Does neonatal and infant neurodevelopmental morbidity of multiples and singletons differ?

      Summary

      The mortality and morbidity of twins may differ from that in singletons because of the greater incidence of intrauterine growth restriction, higher rates of prematurity, zygosity and even from the presence of a same age sibling during childhood. Early outcomes appear poorer for twins, but any differences are lost when corrections for gestation and growth restriction are made. Some studies show poorer cognitive outcomes for twins; larger and more recent studies show small but significant differences even when confounders are taken into account. Cerebral palsy rates are considerably higher in twins, especially with the death of a co-twin. Behavioural outcomes are broadly similar in twins and singletons, with growth and gestation being more important determinants than plurality. Psychiatric symptoms again are broadly similar, although there appears to be a reduced risk of suicide in twins.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Seminars in Fetal and Neonatal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Smith G.C.S.
        Birth order of twins and risk of perinatal death related to delivery in England, Northern Ireland, and Wales, 1994–2003: retrospective cohort study.
        BMJ. 2007; 334: 576-580
        • Odibo A.O.
        • McDonald R.E.
        • Stamilio D.M.
        • Ural S.H.
        • Macones G.A.
        Perinatal outcomes in growth-restricted twins compared with age-matched growth-restricted singletons.
        Am J Perinatol. 2005; 22: 269-273
        • Ray B.
        • Platt M.P.
        Mortality of twin and singleton livebirths under 30 weeks gestation: a population-based study.
        Arch Dis Child Fetal Neonatal Ed. 2009; 94: F140-F143
        • Kirkby S.
        • Genen L.
        • Turenne W.
        • Dysart K.
        Outcomes and milestone achievement differences for very low birth weight multiples compared with singleton infants.
        Am J Perinatol. 2010; ([Jan 29, Epub ahead of print])
        • Nielsen H.C.
        • Harvey-Wilkes K.
        • MacKinnon B.
        • Hung S.
        Neonatal outcome of very premature infants from multiple and singleton gestations.
        Am J Obstet Gynecol. 1997; 177: 653-659
        • Garite T.J.
        • Clark R.H.
        • Elliott J.P.
        • Thorp J.A.
        Twins and triplets: the effect of plurality and growth on neonatal outcome compared with singleton infants.
        Am J Obstet Gynecol. 2004; 191: 700-707
        • Luo Z.C.
        • Simonet F.
        • An N.
        • Bao F.Y.
        • Audibert F.
        • Fraser W.D.
        Effect on neonatal outcomes in gestational hypertension in twin compared with singleton pregnancies.
        Obstet Gynecol. 2006; 108: 1138-1144
        • Canpolat F.E.
        • Yurdakok M.
        • Korkmaz A.
        • Yigit S.
        • Tekinalp G.
        Birthweight discordance in twins and the risk of being heavier for respiratory distress syndrome.
        Twin Res Hum Genet. 2006; 9: 659-663
        • Armson B.A.
        • O’Connell C.
        • Persad V.
        • Joseph K.S.
        • Young D.C.
        • Baskett T.F.
        Determinants of perinatal mortality and serious neonatal morbidity in the second twin.
        Obstet Gynecol. 2006; 108: 556-564
        • Shinwell E.S.
        • Reichman B.
        • Lerner-Geva L.
        • Boyko V.
        • Blickstein I.
        Israel Neonatal Network. “Masculinising” effect on respiratory morbidity in girls from unlike-sex preterm twins: a possible transchorionic paracrine effect.
        Pediatrics. 2007; 120: e447-e453
        • Battista L.
        • Winovitch K.C.
        • Rumney P.J.
        • Davis E.
        • Hagemann C.
        • Wing D.A.
        A case–control comparison of the effectiveness of betamethasone to prevent neonatal morbidity and mortality in preterm twin and singleton pregnancies.
        Am J Perinatol. 2008; 25: 449-453
        • Wolf E.J.
        • Vintzileos A.M.
        • Rosenkrantz T.S.
        • Rodis J.F.
        • Lettieri L.
        • Mallozzi A.
        A comparison of pre-discharge survival and morbidity in singleton and twin very low birth weight infants.
        Obstet Gynecol. 1992; 80: 436-439
        • Ballabh P.
        • Kumari J.
        • AlKouatly H.B.
        • et al.
        Neonatal outcome of triplet versus twin and singleton pregnancies: a matched case control study.
        Eur J Obstet Gynecol Reprod Biol. 2003; 107: 28-36
        • Husen T.
        Intra-pair similarities in the school achievements of twins.
        Scand J Psychol. 1963; 4: 108-114
        • Drillien C.M.
        The growth and development of the prematurely born infant.
        Williams & Wilkins, Baltimore1964
        • Wilson R.S.
        Twins: mental development in the preschool years.
