Mothers Of Singletons Research Articles

Maternal birthweight and outcome of twin pregnancy

There is evidence from singletons that maternal birthweight is positively related to offspring gestational length and birthweight, and some evidence of an inverse relationship with preterm birth. Among twins very preterm birth is the major cause of neonatal mortality and of immediate and later morbidity, including neurodevelopmental impairment. We hypothesised that the relationship between maternal birthweight and gestational length would be more evident in twin than in singleton pregnancies, as there is more variation in gestation in the former. Among 131 singleton mothers carrying twins, there was weak evidence of a positive relationship between maternal birthweight and twin gestational length (+0.6 weeks [95% CI -0.05, +1.3] per kg increase in maternal birthweight, but stronger evidence among 56 of these who went into labour spontaneously (+1.9 weeks [+0.7, +3.1], P = 0.003 for interaction). In the latter group we estimated that the odds of very preterm birth (at <32 weeks) were reduced by 50% [95% CI 10%, 82%] per 250 g increase in maternal birthweight. In the whole cohort, and in this subgroup, maternal birthweight was strongly positively related to both twin offspring total birthweight and total placental weight. Our data, consistent with intergenerational programming of early development, suggest the possibility of a stronger and more clinically relevant association among twins than among singletons. Nevertheless, our sample size was modest and this finding needs to be confirmed in a larger cohort.

Maternal risk factors for potential maltreatment deaths among healthy singleton and twin infants.

Our aim was to evaluate the risk of death among healthy infants due to maltreatment, using national linked vital statistics data. The study population included all nonanomalous, full-term (> or = 37 weeks), non-low birthweight (> 2500 grams) infants born between 1995 and 2000 and their linked death certificates: 18,673,439 singleton pregnancies (36,864 deaths) and 77,800 twin pregnancies (356 pregnancies with a death). The underlying cause of death was characterized as due to maltreatment, sudden infant death syndrome (SIDS), and other causes, based on ICD-9 and ICD-10 codes, and modeled by maternal age using multinomial logistic regression; mothers aged 25 to 29 were the reference group. The highest risk for infant mortality was among the youngest mothers for maltreatment (AOR 2.45 and 1.95 for singleton mothers < 20 and aged 20 to 24, respectively; AOR 4.34 and 2.25 for twin mothers < 20 and aged 20 to 24, respectively). The risk of death overall and for each category was modeled by maternal age < 20, aged 20 to 24, and > or = 25, with and without the father's age present on the birth certificate, with mothers > or = 25 and father's age present as the reference group. All risks of death were significantly increased for mothers younger than age 25, with the highest risks among the youngest mothers and missing father's age. The pattern for twins was similar, with elevated risks among younger mothers with or without father's age present on the birth certificate. These results add to the body of knowledge regarding risk factors for infant mortality among healthy singletons and twins.

Parenting and the psychological development of a representative sample of triplets conceived by assisted reproduction

The aim of the study was to examine the quality of parenting and the psychological development of three-year-old children in IVF/ICSI families with triplets. Comparisons were carried out between a representative sample of 10 families with triplets and matched groups of 15 families with twins and 30 families with singletons. The families were recruited from Follow-Up, a national organization in France that was established to study children conceived by assisted reproduction. Standardized measures of the mother's psychological well-being (parenting stress, depression and quality of marriage) and standardized measures of the child's psychological development (emotional/behavioural problems and general development) were completed by the mother. Mothers with a multiple birth were found to experience greater difficulties in parenting than mothers of singletons, with no differences between mothers of triplets and mothers of twins. Regarding the children, there were no differences in emotional or behavioural problems between triplets, twins and singletons. However, there were indications of mild delay among triplets and twins in some aspects of language development in comparison with the singleton children. The birth of triplets or twins does appear to cause difficulties for parents in the early years, however, the children themselves do not seem to experience markedly raised levels of psychological or developmental problems.

