Twinning is rare among humans, but there is much variability among populations. Several studies show that certain demographic and socioeconomic factors, such as maternal age, mother’s educational level and income, influence twinning rate. There is no background of analytical studies of twins in Uruguay. To the best of our knowledge, this is the first study that has focused on describing and analyzing Uruguayan twinning rates over a period of 17 years (1999–2015). The birth data were collected from the website of Uruguay’s Ministry of Public Health. Economic data were obtained from Uruguay’s Instituto Nacional de Estadísti’s website for the period 2001–2013, since these variables are defined specifically for that period of time. The statistical software R (The R Project for Statistical Computing) was used. The twinning rate varied from 8.51 to 13 in the studied period. Montevideo has the highest median and the smallest variability in comparison with the other departments. In Uruguay (1999–2015), the highest twinning rate (28.94%) was observed in women aged 45 and older. The analysis also showed a relationship between twin birth rates and the mother’s educational level. In three regions of the country (West, Center and East), twin births show a random pattern but in the other two (North and Metropolitan), there is an increasing trend in the number of twins over time. In conclusion, this study recognizes social, economic and demographic factors that influence in the rate of twin births in Uruguay.

Due to the high rate of complications, special medical care must be provided especially for monozygotic twin pregnancies, which are characterized as having 2.5 times higher mortality of fetuses. In recent years, examination of cell-free DNA (cfDNA) circulating in maternal plasma has become a useful noninvasive method of prenatal diagnosis. However, fetal DNA constitutes only 3–20% of plasma cfDNA during pregnancy. Short tandem repeats (STRs) are routinely used in forensic examination of DNA mixtures and are able to identify 5% minority components. Haplotypes of deletion/insertion polymorphisms and STRs (DIP–STRs) are able to detect even 0.1% minority components of DNA mixtures. Thus, STRs and DIP–STRs seem to be a perfect tool for detection of fetal alleles in DNA isolated from maternal plasma. Here, we present a novel noninvasive prenatal diagnosis technique of determination of pregnancy zygosity based on examination of feto-maternal microchimerism of plasma cfDNA with the use of STRs and DIP–STRs. Our preliminary results based on 22 STR loci showed 67% sensitivity, 100% specificity and 82% accuracy for prenatal detection of twin dizygosity. The corresponding values for seven DIP–STRs were 13%, 100% and 54%, respectively. Owing to assay performance, low DNA input requirements, low costs (below 10 USD per patient) and simplicity of analysis, genotyping of STR/DIP–STR markers in maternal plasma cfDNA may become a useful supplementary test for noninvasive prenatal diagnosis of twin zygosity in cases when chorionicity and zygosity cannot be reliably determined by ultrasound examination and prognostic value may be provided by a DNA test determining pregnancy zygosity.

Exclusive breastfeeding is currently recommended until at least 6 months of postnatal age, due to maternal breast milk (BM) unique composition and beneficial properties. In fact, BM modifies itself according to gestational age (GA) at birth, adapting its composition to neonatal requests during lactation. Multiple births represent about 3% of the whole pregnancies; such neonates result more vulnerable than full-term newborns, due to lower GA and birth weight (BW) and the higher incidence of perinatal complications. Although an adequate nutrition is fundamental for twins and other multiples, studies on this topic are lacking. We collected and analyzed BM from mothers of 19 twins and 5 triplets showing GA < 33 weeks and BW < 1500 g, comparing it to a control group of 28 preterm singletons. As a result, at GA ≤ 28 weeks, we observed that protein content is higher in BM for multiples (1.53 vs. 1.29 g per 100 ml), lactose concentration is greater in BM for singletons (6.72 vs. 6.34 g per 100 ml) and GA results the most relevant factor influencing BM protein composition. BM for multiples results higher in proteins and lower in lactose, if compared with singleton’s samples; this could promote and sustain growth and organ development in this vulnerable category. BM from multiples shows a trophic and immunologic role, since these neonates often show lower GA and BW instead of singletons. These findings could help in optimizing nutritional strategies and improving BM individualized fortification.

