The multiple regression analysis of twin data in which a cotwin's score is predicted from a proband's score and the coefficient of relationship (the basic model) provides a statistically powerful test of genetic etiology. When an augmented model that also contains an interaction term is fitted to the same data set, direct estimates of heritability (h2) and the proportion of variance due to shared environmental influences (c2) are obtained. A simple transformation of selected twin data prior to regression analysis facilitates direct estimates of h2g (an index of the extent to which the difference between the mean of probands and that of the unselected population is heritable) and a test of the hypothesis that the etiology of deviant scores differs from that of variation within the normal range.

Twenty–three cases of symmetrical conjoined twins were registered by the Latin-American Collaborative Study of Congenital Malformations (ECLAMC) in 1,714,952 births, which were observed during the 1967-1986 period in 95 maternity hospitals distributed in eleven Latin-American countries. This results in a birth prevalence rate of about 1/75,000 births. The secular and geographic distribution of this material do not depart from random in spite of one hospital with three cases, and two hospitals with two cases each, within a short time period. These 23 cases include one diprosopus, 3 dicephalus, one ischiopagus, 5 pygopagus, none dipygus, 3 syncephalus, none craniopagus, 9 thoracopagus, one omphalopagus, and none rachipagus. Sex distribution is even, with 12 male and 11 female cases.

Two hundred fifty-one twin deliveries between January 1, 1978 and June 30, 1983 at Prentice Women's Hospital and Maternity Center were reviewed. Cases were excluded if birth weight was less than 500 g, if gestational age was less than 26 weeks or if an antenatal fetal demise had occurred. Maternal demographic characteristics, delivery data and infant characteristics are described. The effect of providing care to a high-risk population of mothers in whom approximately 60% either deliver thair infants preterm or with a birth weight of less than 2,500 g is discussed in terms of costs of care.

No consensus exists for the optimal mode of delivery for twin fetuses. Opinions vary by type of institution (university medical center vs community hospital), country or continent (North America vs Western Europe) and personal preference of individual physicians. This article lists clinical considerations in arriving at the decision and presents them in the form of a decision tree.

The NHLBI Twin Study is a longitudinal study of cardiovascular disease risk factors in 514 pairs of white, middle aged, male, veteran twins. The initial examination took place between 1969-1973. Ten years later, 81% of the living cohort returned for a second examination. Data collected up to 30 years prior to recruitment for the initial examination were used to characterize participants and nonparticipants; data from the initial examination were used to characterize returnees and nonreturnees to the second examination. Participants had significantly lower diastolic blood pressure and higher socioeconomic status than nonparticipants as measured thirty years earlier. Between the first and second examinations, the mortality of participants was less than 50% of the mortality of nonparticipants. Returnees to the second examination had a better health profile at the initial examination than nonreturnees, with significantly lower levels of cigarette smoking, glucose intolerance, hypertension, and diabetes and higher levels of pulmonary function. However, returnees were more obese than nonreturnees. Thus, this study of cardiovascular disease risk factors in twins appears to be affected by response bias in a way similar to studies of individuals. Additional analyses of biases that may affect the genetic component of the study indicated that factors related to classical twin analyses were relatively unaffected by selection.

The trends in births and in twinning in Australia are compared from 1854 to 1982. Until about 1930 the twinning rate increased as births fell. The two rates then became concordant. The relationship of fecundity to twinning is discussed. Comparison with other countries is made. The period embraces the demographic transition when changing contraceptive practices would have had a variable effect on twinning.

Twinning rates for the years 1975-79 in Catalonia (Spain) are presented. Crude rates are very low: 7.62 per 1,000 maternities, the DZTR and the MZTR being 3.74 and 3.88 respectively. Standardized rates remain very low. Sex ratio among twin couples is also very low (0.49 male vs 0.51 female births). A multiple linear stepwise regression on the twinning rates shows MZ rates to be influenced by birth order and father's age, and the DZ rates by mother's age and birth order.

