Am J Public Health 71:317–318.Google Scholar
13.Ghai, V, Vidyasagar, D (1988): Morbidity and mortality factors in twins, an epidemiologic approach. Clinics in Perinatology 15; 1:123–139.Google Scholar
14.Hollenbach, KA, Hickok, DE (1990): Epidemiology and diagnosis of twin gestation. Clin Obstet Gynecol 33:1–21.CrossRefGoogle ScholarPubMed
15.Kleinbaum, DG, Kupper, LL, Morgenstern, H (1982): Epidemiologic Research: Principles and Quantitative Methods. London: Wadsworth.Google Scholar
16.Little, J, Bryan, EM (1988): Congenital anomalies in twins. In MacGillivray, I, Campbell, DM, Thompson, B (eds): Twinning and Twins. Chichester: John Wiley & Sons Ltd.Google Scholar
17.MacGillivray, I (1986): Epidemiology of twin pregnancy. Seminars in Perinatology 1:1–8.Google Scholar
18.MacGillivray, I, Campbell, DM (1988): Management of Twin Pregnancies. MacGillivray, I, Campbell, DM, Thompson, B (eds): Twinning and Twins. Chichester: John Wiley & Sons Ltd.Google Scholar
19.Magiste, M, Von Schenck, H, Sjoberg, N, et al (1976): Screening for detecting twin pregnancy. Am J Obstet Gynecol 126:697–698.Google Scholar
20.Masson, GM (1973): Plasma estriol in normal and pre-eclamptic multiple pregnancies. Obstet Gynecol 42:568–573.Google Scholar
21.McCulloch, K (1988): Neonatal problems in twins. Clinics in Perinatology 15; 1:141–158.Google Scholar
22.Naidoo, L, Jailal, I, Moodley, J, Desai, R (1985): Intravenous glucose tolerance tests in women with twin pregnancy Obstet Gynecol 66; 4:500–502.Google Scholar
23.O'Sullivan, JB, Mahan, CM (1964): Criteria for the oral glucose tolerance test in pregnancy. Diabetes 13; 3:278.Google Scholar
24.O'Sullivan, JB (1975): Long term follow-up of gestational diabetics. In Camerini-Davalos, RA, Cole, HS (eds): Early Diabetes in Early Life. New York: Academic Press, pp 503–510.Google Scholar
25.Posner, BI (1974): Insulin receptors in human and animal placental tissue. Diabetes 23; 3:209.Google Scholar
26.Potter, EL (1963): Twin zygosity and placental form in relation to the outcome of pregnancy. Am J Obstet Gynecol 87; 5:566–577.Google Scholar
27.Queenan, JT, Gadow, EC (1970): Polyhydramnios: chronic versus acute. Am J Obstet Gynecol 108:349–355.Google Scholar
28.Simpson, ML, Gaziano, EP, Lupo, VR, Peterson, PK (1988): Bacterial infections in pregnancy. In Burrow, GN, Ferris, TF (eds): Medical Complications During Pregnancy. 3rd edition. Philadelphia: W.B Saunders Company, pp 345–361.Google Scholar
29.Spellacy, WN, Handler, A, Ferre, CD (1990); A case control study of 1253 twin pregnancies from a 1982-1987 perinatal data base. Obstet Gynecol 75; 2:168–171.Google Scholar
30.Spellacy, WN (1988): Antepartum complications in twin pregnancies. Clinics in Perinatology 15; 1:79–86.Google Scholar
31.Standfast, SJ, Jereb, S, Janerich, DT (1980): The epidemiology of sudden infant death in upstate New York. Am J Public Health 70:1061–1067.CrossRefGoogle ScholarPubMed
32.Strong, SJ, Corney, G (1967): The Placenta in Twin Pregnancy. Oxford: Pergamon Press, pp 39–45.Google Scholar
33.Thompson, B, Fraser, C (1988): Some aspects of first births and the heights of twin sisters of known zygosity. In MacGillivray, I, Campbell, DM, Thompson, B (eds): Twinning and Twins. Chichester: John Wiley & Sons Ltd.Google Scholar
34.Vogel, F, Motulsky, AG (1979): Human Genetics. Berlin: Springer-Verlag, p 176.Google Scholar
35.Walter, SD, Irwig, LM (1988): Estimation of test error rates, disease prevalence and relative risk from misclassified data: a review. Journal of Clinical Epidemiology 41:9; 923–937.Google Scholar
36.Whitsett, JA, Johnson, CL, Hawkins, K (1979): Differences in localization of insulin receptors and adenylate cyclase in the human placenta. Am J Obster Gynecol 133:204–207.Google Scholar