Impact of a multiple, IVF birth on post-partum mental health: a composite analysis

This study explored the impact of a multiple IVF birth on maternal mental health in the early post-partum period. A prospective study of 207 women who had conceived following IVF treatment and followed up at 6 weeks post-partum. Mothers rated their mood using the Edinburgh postnatal depression scale (EPDS) and their baby's behaviour using the Unsettled and Irregular Behaviour scale. Mothers' emotional well-being was explored using theme analysis of semi-structured telephone interviews. Of the 175 (84.5%) followed up post-partum, 56 (32%) had a multiple birth (7 triplets, 49 twins). Nearly 16% of mothers in the multiple group scored>12 on the EPDS indicating clinically significant symptoms, which represented a 3-fold increased risk compared to mothers of singletons (Odds ratio=3.4, Confidence Interval=1.011-11.618, P=0.048). Unsettled and irregular infant behaviour was another independent risk factor. Qualitative analysis of interviews identified 12 themes. Mothers of multiples were more likely to express negative themes including 'tiredness' (P<0.01), 'feelings of stress/depression' (P<0.05) and 'questioning parenthood' (P<0.05). Mothers of singletons were more likely to be 'feeling wonderful', reflecting their delight in parenthood (P<0.05). Mothers of multiples are at increased risk of poorer emotional well-being. Clinicians should focus on the psychological benefits of a singleton birth.

Passive Smoking, Metabolic Gene Polymorphisms, and Infant Birth Weight in a Prospective Cohort Study of Chinese Women

The authors investigated whether polymorphisms in two maternal metabolic genes, cytochrome P-450 1A1 (CYP1A1) MspI and epoxide hydrolase 1 (EPHX1) Tyr113His, affect the association of maternal passive smoking with infant birth weight. The study was conducted in a cohort of 1,388 newly married mothers of liveborn singletons who worked in textile mills in Anqing, China, from 1996 to 2000. Multiple linear regression models were used to estimate the associations of passive smoking and genetic susceptibility with birth weight, with adjustment for important potential confounders. In the passive smoking group, there was a remarkable decrease in birth weight with the C/C6235 genotype (156.3 g, 95% confidence interval (CI): -283.6, -29.0) for CYP1A1 MspI and with Tyr/His113 (93.8 g, 95% CI: -188.6, -1.1) as compared with His/His113 (244.6 g, 95% CI: -491.0, -1.9) for EPHX1. When results were stratified by maternal genotype, passive smoking conferred a significantly negative effect in the EPHX1 Tyr/His113 group (103.5 g, 95% CI: -205.8, -9.2) and in the His/His113 group (687.3 g, 95% CI: -748.3, -178.3). The data further showed that there was a significant interaction between maternal passive smoking and maternal EPHX1 genotype for birth weight. The authors conclude that the CYP1A1 MspI and EPHX1 genotypes modified the association between maternal passive smoking and infant birth weight in this study, which is suggestive of possible gene-environment interaction.

Correlates of mother–premature infant interactions

This study's purpose was to examine whether child characteristics, child illness severity, maternal characteristics, maternal psychological well-being, and paternal support influenced interactions between 108 premature infants and their mothers. Mothers with singletons or more infant illness stress showed more positive involvement. Mothers with less infant illness stress, less education, or less participation in caregiving by fathers showed more negative control. First-time mothers and mothers of singletons provided more developmental stimulation. Children of younger and White mothers showed more social behaviors. Less maternal education and shorter period of mechanical ventilation were associated with greater developmental maturity. Greater maternal worry was related to more child irritability. These findings are consistent with the developmental science view that the mother-premature relationship is a complex, reciprocal process.

Psychological assessment of mothers and their assisted reproduction triplets at age 3 years

The aim of this study was to examine the psychological well-being of mothers and the psychological development of their 3-year-old triplet children conceived by in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Comparisons were carried out between a sample of 10 families with IVF/ICSI triplets and matched groups of 15 families with IVF/ICSI twins and 30 families with IVF/ICSI singletons. The families were recruited from Follow-Up, a national organization in France that was established to study children conceived by assisted reproduction. Standardized measures of the mother's emotional well-being and of the children's psychological development were administered. Mothers with a multiple birth were found to experience greater difficulties in parenting than mothers of singletons, with no differences between mothers of triplets and mothers of twins. Regarding the children, there were no differences in emotional or behavioural problems between triplets, twins and singletons. However, the triplets and twins showed a delay in some aspects of language development in comparison with the singleton children.

Research interviewers’ experience in the Early Births study of very preterm birth: qualitative assessment of data collection processes in a case–control study

This paper describes an evaluation study that aimed to assess data collection processes in a population-based case-control study of very preterm birth. Semi-structured interviews were conducted with the 10 research interviewers to determine their perceptions of the hypotheses, the differences between interviewing cases and controls and between modes of interview, their reactions to questions which they had to ask in interviews and their training. Time and cost of the collection of data were also considered. None of the research interviewers identified which of the questions in the interview constituted the primary hypothesis. All interviewers interviewed cases and controls (including mothers of twins and singletons), and collected data face-to-face and by telephone. Whilst half of the interviewers had no issue with asking sensitive questions, hearing of intimate partner violence, risk-taking behaviour and inappropriate medical care were confronting for others. Training was judged as adequate, as was the continuing support of the project co-ordinator. On average, interviewing took 40% of research interviewers' time, and 25 interviews were completed per effective full-time month of interviewer time. Each interview cost approximately $170AU to complete. In relation to this case-control study, interviewer bias may be lessened since research interviewers had been unable to infer the hypothesis of the study. All interviewers had interviewed both cases and controls and any systematic differences can be adjusted for in the analysis.

