Mothers Of Twins Research Articles

Risk and timing of postpartum depression in parents of twins compared to parents of singletons.

Parents of twins appear to be at increased risk of postpartum depression (PPD), yet little is known about the magnitude and timing of onset in the postpartum period compared to singleton parents. We conducted a cohort study using the Danish nationwide health registers. We defined a study population of parents that is, mothers and fathers of all twin and singleton livebirths between 1997 and 2019. Postpartum depression was defined as incident depression diagnosis or a redeemed antidepressant prescription from childbirth through 365 days postpartum. We performed a parametric time-to-event analysis based on Poisson regression. The time scale was time since birth, modeled using restricted cubic splines. From this we estimated the hazard ratio (HR) representing the momentary risk, and the cumulative risk ratio (RR) over the first year postpartum, in twin compared to singleton parents. The study population was based on 27,095 twin and 1,350,046 singleton births. In adjusted analyses, the HR of twins compared to singletons was highest around 2 months postpartum (HR 1.28, 95% CI 1.10-1.49) for mothers, and around 6 months (1.20, 95% CI 1.02-1.42) for fathers. The 6 months adjusted cumulative RR of PPD in twins compared to singletons was 1.24 (95% CI 1.10-1.40) for mothers and 1.11 (95% CI 0.95-1.30) for fathers. Twin mothers had increased risk of PPD compared to singleton mothers, which was driven by an immediate increase after childbirth. The risk among twin fathers was not increased immediately after childbirth, but we found slightly elevated risk around 6 months postpartum. This could suggest diverse patterns of PPD symptomatology in twin parents compared to singleton parents and between mothers and fathers. Our findings underline parents of twins as a potentially vulnerable group to PPD and emphasize the need for increased awareness of their mental health.

Breastfeeding Practices in the Twin Town of India - A Cross-Sectional Study.

The global rise in twinning rates poses health challenges due to increased risks for infants and mothers. Despite the benefits, breastfeeding rates among multiples are low, with exclusive breastfeeding (EBF) particularly scarce compared to singletons. Our study focuses on the mothers of twins in a unique population in Kodinhi village, Kerala, India, known for its high twinning rates, which aims to contribute to existing knowledge of breastfeeding practices and perspectives in a high twinning environment and offer valuable insights to promote optimal breastfeeding among mothers of twins. A retrospective cross-sectional survey was adopted. Seventy-five mothers with twins under 3 years of age from Kodinhi and neighboring areas were interviewed face to face using structured validated tools. Data collection focused on quantitative data supplemented by narrative descriptions. Most women delivered preterm (57.3%), operative delivery (58.7%), and had a late initiation of breastfeeding (32.9% within 24 hours). Colostrum feed was common (86.7%). The EBF rate was 4%, with 47.9% initiating nonexclusive breastfeeding before 3 months, and most of the twins (46.6%) were breastfed for 1-2 years. Fatigue (69.9%) and low milk supply (38.7%) were chief concerns. While 16.4% of mothers opted for a tandem breastfeeding technique, many preferred consecutive feeding as tandem was challenging. Mothers in Kodinhi demonstrated commendable efforts in breastfeeding twins; despite the low rate of EBF, breastfeeding extended to 1-2 years. Evidence-based interventions and personalized support, primarily focusing on maternal perspectives of milk insufficiency, fatigue and breastfeeding techniques, are crucial for sustaining optimal breastfeeding practices among mothers of twins.

Investigating the link between temperamental and motor development: a longitudinal study of infants aged 6–42 months

