Abstract
Background: Cerebral palsy is more common in twins than singletons. Among twins, if one twin suffers a fetal death or dies in infancy, the prevalence of cerebral palsy in the surviving co-twin is considerably increased, and those from like-sex pairs are particularly at high risk.
Aim: To compare birthweight specific cerebral palsy prevalence in like-sex and unlike-sex twins where both twins survive infancy and to provide a comparative and composite picture of cerebral palsy prevalence according to whether a co-twin died or where both twins survived.
Methods: Parents of twins born in England and Wales in 1994 and 1995 completed a booklet with open ended questions asking whether their twins had any medical, physical, visual, genetic, or chromosomal problems. Any mention of cerebral palsy, hemiplegia, diplegia, or quadriplegia allowed the child to be included as a case of cerebral palsy. Birthweight specific prevalence rates of cerebral palsy were determined for like and unlike-sex twins in birthweight groups < 1000 g, 1000–1499 g, 1500–1999 g, 2000–2499 g, and ≥ 2500 g.
Results: When both twins survived infancy, like-sex were at greater risk of cerebral palsy than unlike-sex twins, but the difference was not statistically significant. If both twins survived infancy, the birthweight specific prevalence of cerebral palsy was significantly less than if the co-twin had died.
Conclusions: Among the generality of twins, like-sex compared with unlike-sex twins are at greater risk of cerebral palsy particularly if one twin suffers a fetal or infant death. Although it is not possible to subdivide the twins according to zygosity, it is postulated that monozygosity and, specifically, monochorionicity may be the crucial feature that leads to the higher prevalence of cerebral impairment among like-sex twins.
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Selected References
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- Glinianaia S. V., Pharoah P. O. D., Wright C., Rankin J. M., Northern Region Perinatal Mortality Survey Steering Group Fetal or infant death in twin pregnancy: neurodevelopmental consequence for the survivor. Arch Dis Child Fetal Neonatal Ed. 2002 Jan;86(1):F9–15. doi: 10.1136/fn.86.1.F9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Grether J. K., Nelson K. B., Cummins S. K. Twinning and cerebral palsy: experience in four northern California counties, births 1983 through 1985. Pediatrics. 1993 Dec;92(6):854–858. [PubMed] [Google Scholar]
- Petterson B., Nelson K. B., Watson L., Stanley F. Twins, triplets, and cerebral palsy in births in Western Australia in the 1980s. BMJ. 1993 Nov 13;307(6914):1239–1243. doi: 10.1136/bmj.307.6914.1239. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pharoah P. O., Adi Y. Consequences of in-utero death in a twin pregnancy. Lancet. 2000 May 6;355(9215):1597–1602. doi: 10.1016/s0140-6736(00)02215-7. [DOI] [PubMed] [Google Scholar]
- Pharoah P. O. Cerebral palsy in the surviving twin associated with infant death of the co-twin. Arch Dis Child Fetal Neonatal Ed. 2001 Mar;84(2):F111–F116. doi: 10.1136/fn.84.2.F111. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pharoah P. O., Cooke T. Cerebral palsy and multiple births. Arch Dis Child Fetal Neonatal Ed. 1996 Nov;75(3):F174–F177. doi: 10.1136/fn.75.3.f174. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Williams K., Hennessy E., Alberman E. Cerebral palsy: effects of twinning, birthweight, and gestational age. Arch Dis Child Fetal Neonatal Ed. 1996 Nov;75(3):F178–F182. doi: 10.1136/fn.75.3.f178. [DOI] [PMC free article] [PubMed] [Google Scholar]