We examined the placentas of 182 like-sexed live-born twins: 73 placentas (40.1%) were monochorionic and 109 (59.9%) were dichorionic. All twin pairs with monochorionic placentas were monozygotic (MZ), but 28.9% of pairs with dichorionic placentas were MZ. Analysis of birth weights demonstrated that dichorionic and dizygotic (DZ) twins were heaviest, and suggested that the chorion status is a more important determinant of birth weight than zygosity. Vascular anastomoses were identified only in monochorionic placentas and occurred in 79.5% of cases. All placentas with deep anastomoses had superficial anastomoses. A higher proportion of velamentous and marginai insertions of the umbilical cord in monochorionic placentas (27.4%) compared to dichorionic placentas (13.8%) supports the belief that lateral placental growth is greatest in twin gestations in which the embryos are initially most closely apposed — The theory of trophotropism.

Recent clinical literature on the causes of twin pregnancy and specific areas of antenatal care are reviewed. Controversial aspects of clinical management are discussed.

The more that twin and other multiple pregnancies are investigated, the more it becomes mandatory that collaborative studies are set up in order to attain the criticai number of cases needed to achieve meaningful and reliable results. The European Multiple Birth Study (EMBS) aims to study two aspects of twin and multiple pregnancy: 1) management of pregnancy and labour, with emphasis on the prevention of preterm delivery; 2) accurate determination of zygosity, a prerequisite for the proper use of the twin method in a variety of fields, eg, congenital malformations, genetics, clinical investigations, etc. The rationale, the methods and the organisation of the study are described and discussed.

Most population studies of twins estimate the number of monozygotic (MZ) and dizygotic (DZ) pairs by Weinberg's differential rule. This rule assumes that within the DZ twins the numbers of unlike-sexed (U) and like-sexed (L) twins are equal. The literature on the validity of Weinberg's rule is still controversial. In this prospective population-based study (EFPTS) of 2,589 twin pairs, of whom 2,577 were of known zygosity and placentation, the estimates of Weinberg's rule agree well with the results of direct zygosity determination.

Ten pairs of full-term and 8 pairs of preterm twins from combined vaginal and Cesarean section deliveries were evaluated on measures of neonatal temperament, developmental status, and integrity to determine if the Cesarean-delivered infant was compromised relative to its vaginally-delivered twin. There were no significant differences, within groups, between the vaginal and Cesarean section infants on measures of risk and developmental status. Analyses of variance of paired comparisons performed on the temperament measures indicated that, for the full-term group, there were no significant differences in ratings between vaginally and Cesarean-delivered infants. In contrast, preterm infants delivered by Cesarean section were more active during sleep than their vaginally-delivered cotwins. This finding, together with previous findings demonstrating a relation between this measure and temperament at 9, 18, and 24 months of age, suggested that the preterm Cesarean-delivered infant may be at risk in this area when compared with its twin. In the main, however, the results demonstrated that infants born by Cesarean section following vaginal delivery of their twins were not more compromised than their twin siblings.

A secular demographic study on the Iniö Island in SW Finland shows an even stronger decline of twinning rates than in the Åland Islands and the rest of the archipelago. Twinning rates in Iniö declined, in fact from about 30‰ to less than 10‰.

We investigated if it is possible to use the data collected in twins to identify areas with high rates of operative deliveries, preterm deliveries and low birthweight infants in singletons. Our data correspond to all deliveries registered in Belgium in 1983. A significant correlation was found between the rates of cesarean sections in twins and in singletons. A significant correlation was also found between the rate of deliveries at a gestational age of less than 32 weeks in twins and the rate of deliveries at less than 37 weeks in singletons. However, correlations between other preterm rates, low birthweight rates and vacuum extraction or forceps rates, were nonsignificant. We conclude that the use of twins as tracers of the quality of care in singletons is of limited value.