BackgroundSince the 1920s, motor development has been a strong research theme, focusing on infants' acquisition of motor skills, such as turning over and crawling. In the 1980s, a dynamic systems approach began emphasizing children's own motivation, which helped explain individual differences in the emergence of motor skills. However, few studies have examined factors contributing to individual differences in early motor development. In response, we investigated directional associations between temperament and motor development in children aged 6 months to 3 years.MethodThe Japan Environment and Children’s Study (JECS-A) recruited mothers between January 2011 and March 2014. 2,639 mothers were sent a questionnaire at 6 months, and responses were received from 1,657 of them, with full data for children aged 6 months, 2 years, and 3 years, including from three mothers of twins, were analyzed through structural equation modeling. Question items regarding fine and gross motor activities at each age were selected by pediatric neurologists specializing in developmental disorders. The Japanese version of the Little Developmental Coordination Disorder Questionnaire was administered at 42 months. Temperament was assessed through the parent-reported Behavior Questionnaire (short version) for infants, toddlers, and children. In all three measures, Surgency and Negative Affectivity were extracted, and Effortful Control, a major form of self-regulation, was found from toddlerhood onward, as in previous studies.ResultsA path diagram reveals that at 6 months, Surgency and Orienting/Regulation interacted positively with the motor function (respectively, r = .57; r = 40, ps < .001). Up to about 3 years, Effortful Control plays a role in facilitating the motor function, resulting in positive effects on Control During Movement (CDM), General Coordination (GC), and Fine Motor Movement (FMM) (β = 14; β = 30; β = 37, ps < .001). Surgency had a positive effect on CDM and GC (β = 18; β = 06, ps < .001), whereas Negative Affect had a negative influence on FMM and GC (β = -.08; β = -.08, ps < .001).ConclusionWhile Surgency may be a key reactive factor in early motor development, Effortful Control and Movement develop in an interactive manner.Trial registrationUMIN000030786.Scientific Title: The Japan Environment and Children’s Study.Date of disclosure of the study: 2018/01/15.Only questionnaires were administered in the study.

Mothers of twins had higher old-age survival than mothers of singletons in Estonian 19th-century birth cohorts.

Do the mothers of twins and singletons differ regarding post-partum and old-age mortality? Twin deliveries were associated with higher post-partum maternal mortality than singleton deliveries, but the lifetime post-partum mortality risk was similar for mothers of twins and singletons; survival of twinners was higher than survival of the mothers of singletons after the 67th lifespan percentile. Twinning is typically associated with higher post-partum maternal mortality. The evidence about whether twinning incurs long-term survival costs of reproduction or is a trait pertinent to long-lived women is scarce and contradictory. The study is based on the data of the Estonian Family Register (operating from 1926 to 1943) and involves 5565 mothers of twins and 119613 mothers of singletons born between 1850 and 1899. The subset for comparing maternal lifespans included 1703-1884 mothers of twins and 19747-36690 mothers of singletons. Post-partum maternal mortality was analyzed in the whole sample (including mothers of a single child) by logistic regression. Most of the analyses were performed in samples where each mother of twins was matched against mothers of singletons based on parity (or number of deliveries), urban versus rural and inland versus coastal origin, whether their lifespan was known, date of birth and age at first birth. Lifespans were compared in linear mixed models. Quantile regression was used to analyze age-dependent variations in maternal mortality rates. All models were adjusted for relevant biodemographic covariates. The twinning rate in the whole sample was 4.4%. During the year after giving birth, maternal mortality for twin deliveries was 0.75% (17/2273) and 0.37% (449/122750) for singleton deliveries (OR = 2.05, 95% CI = 1.21-3.23). However, the lifetime post-partum mortality risk for mothers of twins (0.51%; 28/5557) and singletons (0.37%; 438/119466) did not differ significantly (OR = 1.38, 95% CI = 0.91-1.98). The life spans of the mothers of twins and singletons did not differ in matched samples. Past the 67th lifespan percentile, the odds of survival were significantly higher for mothers of twins than mothers of singletons, as indicated by non-overlapping 95% confidence intervals. Relatively low number of individuals (22802-28335) with known age at death in matched datasets due to discontinuation of the register after 1943. The finding that mothers of twins had higher odds of old-age survival than mothers of singletons is consistent with the contention that twinners represent a non-random subset of women whose robust phenotypic quality allows them to outlive the mothers of singletons in old age. The study was funded by the Estonian Research Council grants PRG1137, PRG2248, and PSG669. The authors declare no competing interests. N/A.

P-519 Polygenic scores for DZ twinning in mothers of naturally and ART conceived twins and singletons