Cesarean rate and its related factors in

Background According to the WHO, no region in the world can justify the Cesarean rate higher than 10-15%. However, statistics of most areas over the world show a great discrepancy with this figure. There has been a gradual increase in Cesarean births over the past 30 years with greater risk for maternal health, lengthier recovery, more cost, and increased mortality rate. Some authorities believe that over half of the Cesareans are unnecessary. Purpose This descriptive correlational study was conducted to determine the rate and related factors of Cesarean birth in Bojnurd. Methods 473 singleton mothers delivering matured term newborns over 2500 gr. were selected. Delivery type was considered as a dependent variable whereas 20 other variables mainly associated with socioeconomic status of family and characteristics of mothers as well as infants were considered as independent variables. Data were collected by a questionnaire, measurement of infants’ head circumference and interview with mothers. Content and test-retest methods were used respectively to validate and made the tool reliable (r=0.7). Results Cesarean birth rate in Bojnurd was 25.4% and was positively correlated with better job position and parents’ level of education (p Conclusion With respect to increased Caesarian rate in mothers with better socioeconomic status and higher age, it seems that providing appropriate educational plans for families and decreasing marital age by national planning may decrease the rate. Keywords Cesarean, Delivery type, Cesarean rate

Cord Blood Islet Autoantibodies Are Related to Stress in the Mother during Pregnancy

A 2-month psychological questionnaire concerning pregnancy was answered by 20,920 nondiabetic mothers of singletons. Retrospective analysis showed increased levels of islet autoantibodies (IA) in 290 (1.4%) newborns. High IA levels in the child's cord blood correlated strongly with IA levels in the mother (GADA r = 0.91, P < 0.0001; IA-2A r = 0.75, P = 0.0001). High IA levels were found in newborns whose mothers during pregnancy had been more worried than usual (P = 0.04), had worried that the child would be sick (P = 0.01) or not survive (P = 0.002), or had experienced serious life events, like "serious accident in the family" (P < 0.0001) or "experienced violence" (P = 0.02). Associations with increased worries by the mother remained in newborns with high type 1 diabetes mellitus (T1DM)-human leukocyte antigen (HLA) risk, but not in non-HLA risk children. The prospective follow-up of these children will determine the importance of this early IA for postnatal islet autoimmunity, type 1 diabetes, or both.

Time to pregnancy and multiple births

Mothers of multiples are alleged to be more fecund than mothers of singletons. Some authors have suggested monitoring twinning rates for assessing temporal changes in a population's reproductive health. Using a nested case-control design, we estimated the odds of a multiple birth in relation to fecundity in the US Collaborative Perinatal Project inclusive of 8546 pregnant women who reported a known time-to-pregnancy (TTP) upon enrolment in the cohort, 1959-1966. Case mothers comprised 81 women giving birth to twins/triplets; control mothers comprised 243 women giving birth to singletons matched to case mothers on maternal age at a ratio of 3:1. The odds ratio (OR) for a multiple birth within 6 months of trying adjusting for maternal age and prior pregnancies was estimated using logistic regression. Discrete time Cox regression analysis was also utilized to estimate the fecundability OR. Women with a TTP of <or=6 months were more likely to have a multiple birth than women reporting a TTP of >6 months [OR=1.95; 95% confidence interval (95% CI)=1.09-3.51]. Excluding pregnancies after 13+ months resulted in a loss of precision (OR=2.14; 95% CI=0.90-5.04). These data support higher fecundity among mothers of multiples than mothers of singletons.

Twins and Their Health Cost: Consequences of Multiple Births on Parental Health and Mortality in Denmark and England and Wales

The rapid increase in twinning rates in developed countries has increased interest in the question as to whether twin mothers have higher mortality and more health problems than mothers of singletons. Here we use a national survey, the Office for National Statistics Longitudinal Study of England & Wales, and a linkage between the Danish Twin Registry and the Danish population register to examine mortality patterns after age 45 (50 for fathers) for twin parents and the whole population born from 1911 to 1950. For England and Wales, presence of limiting long-term illnesses and self-rated health status was also investigated. Overall similar health and mortality was found for twin parents and the whole population although both life table methods and survival analysis suggested a slight excess mortality among older cohorts of twin mothers in England and Wales.