A case-control study was conducted on the termination of menstrual life on mothers of twins. It involves a much larger data base and finer analyses, and makes use of the same methodology of a previous study. The time interval between the twin and the last confinement proved to be shorter in twin-bearing mothers than in a matched set of controls with singletons only after blocking of the effect of birth order, and despite the similarity of maternal age at delivery and confinements numbers. Mothers of like-sex twins only appeared to terminate reproductive life earlier than controls. The separate study of maternal age at twin confinement shows that the earlier the twin birth the shorter the menstrual life thereafter. Both like-sex twin births and early maternal age at delivery of a twin pair have the same shortening effect on subsequent menstrual life without clear evidence of additivity of effects as if both occurrences were alternatives with similar biological effects. Comparison of the results of the current study with those of our earlier analysis shows consistency on above results. However, the current study could not reproduce previous results on the role of unlike-sex twins or late maternal age at delivery on time to last confinement; yet, they cannot be discarded. It is suggested that increased power of interaction analyses and tighter matching of controls with respect to sex might improve the conclusions of subsequent studies.

A comparison was made of the stature of women, twinning rates, and breast cancer mortality for 32 countries. As height increased, so did twinning and breast cancer mortality (P < 0.005). Dizygotic twinning and breast cancer increased sharply with the mean height of the female population. With due caution in drawing causal inferences when uncontrolled confounding variables are present, it is suggested that these findings are an evolutionary consequence of the high mortality found in twin pregnancy.

In 65 consecutive twin pregnancies, 722 measurement of fetal abdominal circumference have been obtained with ultrasound. Zygosity was established after delivery in 85% of the pregnancies. There was no difference in mean abdominal circumference measurements between monozygotic and dizygotic pregnancies. In both groups, the pattern of growth was linear throughout pregnancy in contrast to that predicted by birth-weight for gestational age charts. It is suggested that increasing trunk flexion, in later twin pregnancy, may distort accurate abdominal circumference measurement.

Mean MZ and DZ twinning rates in seven big Greek cities were 3.2 and 4.75 per 1,000 maternities, respectively, during the 1980-1985 period. The seasonal variations in twinning frequencies are not significant. The total twinning rate in Greece shows a decreasing trend from 1956 to 1985.

The components of a research program focussing on early mother-twin interaction is described. Preliminary data obtained from a questionnaire at two months post term, cross-sectional observations at the age of one year, a follow-up study involving home observation and parental interviews from birth to the age of 3, point to the specificity of this triadic situation. During the first months of life, the burden of material tasks and the increase in baby care leave little time for starting a relationship based on pleasure or play. The impossibility of responding simultaneously to the needs of two babies and the difficuty of forming relationships on an individual basis foster early concerns for egalitarianism. The degree of physical resemblance between the babies creates the problem of differentiating them. To tell twins apart, mothers rapidly tend to rely on behavioral characteristics to which they attribute a genetic basis. In contrast, differences in development between the babies that introduce the eventuality of the dominance of one of the twins are often denied. In this highly specific situation, mothers arrive at personal solutions of adjustment over the first 3 years, manifest in a certain number of psychological and educational attitudes. Analysis of these maternal attitudes may help to shed light on some of the features of later psychoemotional development in twins.

Twinning rates were studied in Swedes, Åland Islanders, Finns, Germans, and Dutch during years of starvation when death rates were two to three times higher than average. In contrast to the situation among some animals, this study suggests that nutrition above a certain threshold is unimportant for human reproduction, including twinning. The twinning rates for these different populations display marked temporal differences, but low values in the twinning rate are not consistently associated with periods of epidemics, famine, or similar nutritional stress. After years of privation and/or separation of spouses, a rapid “catch-up effect” can often be seen in the twinning rates, as well as marriage and birth rates. Psychoendocrine factors and interparental immunological conditions that may be involved in this phenomenon are discussed.