Abstract Study question Does the polygenetic score (PGS) of dizygotic (DZ) twinning differ among mothers of naturally conceived DZ twins and mothers of ART twins, or singleton mothers? Summary answer Mothers of naturally conceived DZ twins have the highest PGS for DZ twinning, while mothers who received hormonal induction of ovulation have the lowest PGS. What is known already Natural DZ twinning results from a double ovulation and has a genetic component. Endocrinology studies in mothers of DZ twins observed higher levels of follicle-stimulating hormone (FSH). FSHB and SMAD3 were the first loci identified as significant in genome-wide association studies (GWAS) of having DZ twins. The GWAS also showed a genetic correlation with anovulatory infertility and a PGS that explained ∼1.5% of the phenotypic variance when comparing mothers of naturally conceived DZ twins to controls. As DZ twinning has been proposed to be a measure of female fertility, we hypothesise that a low PGS could indicate infertility. Study design, size, duration We compare the DZ twinning PGS in mothers of naturally conceived DZ twins with other mothers in the Netherlands twin register (NTR) and the Norwegian Mother, Father and Child Cohort Study (MoBa). We tested if the PGS is lower in infertility groups (ART use). We included 1,677 cases, 2,828 other twin mothers and 2,686 controls from the NTR and 396 cases, 1,285 twin mothers and 74,613 singleton mothers from MoBa. Participants/materials, setting, methods We calculated PGSs of DZ twinning for all participants employing LDPred0.9 based on the summary statistics from the 2024 GWAS (Mbarek et al., 2024). Differences between groups were assessed by logistic regression, with corrections for relatedness, maternal age, maternal age at first birth, BMI, height, parity and technical covariates. Main results and the role of chance Mothers of naturally conceived DZ twins differed in age, body composition, parity and smoking behaviour compared to the other groups. The PGSs were higher in mothers of naturally conceived DZ twins (N = 1,677) compared to all other twin mothers, including mothers of naturally conceived MZ twins (N = 2,165) and mothers who conceived MZ (N = 64) or DZ twins through ART (N = 559) and compared to controls (N = 2,686; p &amp;lt; 0.01). For ART mothers whose fertility treatment involved hormones without IVF (N = 257), the PGS was significantly lower than for the other three groups (DZ-IVF and MZ mothers). In MoBA, we replicate our findings of the higher PGSs for mothers who naturally conceived their DZ twin pregnancy (N = 705) compared to mothers of naturally conceived MZ twins (N = 313) and mothers who conceived their DZ twins through ATR (N = 328) (p &amp;lt; 0.05). However, we do not observe differences between the mothers of naturally conceived DZ twins and the mothers of ART MZ twins in MoBa. We are currently adding analysis comparing the mothers of naturally conceived DZ with mothers who naturally or through ART conceived singletons. Limitations, reasons for caution In interpreting our results we should consider that the MZ ART groups are relatively small. Also, we did not have information on the reasons for ART use so we could not distinguish between maternal, paternal or couple fertility issues. Wider implications of the findings Mothers of naturally conceived DZ twins are genetically different from other mothers. Genetic influences found for DZ twinning mainly affect multiple ovulation, rather than other characteristics required for a twin pregnancy. The DZ twinning PGS may be associated with infertility. Trial registration number not applicable

The effect of perceived social support on fatigue in mothers having twin infants: the mediating role of sleep quality

ABSTRACT The aim of this study is to investigate the mediating role of sleep quality in the relationship between multidimensional perceived social support and fatigue among mothers of twin infants. One hundred and six (106) twin mothers participated in this cross-sectional study, who completed the Descriptive Information Form, Multidimensional Scale of Perceived Social Support, Pittsburgh Sleep Quality Index, and Checklist Individual Strength. The scale score averages of the mothers in the study are as follows: social support, 61.41 ± 23.86; fatigue, 77.64 ± 28.68; and sleep quality, 8.26 ± 2.38. According to the path model, perceived social support has a negative effect on poor sleep quality (p = .001, Beta = −0.411), and poor sleep quality has a positive effect on fatigue (p = .001, Beta = 0.335). Sleep quality also mediates the effect of multidimensional perceived social support on mothers’ fatigue levels (p = .001, Beta = −0.138). The study results suggest that the perceived social support and fatigue levels of twin mothers are moderate, while their sleep quality is poor. Therefore, mothers of twin infants may benefit from increased social support to alleviate fatigue and enhance sleep quality.

‘Let’s talk! What will you say to me … ?’: comparing spontaneous dyad-focused maternal speech to singleton and dizygotic twin infants at home

ABSTRACT We compared dyad-focused maternal speech (protoconversations and maternal speech describing the dyad) in interactions of mothers with their twin and singleton infants. Nine twins and nine singletons, coming from urban areas of Crete (Greece), were video-recorded at home in spontaneous face-to-face interactions with their mothers, from the 2nd to the 6th month at 30-day intervals. Continuous micro-analysis revealed that the following: (a) variations in proto-conversations favoured singleton compared to twin infants; (b) twin and singleton mothers addressed different, but possibly of equivalent communicative significance, verbal comments to their infants within protoconversations; (c) both twin and singleton mothers showed age-variant efforts for conversation with their young infants. Though we showed quantitative variations of maternal dyad-focused speech between mother-singleton infant and mother-twin infant dyads, both singleton and twin mothers used devices of equivalent communicative significance and age-variant attempts to respond sensitively to their infants’ expressive behaviours according to the latter’s age-related motives for communication.