Twins and Their Health Cost: Consequences of Multiple Births on Parental Health and Mortality in Denmark and England and Wales

AbstractThe rapid increase in twinning rates in developed countries has increased interest in the question as to whether twin mothers have higher mortality and more health problems than mothers of singletons. Here we use a national survey, the Office for National Statistics Longitudinal Study of England &amp; Wales, and a linkage between the Danish Twin Registry and the Danish population register to examine mortality patterns after age 45 (50 for fathers) for twin parents and the whole population born from 1911 to 1950. For England and Wales, presence of limiting long-term illnesses and self-rated health status was also investigated. Overall similar health and mortality was found for twin parents and the whole population although both life table methods and survival analysis suggested a slight excess mortality among older cohorts of twin mothers in England and Wales.

Coagulation-fibrinolysis is more enhanced in twin than in singleton pregnancies

To examine whether coagulation-fibrinolysis in late pregnancy in women with twin pregnancies is more pronounced than in women with singleton pregnancies. The plasma levels of D-dimer, fibrinogen/fibrin degradation products (FDP), and fibrinogen, the platelet count, and the antithrombin activity were assessed from 3 weeks before delivery until postpartum day 7 in 48 women (24 singleton and 24 twin pregnancies) without preeclampsia who underwent cesarean sections. Women with singleton or twin pregnancies gave birth at 37.3+/-1.2 weeks or 35.2+/-1.4 weeks, respectively. Compared with singleton mothers, prenatal D-dimer and FDP levels were consistently and significantly higher among women with twin pregnancies. A significantly larger proportion of twin mothers exhibited prenatal levels of D-dimer >5.0 microg/mL, FDP >10.0 microg/mL, fibrinogen <420 mg/mL and antithrombin activity <70%. In addition, prenatal antithrombin activity in plasma was significantly lower. Coagulation-fibrinolysis is more enhanced in women with twin gestation than in women with singleton gestation.

Human Milk Pumping Rates of Mothers of Singletons and Mothers of Multiples

Rates of breastfeeding are increasing, but the methods by which human milk is fed to infants is not well described. Using a retrospective survey design, the authors collected information about infant feeding from mothers of term, preterm, singleton, and multiple-gestation infants (n=346). Human milk feeding methods were characterized as solely at the breast, pumped only, or a combination. Sixty-eight percent of mothers in the study fed their infants at least some human milk; 77% of these mothers reported pumping milk. There was no difference in the percentage of pumping based on multiple gestation or length of pregnancy. Feeding human milk solely at the breast at early postpartum time points was associated with longer durations of human milk feeding overall. More research is needed to better understand why mothers choose pumping over direct human milk feedings and to evaluate the health outcomes associated with this practice.

Teen Maternal Age and Very Preterm Birth of Twins

As teen singleton pregnancy is associated with higher risks of adverse birth outcome, and twin pregnancy, regardless of maternal age, may result in poor outcome, teens pregnant with twins may represent a particularly vulnerable group. However, little has been documented regarding teen twin pregnancy outcome. To characterize the risk of very preterm birth among teens having twins. Cross-sectional analysis of the US 1995-2000 Matched Multiple Birth Data Set. We calculated the risk of very preterm birth (<33 weeks' gestation) for teen and young adult mothers of twins (< or =16 years, 17-18 years, 19-20 years), compared to 21-24 year olds, stratified by race/ethnicity. Adjusted odds ratios were estimated controlling for marital status and entry into prenatal care. Odds of very preterm birth decreased significantly with increasing age. Odds ratios ranged from 2.07 (1.73,2.48) to 1.20 (1.11,1.29) according to maternal age for White teen mothers, from 1.76 (1.48,2.09) to 1.13 (1.03,1.24) for Black teen mothers, and from 2.19 (1.77,2.72) to 1.15 (1.02,1.31) for Hispanic teen mothers. Odds of very preterm birth among teen mothers of twins were about the same as those for teen mothers of singletons. Teens having twins have higher odds of very preterm birth than young adult mothers. However, the association between age and preterm birth was similar among teen mothers having twins as for those having singletons.

