Mothers Of Twins Research Articles

Stress and Coping Among Mothers of Twins in Rural Southwestern Nigeria

High rates of twinning have been reported in Africa. This study sought to learn whether mothers of twins experience different stress levels than those who have only singletons. Both twin mothers (101) and singleton mothers (101) were interviewed. Using a scale of 15 stressors the researchers found that the mean stress score was significantly higher for twin mothers than singleton mothers. Higher stress scores were also associated with parity and perceptions of problems in caring for children and inversely related to perceived levels of social support. Confronting stressors or simply accepting them were the two main ways that mothers coped with their problems.

Mothers progressed through a 4 phase process to resume their own lives after having twins

(2002) Qual Health Res 12, 593. Beck CT. . Releasing the pause button: mothering twins during the first year of life. . ; . : . –608 . [OpenUrl][1][Abstract/FREE Full...

Can Marmoset Mothers Count to Three? Effect of Litter Size on Mother–Infant Interactions

AbstractHarper (Parental Care in Mammals, Plenum Press, New York, 1981, p. 158) proposed that ‘there may be lower and upper limits for frequency or intensity of offspring stimulation that, on average, serve as reliable boundaries, below or above which it would be uneconomical to invest at all or at current levels.‘ This proposition was tested in captive common marmosets by comparing the responses of marmoset mothers exposed to differing number of infants. Fifteen common marmoset (Callithrix jacchus) litters (seven twin and eight triplet litters) from 11 different dams were observed for 6–12, 30‐min sessions over days 1–4 following birth. Mothers nursed smaller infants less frequently (F = 4.208, df = 1, 22; p = 0.052) regardless of litter size. The percent time mothers spent transporting (nursing and carrying) each infant was less for triplets than twins (F = 11.785, df = 1, 12; p = 0.005). Average transport bout length was significantly shorter for smaller infants (F = 7.566, df = 1, 22; p = 0.012) and was half as long for triplet infants as for twins (F = 10.733, df = 1, 7; p = 0.013). Twice as many transport bouts for triplets included maternal harassment of infants, than for twins (F = 42.742, df = 1, 24; p = 0.0001). Infant‐initiated transfers to the mother were more common for triplets than for twins (Mann–Whitney U = 79.50, p = 0.006). The overall maternal carrying score (% carry × number of infants carried) was lower for triplet litters than for twin litters (F = 15.38, df = 1, 3; p = 0.029); i.e. mothers of triplets did not, overall, invest in more carrying and nursing than did mothers of twins but instead invested less. These findings suggest that, as opposed to the strong attraction to infants that is common for many primates, the marmoset mother's tolerance for carrying infants does not increase with increasing infant stimuli present; rather, marmoset mothers will only tolerate a limited amount of time transporting and nursing infants, regardless of litter size. This limited tolerance may be due to the species’ small body size and anti‐predator strategies (e.g. concealment) that make infant care incompatible with other essential activities, such as foraging.

Breast-feeding in preterm twins: Development of feeding behavior and milk intake during hospital stay and related caregiving practices

In a prospective study of 13 preterm twins still in the hospital, 85% were breast-fed, of which 46% were breast-fed exclusively. Most mothers preferred simultaneous breast-feeding, using the football hold. Observations and maternal descriptions showed differences between the twins in their development of breast-feeding behavior, especially in sucking. The mothers' suggestions regarding special support for the breast-feeding mothers of preterm twins involved synchronizing feeding with the twins' behavioral states; twin cobedding; appropriate armchairs and breast-feeding pillows; experimenting with breast-feeding positions; information about breast milk production; nurses' spontaneous practical assistance, encouragement, and emotional support; the provision of privacy; the availability of parent rooms; and opportunities for fathers' presence in the hospital. Copyright 2002, Elsevier Science (USA). All rights reserved.