Two babies, two bonds: Frequency and correlates of differential maternal-infant bonding in mothers of twins.

We assessed prevalence and correlates of differential maternal-infant bonding (i.e., experiencing a stronger bond with one baby vs. the other) in mothers of twins, focusing on aspects of maternal mental health, well-being, and pregnancy/birth that have been previously linked with maternal-infant bonding. Participants (N=108 American women, 88.89% White, 82.41% non-Hispanic, aged 18-45, who gave birth to twins in the past 6-24weeks) were recruited from postpartum support websites. Participants completed a Qualtrics survey assessing pregnancy/birth history, symptoms of depression and anxiety, sleep, stress, romantic relationship satisfaction, and postpartum bonding. Twenty-six participants (24.07%) reported a bonding discrepancy. These participants endorsed higher symptoms of depression and anxiety, lower relationship satisfaction, lower average postpartum bonding, higher general and parenting stress, and longer pregnancy (all ps>.05). Greater degree of bonding discrepancy correlated with more depression, higher parenting stress, longer pregnancy, and lower relationship satisfaction (all ps>.05). Mothers of twins may benefit from postpartum mental health support, stress management strategies, and interventions to improve bonding. Future work should assess the role of breastfeeding difficulties, delivery method, birth-related trauma, infant regulatory capacity, and temperament. Longitudinal studies will help test cause and effect and potential long-term repercussions of maternal-infant bonding discrepancies.

Family History of Twinning and Fertility Traits in Nigerian Mothers of Dizygotic Twins.

Familial twinning and fertility traits were investigated in Nigerian mothers of dizygotic (DZ) twins (MoDZT; N = 972) and controls (N = 525) who responded to our person-to-person interview, which included questions on pregnancy history and family history of DZ twinning. Controls were defined as women who are not twins themselves and do not have twins in their first-degree relatives. Over 95% of the participants were Yoruba. We found that Nigerian MoDZT had an average of 4.0 (±2.6) pairs of twins among their relatives, and of these, the prevalence of DZ twins was significantly higher than that of monozygotic (MZ) twins (45.9% vs. 25.8%). Controls had an average of 0.5 (±0.4) pairs, and over 95% of the controls had no twins in their relatives. These results suggest genetic influences on DZ twinning in Nigerians. MoDZT were significantly younger in their mean age at first child, and had higher parity than controls, suggesting increased fertility in MoDZT. As compared to mothers with a single set of twins, mothers (N = 130) with multiple sets had significantly more twins among their relatives (5.4 pairs vs. 3.7 pairs) and had their first twins at a younger age (28.4 vs. 30.7 years), indicating that mothers with multiple sets of twins might have higher genetic propensity for twinning associated with earlier age at twin pregnancy. Our findings argue for genomewide association studies for DZ twinning in Nigerians, and may help to develop intervention strategies to overcome infertility/subfertility problems.

COMMENT ABOUT IN VITRO FERTILIZATION (IVF) PREGNANCIES DELIVERIED AT NATIONAL HOSPITAL OF OBSTETRICS AND GYNECOLOGY IN 2022

Objectives: To determine the rate of in vitro fertilization giving birth at National Hospital of Obstetrics and Gynecology in 2022; Comments on the attitude of handling cases of in vitro fertilization giving birth with preterm labor and the attitude of handling in vitro fertilization at term.Methods: Cross-sectional description.Results: The birth rate of in vitro fertilization at the hospital in 2022 was 8.79%. The multiple pregnancy rate of in vitro fertilization accounted for 5.1% of the total number of births and accounted for 58.04% of the total number of multiple pregnancies, the rate of natural twin mothers accounted for 48%. The casesof twin birth with gestational age over 38 weeks accounted for 26.1%, the remaining 73.9% were preterm twins. The cesarean section rate was 61.5%, normal delivery was 38.3%. Among the cases of vaginal delivery, uterine atony had to transfuse blood accounted for 1.08%; among the pregnant women who had to undergo cesarean section, uterine atony, hemorrhage had to transfuse blood accounted for 0.8%.Conclusion: The birth rate of in vitro fertilization at National Hospital of Obstetrics and Gynecology in 2022 was 8.79%. The attitude of handling is mainly cesarean delivery when the fetus is full-term or preterm labor at a gestational age that can survive.

Analysis on the current situation of twin breastfeeding and its influencing factors.