        Dev Psychol. 1974; 10: 580-588
        • Zazzo R.
        The twin condition and the couple effect on personality development.
        Genet Med Gemello. 1979; 25: 343-352
        • Record R.G.
        • McKeown T.
        • Edwards J.H.
        An investigation of the difference in measured intelligences between twins and single births.
        Ann Hum Genet. 1970; 34: 11-20
        • Ronalds G.A.
        • De Stavola B.L.
        • Leon D.A.
        The cognitive cost of being a twin: evidence from comparisons within families in the Aberdeen children of the 1950s cohort study.
        BMJ. 2005; 331: 1306
        • Postuma D.
        • De Geus E.J.
        • Bleichrodt N.
        • Boomsma D.I.
        Twin–singleton differences in intelligence?.
        Twin Res. 2000; 3: 83-87
        • Christensen K.
        • Petersen I.
        • Skytthe A.
        • Herskind A.M.
        • McGue M.
        • Bingley P.
        Comparison of academic performance of twins and singletons in adolescence: follow-up study.
        BMJ. 2006; 333: 1095
        • Leonard C.H.
        • Piecuch R.E.
        • Ballard R.A.
        • Cooper B.A.
        Outcome of very low birth weight infants: multiple gestation versus singletons.
        Pediatrics. 1994; 93: 611-615
        • Cooke R.W.
        Perinatal and postnatal factors in very preterm infants and subsequent cognitive and motor abilities.
        Arch Dis Child Fetal Neonatal Ed. 2005; 90: F60-F63
        • Benda C.E.
        Cerebral palsy, birth injuries and anoxia.
        in: Developmental disorders of mentation and cerebral palsies. Grune & Stratton, New York1952: 221-291 (Ch. 11)
        • Russell E.M.
        Cerebral palsied twins.
        Arch Dis Child. 1961; 36: 328-336
        • Griffiths M.
        Cerebral palsy in multiple pregnancy.
        Dev Med Child Neurol. 1967; 9: 713-731
        • Alberman E.D.
        Cerebral palsy in twins.
        Guy’s Hospital Report. 1964; 133: 285-295
        • Pharoah P.O.
        • Price T.S.
        • Plomin R.
        Cerebral palsy in twins: a national study.
        Arch Dis Child Fetal Neonatal Ed. 2002; 87: F122-F124
        • Petterson B.
        • Nelson K.B.
        • Watson L.
        • Stanley F.
        Twins, triplets, and cerebral palsy in births in Western Australia.
        BMJ. 1993; 307: 1239-1243
        • Scher A.I.
        • Petterson B.
        • Blair E.
        • et al.
        The risk of mortality or cerebral palsy in twins: a collaborative population-based study.
        Pediatr Res. 2002; 52: 671-681
        • Taylor C.L.
        • de Groot J.
        • Blair E.M.
        • Stanley F.J.
        The risk of cerebral palsy in survivors of multiple pregnancies with cofetal loss or death.
        Am J Obstet Gynecol. 2009; 201: e1-e6
        • Ong S.S.
        • Zamora J.
        • Khan K.S.
        • Kilby M.D.
        Prognosis for the co-twin following single-twin death: a systematic review.
        BJOG. 2006; 113: 992-998
        • Pharoah P.O.
        • Platt M.J.
        Sudden infant death syndrome in twins and singletons.
        Twin Res Hum Genet. 2007; 10: 644-648
        • Moilanen I.
        • Linna S.L.
        • Ebeling H.
        • et al.
        Are twins’ behavioural/emotional problems different from singletons?.
        Eur Child Adolesc Psychiatry. 1999; 8: 62-67
        • Van den Oord E.J.
        • Koot H.M.
        • Boomsma D.I.
        • Verhuis F.C.
        • Orlebeke J.F.
        A twin–singleton comparison of problem behaviour in 2–3 year olds.
        J Child Psychol Psychiatry. 1995; 36: 449-458
        • Lehn H.
        • Derks E.M.
        • Hudziak J.J.
        • Heutinck P.
        • van Beijsterveldt T.C.
        • Boomsa D.I.
        Attentional problems and attention deficit/hyperactivity disorder in discordant and concordant monozygotic twins: evidence of environmental mediators.
        J Am Acad Child Adolesc Psychiatry. 2007; 46: 83-91
        • Kendler K.S.
        • Martin N.G.
        • Heath A.C.
        • Eaves L.J.
        Self report psychiatric symptoms in twins and their non-twin relatives: are twins different?.
        Am J Med Genet. 1995; 60: 588-591
        • Tomassini C.
        • Juel K.
        • Holm N.V.
        • Skytthe A.
        • Christensen K.
        Risk of suicide in twins: 51 year follow-up study.
        BMJ. 2003; 327: 373-374