Subjects were 189 twin pairs, 165 MZ and 24 same-sexed DZ, who entered the junior high school affiliated to Tokyo University (sample T), and 93 twin pairs, 71 MZ and 22 same-sexed DZ, who were registered at Kinki University (sample K). The zygosity was previously identified by many genetic markers, and this study aimed at zygosity diagnosis by questionnaire. The latter included three questions: “How are you alike?”, “How often are you mistaken?”, and “By whom are you mistaken?”. According to the degree, 1-3 points, 1-3 points, and 1-4 points were given for each question, and the sum of the points of each pair of twins was calculated. Zygosity was determined by the sum of points, distributed from 6 to 20. Namely, if the sum was 6-13, the twin pair was considered MZ, and if the sum was 14-20, DZ. More than 90% of twins were diagnosed correctly by use of this cutting point. This result was in accordance with that obtained by use of discriminant function analysis. It is concluded that zygosity diagnosis by questionnaire is convenient and useful, in particular for epidemiological research.

Within the same in vitro fertilization (IVF) program, treatment trials leading to single and multiple ongoing gestation were compared. Rates of cesarean delivery, prematurity and perinatal mortality were found much higher among twin and multiple IVF pregnancies. Our work thus attempts at defining characteristics of proneness to multiple gestation in IVF treatment, in order to try and avoid its occurrence. The mean vitality score of embryos replaced is the most reliable criterion for this purpose, enabling one to replace no more than two embryos when the average score is high. Age of the patient and cause of infertility are almost nondiscriminant in this respect. Ovarian stimulation parameters such as total dosage of gonadotropin treatment and level of estrogenic response, as well as numbers of oocytes and embryos obtained, may serve as secondary criteria for assessing the twinning risk.

Out of 296 mothers of twins interviewed about difficulties encountered while rearing twins, 49% mentioned inadequate sleep, 18% financial strain, 39% emotional disturbance, 22% disturbance in the marital relationship, and 43% lack of time to take care of other children. With the growth of twins, the problems gradually decreased, except for emotional disturbance, the most difficult period being the first year. Only 15% reported leaving the babies in the care of relatives during the day time. Overall, 68.2% felt the support from the father, but 39% of them felt the support was useless; 49% felt support from the mother-in-law, but 43% of them regarded the mother-in-law to be of no help; 36% were supported by their own mothers, but 54% mentioned that they had received little help. One must conclude that social support from relatives was inadequate. Public policy should take this fact into account and provide public health nurses and social workers to help the mothers of twins, especially during the first year.

Advances in the management of the multiple pregnancy and delivery must be accompanied by corresponding improvements in service access outside key centres and especially in the information families receive about what may happen during or after the pregnancy. A major review of birthing services in Victoria has focussed attention on four areas where the quality of information is often inadequate. 1) Prepregnancy and the standard of counselling about the incidence of multiples as a result of fertility drugs and in vitro fertilization procedures and about problems which may accompany a multiple birth. 2) Antenatal: At what stage of the pregnancy should parents be told of the multiple pregnancy and how should monitoring of the mother and procedures such as bedrest take into account what are often conflicting demands within the family? 3) Perinatal: Families are frequently illprepared for a cesarean delivery and for the procedures for premature multiples. The problem is often compounded by separation of the mother from one or both twins. While bereavement services are improving, much still needs to be learned about handling congenital abnormalities in one or more multiples. 4) Postnatal: Irrespective of the level of prenatal advice, families greatly underestimate the workload with multiples. The resulting stress contributes to the incidence of postnatal depression, child abuse and divorce now being reported from multiple birth families. Some suggestions are made from social psychology and genetic counselling about how families can best handle risk information to achieve the goal of neither under- nor overestimating the risks at these different stages of the multiple pregnancy.

Current antenatal technologies have improved the obstetrician's ability to assess fetal well-being as well as to diagnose fetal compromise. These technologies have given rise to very difficult ethical issues in the management of compromised twin pregnancies: for example, a choice must be made between putting a healthy twin at risk due to preterm delivery for the sake of a compromised cotwin or of allowing the compromised twin to die in order to buy time for the healthy twin. Though each case is unique, good medical practice requires a standard of care by which consistent patient management can be proposed. In the pluralistic environment of Northwestern Memorial Hospital, our staff has favored a standard of care based on patient autonomy. This approach demands: 1) a practitioner who offers a thorough explanation of the diagnosis and possible treatment approaches; 2) time for the patient and her partner to assimilate this information and test treatment options against their personal value system; 3) a third, but disinterested, party to facilitate patient understanding and value clarification; 4) a practitioner either willing to support the patient's decisions or refer her to another practitioner who will.

Over 80,000 multiple birth babies are born each year in the U.S. Their families must cope with a constellation of complex physical and psychosocial challenges, which jeopardizes their health and functioning. The demands of twin pregnancy and the parenting of twins, triplets, quadruplets, quintuplets or more puts these families at disproportionately high risk for infant mortality, birth defects, child abuse, substance abuse, financial problems and marital problems. Health and social service resources must be developed to alleviate the stresses associated with multiple birth and to empower parents to cope well. Guidelines for policies, parent education, professional training and service delivery developed for the California Department of Health Service, Maternal and Child Health Branch, are here offered for the consideration of policy makers and public health planners.