Studies have found that exclusive breastfeeding can not only promote the growth and development of infants, but also increase the emotional communication between mothers and infants, and reduce the incidence of maternal breast diseases. To analysis the current situation and influencing factors of breastfeeding twins. A total of 420 twin mothers delivered in our hospital from January 2019 to December 2022 were selected to investigate the situation of breastfeeding within 6 months after delivery. An electronic questionnaire was conducted, and clinical information were collected. Univariate analysis and multivariate logistic regression analysis were applied to analyze the factors influencing exclusive breastfeeding. The rate of exclusive breastfeeding was 21.90%; in the exclusive breastfeeding group, the age <35 years old, bachelor degree or above, rural areas, no nipple depression or flat, no breast distension, no postpartum depression, adequate breast milk, participation in health education during pregnancy, husband support for breastfeeding, no infant feeding difficulties, infant diarrhea, lactose intolerance and return to milk were 96.74%, 53.26%, 65.22%, 80.43%, 76.09%, 80.43%, 73.91%, 63.04%, 69.57%, 71.74%, 65.22%, 70.65%, and 66.30%, respectively. It was significantly higher than that in the non-exclusive breastfeeding group (P < .05). The score of Edinburgh Postpartum Depression Scale (EPDS) was (8.08 ± 1.03) in the exclusive breastfeeding group, which was significantly lower than that in the non-exclusive breastfeeding group (P < .001), while the score of Perceived Social Support Scale (PSSS) was (67.32 ± 9.92), which was significantly higher than that in the non-exclusive breastfeeding one(P < .001). Logistic regression analysis showed that age, education level, nipple depression or flat, breast tenderness, postpartum depression, breast milk volume, health education training during pregnancy, husband support for breastfeeding, PSSS score, infant diarrhea, lactose intolerance, and delectation were the influencing factors of exclusive breastfeeding (P < .001). Our findings suggest that various factors were associated with a low rate of exclusive breastfeeding in twin births, such as age, educational level, and social support. Corresponding measures should be formulated for intervention to promote exclusive breastfeeding.

Maternal diabetes following gestational diabetes: Does multiple gestation multiply the risk?

To assess whether the risk for future diabetes is higher among women diagnosed with gestational diabetes (GD) during twin versus singleton gestations. A retrospective cohort study was performed including all women who delivered at a tertiary medical center between the years 1991 and 2021 and had at least one GD diagnosis. The first GD diagnosis per women was defined as the index pregnancy. Women diagnosed with GD during multiple gestations were compared with women diagnosed with GD during singleton gestations. The outcomes included first hemoglobin A1C (Hba1C) level > 6.4 mg/dL post partum, and the highest level measured during the follow-up period of up to 30 years. Multivariable logistic and Cox proportional analysis were used to compare the risk between the two groups while adjusting for confounding variables. The current study included 13 770 mothers, with 458 patients (3.3%) diagnosed with GD during twin gestations and 13 312 (96.7%) during singleton gestations. The mean follow-up was 12.25 ± 9.3 years. Mothers of both groups did not differ in age at index pregnancy; however, mothers of twins were more likely to conceive following fertility treatments. Incidence of diabetes and prediabetes (defined as Hba1C > 6.4 and >5.7, respectively) were lower among the twin-gestation group, both during the 6-month postpartum period (for diabetes: 15.5% vs 22.1%; odds ratio [OR], 0.65 [95% confidence interval (CI), 0.46-0.91]) and during the long-term follow-up (for diabetes: 31.8% vs 40.7%; OR, 0.68 [95% CI, 0.52-0.88]). These results remained significant in the multivariable analysis, while accounting for age, ethnicity, and fertility treatments. GD diagnosis during multiple versus singleton gestations is associated with a lower risk for future diabetes.

Relationships between birth weight discordance and maternal and perinatal risks among twin pregnancies conceived following frozen embryo transfer.