Twin and Singleton Births in Ghana — A Case-control Study

AbstractAretrospective study involving 623 twin and 1246 singleton births was conducted to compare the two groups with regard to selected maternal, fetal and labor and delivery characteristics and outcomes. Maternal age and parity were significantly higher for twins. The risks of preterm delivery, arrival in the labor ward in second stage of labor, cesarean births and postpartum haemorrhage were significantly higher in twin than in singleton births. In vaginal deliveries twin mothers were significantly less likely to have had episiotomies or perineal lacerations. There was no difference in the duration of the third stage of labor or in the incidence of retained placentae. Antepartum haemorrhage was a less likely indication for cesarean delivery among twins, while there was no significant difference in the likelihood of severe pre-eclampsia/eclampsia being an indication. Singleton babies were significantly heavier than twins. The incidences of malpresentation, low birth weight, stillbirths and of admission of live births to the neonatal intensive care unit were significantly higher in twins. There was no difference in the rate of instrumental vaginal delivery, or in the route of delivery of fetuses presenting by the breech. There is the need for detailed study of the incidences of antepartum haemorrhage and hypertensive diseases in twin and singleton pregnancies and of the factors determining the mode of delivery when such complications arise. Labor and delivery should also be examined to determine any differences between the two groups, especially in the first and second stages.

Maternal speech style with prelinguistic twin infants

AbstractThe mother–infant communicative speech of a group of mothers of 4‐month‐old first‐born twin infants was compared to the speech of a group of mothers of first‐born singleton infants. Maternal groups were matched on age, education level, mother–infant attachment status and infant gender, and maternal depression was assessed as a control variable. Maternal speech was coded for focus, content, complexity and syntax of mothers' utterances. The findings of earlier studies with toddler age twins, that maternal speech style was more directive and less infant‐focused, were replicated in this prelinguistic period of infancy. Compared to mothers of singletons, mothers of twins used less infant‐focused speech, were less responsive to their infants' cues, and attributed less agency to their infants. Mothers of twins also used fewer questions and requests but did not differ from mothers of singletons in their use of negatives and imperatives. These early differences in the language learning environments of twin and singleton infants may be due to the reduced opportunities that mothers of twins have to establish dyadic communicative routines with their infants and to familiarize themselves with their infants as interactive partners, and may have implications for the early language development of twins. Copyright © 2002 John Wiley & Sons, Ltd.

Twinning and Birth Weight in the Israeli Jewish Versus Muslim Maternities

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 therefore differences attributed to levels of medical care are practically negligible. We previously evaluated the overall relationship between ethnicity and outcome in a population-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.

Twinning and Birth Weight in the Israeli Jewish Versus Muslim Maternities

AbstractEthnicity 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.

Hypertensive Disease in Twin Pregnancies: A Review

AbstractReports 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.

Hypertensive Disease in Twin Pregnancies: A Review

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.

Familienstruktur bei Mehrlingseltern im Vergleich zu Einlingseltern nach erfolgreicher reproduktionsmedizinischer Behandlung (ICSI)

Objective: Assisted reproduction is associated with an increased rate of multiple gestation. In an in-vitro fertilization registry, 74% of births were singletons, 22% were twins, and 4% were triplets. Twins and triplets have certain risks regarding physical and psychosocial development compared with singletons, and are a challenge to parents. We studied family structures after delivery of singletons and multiple infants after intracytoplasmatic sperm injection (ICSI). Methods: One year after delivery 55 mothers and 51 fathers were asked to complete family questionnaires assessing family functions. The questionnaires had scales assessing task fulfillment, role behavior, communication, emotionality, affective establishment of relations, control, values, and norms. Results: In our study there were 44 singleton (80%), 8 twin (14.5%), and 3 triplet births (5.5%). In the general family questionnaire mothers of singletons and twins or triplets scored in the mean range. Fathers of twins or triplets indicated problems in emotionality, affective relationship, and control with insufficient or inappropriate expression or suppression of emotion. Problems of control behavior suggest hidden or open power struggles in the family. There were significant differences between mothers and fathers of multiple babies in communication, emotionality, affective establishment of relations, control, values and norms. Conclusion: Families with multiple babies after ICSI are at risk of problems. Appropriate counseling should be considered for parents of multiple infants after assisted reproduction.