Findings related to visual functioning, drawn from early reared-apart twin studies, are summarized. These data are supplemented by more recent research from similar investigations. This section is followed by a survey of findings and conclusions from a special issue of the journal Seminars in Perinatology concerning the challenges and management of conjoined twins. An early case report on thoracopagus-conjoined twin cattle is also presented, as are neuroanatomical findings from a study of monozygotic twins discordant for musical training. Items noted in the news include college benefits for twin parents, an update on octomom, claims of gene editing of infant twins, the nature of quarternary marriages and an unusual planned twin pregnancy.

The seasonality of demographic data has been of great interest. It depends mainly on the climatic conditions, and the findings may vary from study to study. Commonly, the studies are based on monthly data. The population at risk plays a central role. For births or deaths over short periods, the population at risk is proportional to the lengths of the months. Hence, one must analyze the number of births (and deaths) per day. If one studies the seasonality of multiple maternities, the population at risk is the total monthly number of confinements and the number of multiple maternities in a given month must be compared with the monthly number of all maternities. Consequently, when one considers the monthly rates of multiple maternities, the monthly number of births is eliminated and one obtains an unaffected seasonality measure of the rates. In general, comparisons between the seasonality of different data sets presuppose standardization of the data to indices with common means, mainly 100. If one assumes seasonality as ‘non-flatness’ throughout a year, a chi-squared test would be an option, but this test calculates only the heterogeneity and the same test statistic can be obtained for data sets with extreme values occurring in consecutive months or in separate months. Hence, chi-squared tests for seasonality are weak because of this arbitrariness and cannot be considered a model test. When seasonal models are applied, one must pay special attention to how well the applied model fits the data. If the goodness of fit is poor, nonsignificant models obtained can erroneously lead to statements that the seasonality is slight, although the observed seasonal fluctuations are marked. In this study, we investigate how the application of seasonal models can be applied to different demographic variables.

The Chinese National Twin Registry (CNTR), initiated in 2001, has now become the largest twin registry in Asia. From 2015 to 2018, the CNTR continued to receive Chinese government funding and had recruited 61,566 twin-pairs by 2019 to study twins discordant for specific exposures such as environmental factors, and twins discordant for disease outcomes or measures of morbidity. Omic data, including genetics, genomics, metabolomics, and proteomics, and gut microbiome will be tested. The integration of omics and digital technologies in public health will advance our understanding of precision public health. This review introduces the updates of the CNTR, including study design, sample size, biobank, zygosity assessment, advances in research and future systems epidemiologic research.

It has been suggested that the risk of adverse perinatal outcomes in twin pregnancies is exacerbated by concomitant gestational diabetes mellitus (GDM). This study aimed to assess the risk incurred by twin pregnancy and by a diagnosis of GDM, separately, on the development of poor perinatal outcomes. A retrospective cohort study was conducted on all pregnant women at a tertiary center between 2016 and 2017. The impact of GDM and twin pregnancies on perinatal outcomes — birth weight above the 90th centile for gestational age, cesarean delivery, clinical neonatal hypoglycemia, and premature delivery (before 37 weeks’ gestation) — was assessed using univariate and multivariate analyses. Overall, 13,527 women were eligible for the study; 11,915 were uncomplicated singleton pregnancies; 1379 of these had GDM; 194 were twin pregnancies, and 39 of these had GDM. Univariate analyses showed that twin pregnancies were associated with a higher risk of all perinatal outcomes except macrosomia. In the multivariate analyses, twin pregnancy was a much higher predictor of cesarean delivery (OR 8.40, 95% CI [6.25, 11.49], p < .0001) and preterm birth (OR 58.82, 95% CI [31.25, 125], p < .0001) compared to GDM but GDM was a higher predictor of neonatal hypoglycemia (OR 4.87, 95% CI [3.74, 6.29], p < .0001). Twin pregnancy is more strongly associated with all adverse perinatal outcomes except macrosomia. GDM does not increase risk of adverse perinatal outcomes except for neonatal hypoglycemia.