Behavioral and cognitive development as well as family functioning of twins conceived by assisted reproduction: findings from a large population study

To establish the nature and extent of difficulties in parenting and child development in families with twins conceived by assisted reproduction. Comparisons were carried out between a representative sample of 344 families with 2- to 5-year-old twins conceived by IVF/intracytoplasmic sperm injection (ICSI) and a matched comparison group of 344 families with singletons from IVF/ICSI. One twin was randomly selected for data analysis to avoid the bias associated with nonindependence of measures. A general population sample of IVF/ICSI families. Mothers and children. Mothers completed a questionnaire booklet. Standardized measures of the mother's psychological well-being (parenting stress, depression, and quality of marriage) and standardized measures of the child's psychological development (emotional/behavioral problems and cognitive development). Mothers of twins showed significantly higher levels of parenting stress and depression than mothers of singletons and were significantly more likely to find parenting difficult and significantly less likely to obtain pleasure from their child. Regarding the children, there was no difference in the level of emotional or behavioral problems between twins and singletons. However, twins showed significantly lower levels of cognitive functioning. Greater difficulties in parenting and child development were experienced by IVF/ICSI families with twins than by IVF/ICSI families with singletons.

Explanation for Cessation of Breastfeeding in Mothers of Twins

This study used content analysis to examine reasons for cessation of breastfeeding of twins by 2 time points: 9.4 weeks and 28.3 weeks of age. From a convenience sample of 123 mothers, 110 initiated breastfeeding for their twins. Thirty women had stopped breastfeeding by time 1, with an additional 37 women stopping by time 2. Three major themes were identified regarding weaning: factors related to breastfeeding process, to mother's role and health, and to infant behavior and health. Subcategories were identified for each theme, with additional subcategories emerging at time 2. Cited reasons are similar to those given by singleton mothers; however, mothers of twins identified unique issues related to infants' behaviors, challenges presented by growth and development, and time commitments that interfered with breastfeeding continuation. Implications of the study suggest the need for continued lactation support as the twins grow and develop and new breastfeeding issues arise.

Childhood and Adult Cancer in Twins: Evidence from the Utah Genealogy

Evidence suggests that the in utero environment may contribute to subsequent development of cancers in childhood and adulthood. Raised levels of estrogen during pregnancy may be the primary in utero etiologic factor. Mothers of twins have higher estrogen levels during pregnancy than mothers of singletons, therefore, assessment of cancer risk in twins may be informative. We conducted a retrospective cohort study of cancer among twin and singleton newborns selected from the Utah Population Database, matched on birth year and sex. Cancer diagnoses were determined by linkage with the Utah state cancer register. Relative rates of all cancers in childhood and in adulthood in twins compared with singletons, and for specific cancers including testicular, breast and melanoma, were calculated using Poisson regression. Twin (35,271) and singleton (74,199) births were identified, among whom there were 336 and 691 cancer diagnoses, respectively. The relative risk (RR) of childhood cancer in twins compared with singletons was 0.82 [95% confidence interval (CI) 0.55-1.24] and of adult cancer was 1.06 (0.92-1.22). We found nonsignificant increases in risk among adult twins for cancers of the breast, prostate, testis, lymphatic system, thyroid, and large bowel. The largest departures from unity were for testicular cancer (RR 1.47; 95% CI, 0.73-2.95) and melanoma (RR 0.67; 95% CI, 0.42-1.06). These results are consistent with the body of evidence suggesting that twins have a reduced risk of cancer in childhood. Although there is no overall differential in adult cancer risk, these data support the hypothesis that the in utero environment may play an important role in specific cancers.

Comparison of Feeding Among Multiple Birth Infants

Mothers of multiples who choose to feed their infants breast milk are faced with a seemingly overwhelming set of circumstances. Since mothers of multiples could potentially feed their infants differing proportions of breast milk, current methods of obtaining breastfeeding data for mothers of singletons may not adequately describe the breastfeeding behaviors of mothers of twins and triplets. The goal of our study was to determine the proportion of breast milk each infant of a multiple set was fed over a six-month period and compare the feeding regimens of sibling infants. Results of this retrospective study based on maternal reports indicated that there was almost complete agreement in the proportion of breast milk fed to siblings born from the same pregnancy, regardless of stratification based on gestational age, plurality, or location of the infants (hospital vs. home). The Pearson correlation coefficient for duration of breast-milk feeding between sibling twins was 0.99 (p &lt; .0001); among sibling triplets the values were .97, .98 and .99 (p &lt; .0001). A better understanding of the process by which twins and triplets are fed breast milk sets the stage for future research and can ultimately lead to the development of strategies to increase breast-milk feeding rates for multiple birth children.