Lactation, maternal behavior and infant growth in common marmoset monkeys ( Callithrix jacchus ): effects of maternal size and litter size

We examined the relationship between lactation performance and infant growth in a captive population of common marmosets (Callithrix jacchus) that varied in both maternal and litter size. Though common marmosets display a typical primate pattern of dilute milk and relatively slow infant growth rates (factors associated with low daily lactation investment and minimal maternal size effects), we hypothesized that the marmoset's small body size would make lactation investment more sensitive to maternal size than is true for larger-bodied primates. Smaller mothers rearing twins had lower milk fat, lower gross energy in milk samples collected in mid to late lactation and lower nursing-bout frequencies than did large mothers nursing twins. Lactation performance and maternal behavior did not differ between large and small mothers when rearing singletons, with a single exception: small mothers had a lower gross energy in mid-lactation milk samples. Relative growth rates in twins but not singletons were affected by maternal size, such that small mothers supported more growth per infant when rearing singletons while large mothers supported more growth per infant when rearing twins. Among the larger mothers, only, older mothers supported somewhat, though not significantly, less growth per infant, regardless of litter size. Twin infants of small mothers appeared to respond to below-optimal levels of milk yield by initiating maternal carrying less often. The relative energy intake of mothers was similar regardless of litter or maternal size. Small mothers rearing twins drew more heavily on reserves, reflected in a linear weight loss during lactation; however, the reserves drawn upon were inadequate to meet the lactation demand, resulting in lower milk energy output. In addition, small mothers rearing twins were more likely to be ill and less likely to be fertile in the year following lactation than were large mothers of twins or mothers of any size rearing singletons.

The fitness of twin mothers: evidence from rural Gambia

Abstract We used a longitudinal database from a natural fertility population in rural Gambia to compare the overall fertility of mothers who had given birth to twins at some point in their reproductive history and mothers who had only ever given birth to singletons. We found that twin mothers had shorter birth intervals, higher age-specific fertility and more surviving children than singleton mothers. This suggests that, despite the considerably higher mortality of twins found in this population, twin mothers have a fitness advantage over singleton mothers, even in the absence of modern medical care. We ran a simple simulation model to estimate the relative fitness of twin and singleton mothers, and found that the model also estimated higher fitness for twin mothers. Further, girls who went on to become twin mothers were of higher anthropometric status during their teenage years than those who became singleton mothers.

Natural versus induced twinning and pregnancy outcome: a Dutch nationwide survey of primiparous dizygotic twin deliveries

Objective: To compare obstetrical outcome of twin pregnancies after assisted reproduction with that of natural twin pregnancies. Design: Retrospective national database study. Setting: Academic Medical Centre. Patient(s): One thousand ninety-three primiparous mothers registered in the Dutch National Birth Registry who gave birth to a dizygotic (DZ) twin (male/female) in 1994, 1995, and 1996. We compared 613 natural twin pregnancies and 480 twin pregnancies born after assisted reproduction. Main Outcome Measure(s): Gestational length, mode of delivery, mode of presentation of the children, birth weight, APGAR score, congenital anomalies, perinatal mortality rate, highest recorded maternal diastolic blood pressure, and maternal postpartum complications. Result(s): Rates of perinatal mortality and very premature parturition (<29 weeks) were lower in natural twin mothers. Overall, induced DZ twins were born 3.5 days earlier with a lower birth weight and APGAR score compared with controls. Rates of congenital anomalies and incidence of cesarean section were not different. The highest recorded diastolic blood pressure was lower in induced twinning with a 30% lower incidence of diastolic blood pressure >90 mm Hg. Conclusion(s): Obstetric outcome for induced DZ twin pregnancy is less optimal than in natural DZ twin pregnancy. Twinning in assisted reproduction is known for its contribution to the high rate of premature deliveries, but in addition being a subfertile patient undergoing treatment makes an intrinsic contribution to adverse events as well.

Mutations in the follicle-stimulating hormone receptor and familial dizygotic twinning

Concentrations of follicle-stimulating hormone (FSH) have an important role in multiple ovulation. An association has been reported between mutations in the FSH receptor (FSHR) in a family with increased twinning frequency. We sequenced the transmembrane region of FSHR (located on chromosome 2) in 21 unrelated mothers of dizygotic twins and found no differences to the published sequence. A linkage study of 183 sister pairs and trios, in which all sisters had given birth to spontaneous dizygotic twins, excluded linkage to this region of chromosome 2. We conclude that mutations in FSHR are not a common cause of familial dizygotic twinning.