The Beijing Twin Study (BeTwiSt), which was established in 2006, is an ongoing study aiming to investigate the genetic and environmental etiology of adolescent psychopathology. Resting-state brain imaging datasets have been examined for same-sex twins, and other psychological traits and emotional and behavioral variables have been examined for all twins. Based on the registry, the main findings regarding the etiological mechanism underlying adolescent development, magnetic resonance imaging results, and genetic and environmental influences on other psychological traits have been published. This article summarizes the key findings in these three areas and discusses future plans for the BeTwiSt.

The second recorded case of sesquizygotic (SQZ) twins is summarized. It is suspected that SQZ twins result from the fertilization of an egg by two separate spermatozoa, followed by division of the fertilized ovum. Next, recent studies examining how differences in parental affection affect co-twins’ personality profiles, the prenatal demise of fetuses during twin pregnancy, a forensic case of heteropaternal superfecundation and selective feticide in dichorionic twins are reviewed. Finally, summaries of newsworthy items featuring an identical twin Oscar winner, a case of ‘superfecundated’ twins born to a gay couple, identical twins who try partly living apart and new molecular techniques to distinguish an innocent identical twin from his or her guilty co-twin are presented.

Twin studies have shown that our sense of humor has an underlying genetic component, but less investigation of the origins of stand-up comedy has been undertaken. This article briefly reviews twin research findings on humor, then describes the working partnership and social affiliation of a pair of monozygotic male twins who perform together as stand-up comedians. The abilities, personalities and temperaments of these twins suggest future avenues for research in this interesting area. Next, findings from twin studies and case reports of twins with cleft lip and palate, dental caries, noninvasive prenatal testing and Capgras syndrome (with folie à deux) are summarized. In conclusion, recent news about athletic twins, transgendered twins, crib-sharing and career choice are presented.

Co-twin control is a well-known methodological twin research design, but its variations and complexities are less well known. Various issues and illustrations are presented with reference to studies involving natural events, experimental interventions and rare happenings that underlie monozygotic (MZ) twins’ environmental differences. This discussion is followed by summaries of recent twin research pertaining to cancer risk in overweight twins, the physical risk to surviving twins after fetal loss of a co-twin, a 20-year update of twin concordance for Parkinson’s disease, and neuroanatomical differences in musically discordant MZ twin pairs. Several twin-related items that have attracted attention in the news are also summarized.

The primary aim of the Guangzhou Twin Eye Study (GTES) is to explore the impact that genes and environmental influences have on common eye diseases. Since 2006, approximately 1300 pairs of twins, aged 7–15 years, were enrolled at baseline. Progressive phenotypes, such as cycloplegic refraction, axial length, height and weight, have been collected annually. Nonprogressive phenotypes such as parental refraction, corneal thickness, fundus photo, intraocular pressure and DNA were collected once at baseline. We are collaborating with fellow international twin researchers and psychologists to further explore links with general medical conditions. In this article, we review the history, major findings and future research directions for the GTES.

This article explores some rare sides of twin research. The focus of this article is the sad plight of the Dionne quintuplets, born in Canada in 1934. However, several other studies belong in this category, such as Dr Josef Mengele’s horrifying twin research conducted at the Auschwitz concentration camp, Dr John Money’s misguided attempt to turn an accidentally castrated male twin into a female, Russian scientists’ cruel medical study of conjoined female twins and Dr Peter Neubauer’s secret project that tracked the development of separated twins. Reviews of current twin research span twins’ representation of self-image, twins with Kleine–Levin Syndrome, heteropaternal twinning in lemurs and factors affecting risk of dental caries. Media coverage includes a pair of high-society models, a book about the ‘Winkelevii’ twins, Super Bowl twin teammates, a family with three sets of fraternal twins, a twin sister surrogate and a near presidential twin.