Is intertwin birth weight discordance associated with adverse maternal and perinatal outcomes following frozen embryo transfer (FET)? For twins conceived following FET, intertwin birth weight discordance is related to elevated risks of neonatal mortality irrespective of chorionicity, and the risk of hypertensive disorders of pregnancy (HDP) is elevated for the mothers of dichorionic twins affected by such birth weight discordance. While the relationships between intertwin birth weight discordance and adverse maternal or fetal outcomes have been studied for naturally conceived twins, similarly comprehensive analyses for twins conceived using ART remain to be performed. This was a retrospective cohort study of all twin births from 2007 to 2021 at Shanghai Ninth People's Hospital in Shanghai, China that were conceived following FET (N = 6265). Intertwin birth weight discordance was defined as a 20% difference in neonatal birth weights. The primary study outcome was the incidence of HDP and neonatal death while secondary outcomes included gestational diabetes, placenta previa, placental abruption, intrahepatic cholestasis of pregnancy, preterm premature rupture of the membranes, Cesarean delivery, gestational age, birth weight, stillbirth, birth defect, neonatal jaundice, necrotizing enterocolitis, and pneumonia incidence. Logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% CIs for maternal and neonatal outcomes. Subgroup analyses were conducted, and Kaplan-Meier survival analysis was used to estimate the survival probability. The sensitivity analysis was performed with a propensity score-based patient-matching model, an inverse probability weighting model, a restricted cubic spline analysis, and logistic regression models using other percentage cutoffs for discordance. Of 6101 females that gave birth to dichorionic twins during the study interval, birth weight discordance was observed in 797 twin pairs (13.1%). In this cohort, intertwin birth weight discordance was related to an elevated risk of HDP (aOR 1.56; 95% CI 1.21-2.00), and this relationship was confirmed through sensitivity analyses. Hypertensive disease risk rose as the severity of this birth weight discordance increased. Discordant birth weight was also linked to increased odds of neonatal mortality (aOR 2.13; 95% CI 1.03-4.09) and this risk also increased with the severity of discordance. Of the 164 women with monochorionic twins, the discordant group exhibited an elevated risk of neonatal death compared to the concordant group (crude OR 9.00; 95% CI 1.02-79.3). The limitations of this study are its retrospective nature and the fact that the available data could not specify which twins were affected by adverse outcomes. There is a lack of an established reference birth weight for Chinese twins born at a gestational age of 24-41 weeks. These findings suggest that twins exhibiting a birth weight discordance are related to an elevated risk of adverse maternal and perinatal outcomes, emphasizing a potential need for higher levels of antenatal surveillance in these at-risk pregnancies. Authors declare no conflict of interest. This study was funded by the Clinical Research Program of Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine (JYLJ202118) and the National Natural Science Foundation of China (Grant Nos 82271693 and 82273634). N/A.

Prospective longitudinal comparative study showed that breastfeeding outcomes were comparable in preterm twins and singleton infants.

We compared milk volumes, skin-to-skin contact and breastfeeding by the mothers of very preterm twins and singleton infants born at 28-32 weeks of gestation. This Norwegian longitudinal prospective comparative study was carried out in two neonatal intensive care units: one with single family rooms and one open bay unit. It comprised 49 singleton infants, 28 twins and their mothers. The mothers' milk volume and direct breastfeeding were recorded from birth until 4 months' of corrected age. They also answered the breastfeeding self-efficacy scale and skin-to-skin contact was recorded. The mothers of preterm twins produced doubled the volume of expressed milk at day 14, compared to the mothers of singletons (mean 816 ± 430 mL vs. 482 ± 372 mL, p < 0.05) and this difference was still sustained at 34 + 0 weeks/days (p < 0.02). Mothers of twins had their first breastfeeding attempt later than mothers of singletons (median of 133 h compared to 56 (p < 0.002). Preterm twins received less daily skin-to-skin contact (mean 157 ± 66 min each vs. 244 ± 109) (p < 0.001). There were no differences in receiving mother's own milk, exclusively direct breastfeeding or perceived breastfeeding self-efficacy. Breastfeeding was initiated as successfully in preterm twins as singletons as the mothers' milk production doubled.

From the Library of the Late Irving I. Gottesman: Memories and Treasures/Twin Research Reviews: Twin Study of Callous-Unemotional Traits; Depressive Symptoms in Prospective Chinese Twin Mothers; Twins With Sagittal Suture Craniosynostosis; Creative Expressiveness and Educational Achievement/Media Reports: Male-Female Twin Holocaust Survivors; Nontuplets Born in Mali; Indian Twins Marry Same Man; Twins Born From Longest-Frozen Embryos; Infant Twin Abduction; Twins Born

The experience of going through the personal library of our late esteemed twin research colleague, Dr Irving I. Gottesman, is described. I came away with fond memories and unexpected treasures. This essay is followed by brief reviews of timely research on factors affecting callous-unemotional traits, depressive symptoms in prospective Chinese twin mothers, twins with sagittal suture craniosynostosis, and creative expressiveness and educational achievement. Media reports on informative topics of interest to researchers and the general public include male-female twin Holocaust survivors, nontuplets born in Mali, Indian twins who married the same man, twins born from the longest frozen embryos, an infant twin abduction and twins born in different years.

