No randomised controlled trials of treatment of twin-to-twin transfusion syndrome (TTTS) exist. Since severely preterm neonatal survival has increased over time, survival as an outcome measure is confounded by improvements in neonatal care. The diagnosis-to-delivery interval is a measure of success of treatment independent of improvements in neonatal care. We wished to evaluate whether treatment of TTTS is associated with a lengthening of the diagnosis-to-delivery interval. MEDLINE search was performed supplemented by careful reference review. All TTTS series were included where the following information on each patient was available: survival, fetal demise, gestational age at diagnosis and diagnosis-to-delivery interval in days. Inclusion criteria: gestational age at diagnosis < 29 weeks and diagnosis by ultrasound in the absence of maternal symptoms. Cases undergoing multiple types of treatment were excluded. Eight publications met inclusion criteria and included the following cases: controls (n = 16), amnioreduction (n = 61), septostomy (n = 12), and fetoscopic laser occlusion of chorioangiopagus vessels (n = 51). There was no difference in the diagnosis-to-delivery interval, overall survival, at least one survivor, or number of fetal deaths between the four groups. Logistic regression using at least one survivor as the dependent variable revealed a positive association with gestational age at diagnosis and with diagno-sis-to-delivery interval, a negative correlation with fetal death, and no correlation with treatment group. We conclude that there is no difference in diagnosis-to-delivery interval or survival for any treatment for TTTS compared to expectant management. The lack of significance appears to be due to small sample sizes.

Assessment of treatment options in twin-twin transfusion should involve a detailed interrogation of the placenta and fetuses prior to treatment, stratification according to response to amnioreduction and careful analysis of quality of survival. Amnioreduction and laser coagulation are not alternative and equivalent modalities for the treatment of twin-twin transfusion. Randomized trials may not be ethical without prior therapeutic/ diagnostic amnioreduction.

Reports over the past seventy years show that twin gestations lead to an increased risk of hypertensive disorders. Numerous studies discuss the incidence of hypertensive disease in twin versus singleton gestations, as well as effects of parity, race, age, income level, smoking, zygosity and heritability on this condition. The range of relative risk of gestational hypertension, preeclampsia and eclampsia for twin compared to singleton gestations is 1.2 to 2.7, 2.8 to 4.4 and 3.4 to 5.1 respectively. Parity, African-American ethnicity, and young maternal age are all factors that increase the relative risk of acquiring hypertensive disease to 4.0, 1.8 and 1.5 in mothers of twin gestations. Factors such as maternal smoking, income level and zygosity have a negligible effect on the relative risk of acquiring hypertensive disease in twin gestations. In addition to twin mothers exhibiting a higher incidence of hypertensive disease compared to their singleton counterparts, they also exhibit an earlier onset of hypertensive disease at both 35 and 37 weeks of gestation comparatively. Uric acid levels measured at 30–31 weeks of gestation in twin mothers predicted the onset of preeclampsia with a sensitivity of 73% and a specificity of 74%. The range of risks presented in the literature is wide and the therapies avocated are diverse. We therefore decided to summarize the risks in a comparative fashion and to review current therapeutic strategies for the convenience of clinicians who confront increasing numbers of multiple pregnancies. The tables bring all recent published risks together in the first comparative analysis in which the data has been converted to relative risks and confidence intervals. Because the literature is relatively silent on specific management of hypertensive disease in twin pregnancies, general management recommendations for singleton gestations should be used by practitioners caring over twin gestations.

Ethnicity differences account for genetic, environmental, lifestyle, and reproductive variables, influencing the rate of twinning (Nylander, 1981). Frequently, ethnic differences correlate with variable perinatal care leading to differences in outcome. Free access to antenatal care, and to facilities for delivery and neonatal care is available for the entire population in Israel, and therefor differences attributed to levels of medical care are practically negligible. We previously evaluated the overall relationship between ethnicity and outcome in a popula-tion-based cohort of mothers of twins (Goldman et al., 2001). However, the overall comparison may have masked some differences that could be present. The purpose of this study was to evaluate whether ethnicity is associated with differences in perinatal outcome in randomly selected, matched-controlled Israeli Jewish and Muslim mothers of twins.