A questionnaire was given to parents of twins concerning their perceptions of dependency and similarity in their twin children. Also, the parents were asked if they tried to influence their children to become more dissimilar. 70 samesex twin pairs (35 MZ and 35 DZ) were included in the study and a questionnaire was sent both to the mother and the father of the twins. The twins were approximately 12 years old and attended grade 4, 5 or 6 in the Swedish compulsory school. Results indicated that parents consider MZ twins to be dependent upon each other and to spend more time together. This was especially evident for girls. If the twins had a free choice they would also tend to choose similarly. This trend was also more pronounced for the MZ girls. Irrespective of zygosity, most parents reported that they did not try to influence their children. In the case of MZ twins this will probably make them become more similar over time. Differences between maternal and paternal answers tended to be nonsignificant.

The present study deals with the relationship between blood uric acid level and human behavior. Subjects were 37 MZ and 7 DZ twins aged from 18 to 45 years. In males, blood uric acid level increased with age, while it decreased with age in females. Blood uric acid level was corrected and standardized using regression lines separately for males and females. The distribution of standardized uric acid level corresponded well with the theoretical curve of normal distribution. The intraclass correlation coefficient for standardized uric acid level was r = 0.370 (P < 0.05) for the 37 MZ twins, but not significant for the 7 DZ twins. These findings suggest that blood uric acid level is genetically controlled. By the analysis of 12 personality traits in YG (Yatabe-Guilford) character test, it was revealed that “General activity” was more controlled by genetically than environmentally. In the evaluation of the correlation between standardized uric acid level and the YG 12 personality traits, significant correlation was observed in “Lack of agreeableness” and “Rhathymia”. Since these two personality traits include the factor of “activity”, it is concluded that the plasma uric acid level and activity in a broader sense are under genetic control. This conclusion is consistent with the generally accepted view that persons with high uric acid level are more active and energetic than those with low level.

It has been suggested that the surviving cotwin and the mother are seriously affected when intrautrine fetal death of one monozygotic twin occurs. Several authors have reported brain damage in the surviving twin coexisting in utero with dead monozygotic cotwin. Most of such instances are monochorionic and show vascular communication between paired twins in the placenta. In a total of 133 pairs of monochorionic twins, death of one twin during pregnancy occurred in 33 cases (24.8%). Of 33 surviving twins, 8 babies suffered from porencephaly, cerebral palsy and other abnormalities. More unfavorable prognosis was recognized when a cotwin died in the latter half of pregnancy, while when a monozygotic cotwin died in the early stage of pregnancy, the surviving twin uneventfully grew to term in most cases.

In order to examine the genetic variance and heritability of serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides, a total of 349 pairs of same-sexed twin neonates born in four major general teaching hospitals in Taipei City were studied. Based on the placental pattern and 12 red blood cell antigens, 271 monozygotic (MZ) and 78 dizygotic (DZ) twin pairs were identified. There was a significant genetic variance for total cholesterol, HDL-C, LDL-C, and triglycerides both unadjusted and adjusted for sex, gestational age and placentation. The unadjusted heritability of total cholesterol, HDL-C, LDL-C, and triglycerides was 0.59, 0.30, 0.25 and 0.75, respectively; while the corresponding adjusted heritability was 0.74, 0.38, 0.31, and 0.49, respectively. Intrapair variance of serum lipids was not significantly different between monochorionic and dichorionic MZ twins.

A case is reported of a transfusion syndrome in a triplet pregnancy with intrauterine death of two of the fetuses. This is an exceptional occurrence in a triplet pregnancy and raises the problem of the management of multiple pregnancies associated with the death of one or more of the fetuses. The problem of the method of delivery and the complications arising in triplet dizygotic pregnancies is discussed.

The Finnish Twin Cohort material was used to estimate genetic and environmental effects in the etiology of hyperopia (farsightedness). All twin pairs in the cohort born before year 1927 (age 60 years and over at the time of the study), with both members alive, were sent a questionnaire. The questionnaire included questions of past and present eye diseases, visits to ophthalmologists, use of glasses and other vision-related questions. The hyperopia was assessed by asking the patients to send their last prescription for glasses to the authors. Twins with any eye disease affecting refraction (cataract, corneal damage), operation or trauma to their eyes were discarded from the present study. In 191 pairs (80 monozygotic and 111 dizygotic pairs) one or both members of the pair had a hyperopic refractive error. The correlations of refraction between right and left eyes of both MZ and DZ pairs were high (Spearman Rank Correlations of 0.86-0.89). The intrapair correlations among MZ pairs were higher (0.44 for right and 0.45 for left eyes) than intrapair correlations among DZ pairs (0.24 for right and 0.15 for left eyes). The variances were not significantly different among MZ and DZ pairs. The classical analysis of heritability gave an estimate of 0.75 for hyperopia. The result suggests that genetic factors are important in hyperopia and especially in hyperopia of higher degree.

Ultrasonic assessment of fetal weight derived from multiple measurements of the fetus has become accepted in clinical practice as being useful in singleton pregnancies. Several different formulae for estimating fetal weight have been derived from differing measurements of the fetus, such as biparietal diameter, trunk circumference, and femur length. To date, there has been no attempt to evaluate such a technique in multiple pregnancy. This study aims to see whether the formulae derived for singleton pregnancy are applicable to twin pregnancies. Estimated fetal weight will be derived by mathematical modelling from ultrasonic measurements made within a week of delivery and the results compared with the actual birthweight to give an indication of how good such estimated fetal weights are. Factors to be considered in the analysis include whether there are differences between Twin I and Twin II, differences of presentation with twins and differences by gestation at delivery.