Clinical characteristics in 26 children with congenital tuberculosis in Central Southern China: a retrospective study

ABSTRACT Background Congenital tuberculosis (CTB) is relatively rare and most patients are described in case reports. Aim To investigate the clinical characteristics of CTB in 26 children. Methods A retrospective analysis of 26 children with CTB from January 2013 to December 2021 in Changsha Central Hospital in Central Southern China was undertaken. Results The median age at onset was 25 days (17–33) and within 4 weeks of age in approximately 73% of cases. Of 24 mothers (including two mothers of twins), 18 (75.0%) were asymptomatic during pregnancy, and four were diagnosed with tuberculosis prenatally. The numbers of tuberculous meningitis, tuberculous encephalitis and liver TB were 17 (65.4%), five (19.2%) and four (15.4%), respectively. The main symptoms were fever (n = 18, 69.2%) and cough (n = 16, 61.5%). Positive rates of T-SPOT.TB, acid-fast bacilli smear, culture of Mycobacterium tuberculosis and GeneXpert MTB/RIF test were, respectively, 84.2% (16/19), 42.3% (11/26), 43.5% (10/23) and 83.3% (5/6). Radiograph or computed tomography demonstrated typical pulmonary tuberculous lesions in all cases and the head magnetic resonance imaging (MRI) showed marked meningeal enhancement or parenchymal lesions in seven cases (26.9%). One case had drug-resistant TB. During follow-up, nine cases had varying degrees of liver injury, and one had delayed growth and development. Eight died and 18 recovered satisfactorily. Conclusion Maternal TB status during pregnancy, the epidemiological history, T-SPOT.TB and other TB-related aetiological tests and imaging are important for the early diagnosis and treatment of CTB, and are associated with a favourable outcome. Abbreviations AFB: acid-fast bacilli; Amk: amikacin; Cs: cycloserine; CT: computed tomography; E: ethambutol; GeneXpert MTB/RIF: GeneXpert Mycobacterium tuberculosis and rifampicin resistance; H: isoniazid; IVF-ET: in-vitro fertilization-embryo transfer; Lzd: linezolid; Mfx: moxifloxacin; MTB: Mycobacterium tuberculosis; mNGS: next generation sequencing; MTB-DNA: Mycobacterium tuberculosis-deoxyribonucleic acid; Pto: protionamide; R: rifampicin; TB: tuberculosis; T-SPOT.TB: spot test of mycobacterium TB infection T-lymphocytes; Z: pyrazinamide.

Long-term cardiovascular mortality in women with twin pregnancies by lifetime reproductive history.

Women with one lifetime singleton pregnancy have increased risk of cardiovascular disease (CVD) mortality compared with women who continue reproduction particularly if the pregnancy had complications. Women with twins have higher risk of pregnancy complications, but CVD mortality risk in women with twin pregnancies has not been fully described. We estimated risk of long-term CVD mortality in women with naturally conceived twins compared to women with singleton pregnancies, accounting for lifetime number of pregnancies and pregnancy complications. Using linked data from the Medical Birth Registry of Norway and the Norwegian Cause of Death Registry, we identified 974,892 women with first pregnancy registered between 1967 and 2013, followed to 2020. Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for maternal CVD mortality were estimated by Cox regression for various reproductive history (exposure categories): (1) Only one twin pregnancy, (2) Only one singleton pregnancy, (3) Only two singleton pregnancies, (4) A first twin pregnancy and continued reproduction, (5) A first singleton pregnancy and twins in later reproduction and (6) Three singleton pregnancies (the referent group). Exposure categories were also stratified by pregnancy complications (pre-eclampsia, preterm delivery or perinatal loss). Women with one lifetime pregnancy, twin or singleton, had increased risk of CVD mortality (adjusted hazard [HR] 1.72, 95% confidence interval [CI] 1.21, 2.43 and aHR 1.92, 95% CI 1.78, 2.07, respectively), compared with the referent of three singleton pregnancies. The hazard ratios for CVD mortality among women with one lifetime pregnancy with any complication were 2.36 (95% CI 1.49, 3.71) and 3.56 (95% CI 3.12, 4.06) for twins and singletons, respectively. Women with only one pregnancy, twin or singleton, had increased long-term CVD mortality, however highest in women with singletons. In addition, twin mothers who continued reproduction had similar CVD mortality compared to women with three singleton pregnancies.