In many studies the twinning rate, being strongly dependent on maternal age (and parity), has been standardised according to the maternal age distribution. The direct method requires very informative twinning data for the target population. The indirect method is used when the data for the target population is not sufficiently informative or when the target population is small. We have earlier introduced an alternative indirect technique for standardising the twinning rate. Our technique requires even less of the twinning data. Besides maternal age, parity is an influential factor, and should, if possible, be taken into account. In this study we present the traditional standardisation methods based on both maternal age and parity, we propose a new direct standardisation method and we develop our standardisation methods so that they take into account both maternal age and parity. We apply these standardisation methods to data from Finland, 1953–1964, from St. Petersburg, Russia, 1882–92, from Canada 1952–1967, and from Denmark, 1896–1967. These methods all give results very similar to those for the Finnish data, but the effect of parity is strongest with the direct methods. This may be due to the fact that, among extramarital maternities, parity has a strongly increasing effect on the twinning rate. This may be attributed to a higher reproduction capacity among unmarried mothers. Standardisations of the Canadian and the Danish data also give reliable results. With the St. Petersburg data, however, the different standardisations show notable discrepancies. These discrepancies are compared with Allen’s findings.

There have been few replicated examples of genotype x environment interaction effects on behavioral variation or risk of psychiatric disorder. We review some of the factors that have made detection of genotype x environment interaction effects difficult, and show how genotype x shared environment interaction (GxSE) effects are commonly confounded with genetic parameters in data from twin pairs reared together. Historic data on twin pairs reared apart can in principle be used to estimate such GxSE effects, but have rarely been used for this purpose. We illustrate this using previously published data from the Swedish Adoption Twin Study of Aging (SATSA), which suggest that GxSE effects could account for as much as 25% of the total variance in risk of becoming a regular smoker. Since few separated twin pairs will be available for study in the future, we also consider methods for modifying variance components linkage analysis to allow for environmental interactions with linked loci.

Many studies have found strong peer correlations for a variety of problem behaviors that begin in adolescence (e.g. substance use). Such correlations are commonly attributed to peer influences, but could also be explained by selective (‘assortative’) friendship: the tendency for those with similar patterns of behavior to become friends. Here we show how, under certain assumptions, cross-sectional data from pairs of siblings or twins and their peers may be used to resolve the contributions of peer selection and reciprocal peer environmental influences to peer resemblance. We performed power calculations to determine necessary sample sizes for rejecting with 80% power, at the 5% significance level, the hypothesis of only peer selection effects, or only reciprocal peer environmental effects. A false hypothesis of only selective friendship effects was always easier to reject than a false hypothesis of only reciprocal peer environmental influences. Limitations of these simulations, including uncertainty about the most appropriate way to model peer selection, are discussed.

While heritability studies show that most of the variance in adult personality can be attributed to genetic or so-called nonshared environmental influence, this does not mean that shared events lack importance for the development of later personality differences. We studied the relationship between Big Five personality differences in monozygotic (MZ) twins at age 29, and life stressors at age 6 to 15, using prospective data from 26 MZ pairs studied from birth onwards. A positive significant correlation was found between stressors in childhood and early adolescence, and intrapair personality differences in Agreeableness, Openness, Conscientiousness, and five-factor profiles. We note that the effects of shared events are labeled “nonshared” environment when the effect is to make siblings more different. Case examples illustrate the relationship between stress and personality differences, and provide hypotheses for further studies in larger samples.

The 2001 honoring of Russian twin researcher, Dr. Inna V. Ravich-Shcherbo, at the Tenth International Congress on Twin Studies (ISTS), in London, brought timely recognition to an international colleague. It also marked an occasion for reflecting on the course of twin studies in Russia. Historical trends and current accomplishments are examined with an eye toward future developments. Next, the distinguished careers of Russian monozygotic twins, Drs. Alexander and Andrew Fingelkurts, exemplify twin research findings on intelligence and occupational choice, and illuminate the status of twin studies and other scientific research in their country, are told. Their life histories are followed by the initially tragic, but ultimately heartwarming, story of young twins, Max and Andy, whose physical disabilities were overcome through the efforts of an empathic war veteran. The recent Moscow Summer School, the first in a three-time lecture series, encouraged crucial academic exchange among scientific investigators and students from around the world. Final thoughts are that much can be learned and much can be accomplished, given that we continue to nurture the twin-related resources available to us.