Breastfeeding initiation, duration, and experiences of mothers of late preterm twins: a mixed-methods study

BackgroundTwins and late preterm (LPT) infants are at an increased risk of being breastfed to a lesser extent than term singletons. This study aimed to describe the initiation and duration of any and exclusive breastfeeding at the breast for mothers of LPT twins and term twins during the first 4 months and to explore the breastfeeding experiences of mothers of LPT twins.MethodsA sequential two-sample quantitative–qualitative explanatory mixed-methods design was used. The quantitative data were derived from a longitudinal cohort study in which 22 mothers of LPT twins and 41 mothers of term twins answered questionnaires at one and four months after birth (2015–2017). The qualitative data were obtained from semi-structured interviews with 14 mothers of LPT twins (2020–2021), based on results from the quantitative study and literature. Analysis included descriptive statistics of quantitative data and deductive content analysis of the qualitative data, followed by condensation and synthesis.ResultsAll mothers of LPT twins (100%) and most mothers of term twins (96%) initiated breastfeeding. There was no difference in any breastfeeding during the first week at home (98% versus 95%) and at 1 month (88% versus 85%). However, at 4 months, the difference was significant (44% versus 75%). The qualitative data highlighted that mothers of LPT twins experienced breastfeeding as complex and strenuous. Key factors influencing mothers’ experiences and decisions were their infants’ immature breastfeeding behaviors requiring them to express breast milk alongside breastfeeding, the burden of following task-oriented feeding regimes, and the lack of guidance from healthcare professionals. As a result, mothers started to question the worth of their breastfeeding efforts, leading to changes in breastfeeding management with diverse results. Support from fathers and grandparents positively influenced sustained breastfeeding.ConclusionsMothers of LPT twins want to breastfeed, but they face many challenges in breastfeeding during the first month, leading to more LPT twins’ mothers than term twins’ mothers ceasing breastfeeding during the following months. To promote and safeguard breastfeeding in this vulnerable group, care must be differentiated from routine term infant services, and healthcare professionals need to receive proper education and training.

Twin birth: The maternal experience

ObjectiveTwin birth is a special setting for women giving birth, and the experience of childbirth can be different from singleton birth. The objective of this study was to evaluate and compare the childbirth experiences of twin mothers and singleton mothers. We also aimed to identify the risk factors of a negative childbirth experience in the whole study population. MethodsAll live diamniotic twin deliveries in the study hospital of at least 35+0 weeks of gestation with a plan of vaginal birth were included in this matched groups study from August 2015 to August 2019. For every twin birth, two singleton birth controls were selected and matched with parity, the actual mode of birth, and gestational weeks at birth. Six weeks after birth, a Childbirth Experience Questionnaire (CEQ) was sent to mothers, and 72 twin mothers and 126 singleton mothers returned the questionnaire. ResultsThe twin mothers’ overall childbirth experience was positive. They reported a significantly lower opportunity to choose the birthing position (p < 0.001). Otherwise, there were no differences in the CEQ mean total scores between the study groups. Intrapartum cesarean section raised the risk of a negative childbirth experience and there was a high level of satisfaction with midwifery care among the whole study population. ConclusionThe overall maternal experience in planned vaginal twin birth was positive. Twin mothers felt less often able to choose their birthing position, otherwise the childbirth experience did not differ from that of singleton mothers.

Brazilian portuguese version of twin relationship questionnaire (TRQ-BR): Evidence of validity

Our aim was to adapt and validate a Brazilian Portuguese version of the Twin Relationship Questionnaire developed by Fortuna et al. (2010) and validated by H. Segal and Knafo-Noam (2019) in Israel. The respondents were 862 Brazilian mothers of twins ( N = 1724 twins) with mean age of 35 years (SD = 6.1). The majority of the sample lived in the Southeast (61.8%) or in the South (24.5%) of Brazil. We conducted a Multilevel Confirmatory Factor Analysis with the pair of twins as second level variable, and the five-factor structure (closeness, dependence, conflict, dominance, and rivalry) proposed by the original validation study of H. Segal and Knafo-Noam (2019) was confirmed. The final model retained 15 items out of 22 proposed in the original version of the questionnaire. Although the TRQ-BR has fewer items, the accuracy compared to the original questionnaire was maintained. Mixed Model Analysis (LMM) of TRQ scores were used to investigate twins’ relationships as a function of zygosity, age groups, and sex in order to provide evidence of convergent validity of the instrument. As expected, mothers perceived monozygotic twins (MZ) as more depedent than dizygotic twins (DZ). Furthermore, male twin pairs were considered more conflictive when compared to female twins. The present study showed that TRQ-BR is an adequate instrument for research purposes in the Brazilian population. It can also be useful for applied areas such as clinical and educational fields.