Establishing a twin register in Sri Lanka

We report the process of adaptation into Sinhala of a questionnaire given to mothers of twins to determine zygosity. Adaptation and validation was carried out in three stages. Firstly, we used a nominal group to translate the English version and to assess the extent of agreement (consensus measurement) on the appropriateness of the translation and resolve disagreement (consensus development). Secondly we used a qualitative interview with 25 mothers of twins. The three main stems of the translated questionnaire were used as a semi-structured interview, and the responses noted verbatim. These were categorised and analysed, and the translated full questionnaire was then presented as closed questions with fixed choice responses. The categorised responses generated during the qualitative interview were compared with the responses to the fixed choices in the full questionnaire. The third stage was the appraisal of the questionnaire by 17 bilingual parents of twins. The source and translated version of the questionnaire were given to them at least 3 days apart. The responses were rated and the total scores were computed to determine the zygosity. This step was carried out to measure the validity and reliability of the Sinhala version. A perfect correlation between the original and adapted version was obtained, with a kappa of 1. The results suggest that the Sinhala version of the questionnaire is conceptually equivalent to the original questionnaire. Comparison of the zygosity determination by using this adapted questionnaire with results from analysis of genetic markers on Sri Lankan twins is needed for final validation of the translated questionnaire. Twin Research (2000) 3, 205–212.

The number of dichorionic twin pregnancies is reduced by the common MTHFR 677C→T mutation

In multiple pregnancies, demands for folic acid are considerably increased. The most common inborn error of folate metabolism is mild methylenetetrahydrofolate reductase (MTHFR) deficiency due to the synthesis of a thermolabile variant of the enzyme with impaired catalytic activity which leads to reduced 5-methyltetrahydrofolate (5-methyl-THF) and mildly elevated homocysteine plasma concentrations when folate status is inadequate. To investigate whether the number of offspring is influenced by this mutation, we determined the frequency of the 677C-->T substitution in 156 singleton and 40 twin mothers with dichorionic placentation. The T allele frequency in singleton (0.30) and twin mothers (0.16) was significantly different (P = 0.011). Mothers with the 677C-->T mutation had a 2.28 times lower risk of having a twin pregnancy than those without (95% confidence interval = 1.18-4.66; P = 0.008). Our observation would explain, at least in part, the hereditary trait of multiple gestations and is in agreement with the ethnic distribution pattern of the T allele which has been found to be inversely correlated with the incidence of dichorionic twins. Our findings suggest that the MTHFR 677C-->T mutation interferes with human brood size, probably by influencing the proliferation of rapidly dividing embryonic and maternal cells.

Pre- and Postnatal Determinants of Parenting Stress in Mothers of One-Year-Old Twins

SUMMARY This study examined whether parenting stress in mothers of one-year-old twins can be predicted by their prenatal and postnatal personal well-being, marital support, social support and the presence of other children in the family. Forty mothers of twins participated in a research study conducted pre- and postnatally in their homes. The first interview was at around 27 weeks of pregnancy; the second occurred one year following the twins' birth. At both times, the mothers completed the General Health Questionnaire (GHQ-30). At the second interview, the Parenting Stress Index (PSI) was also administered. Regression analyses showed that parenting stress was significantly predicted by pre- and postnatal personal well-being and marital support. Neither social support nor the presence of other children in the family predicted parenting stress in a significant way.

Maternal behavior toward premature twins: implications for development

Assisted reproductive techniques and fertility enhancing therapies have increased multiple births and, therefore, the risk of prematurity and its developmental consequences. Parent intervention is an effective source of compensation for the cognitive effects of prematurity. We hypothesized that relative to parents of preterm singletons, parents of preterm twins are less able to provide such enhancing care, resulting in a developmental disadvantage for preterm twins. Maternal–infant interactions of premature singletons (n =22; birth weight =1668 ± 350 g, gestational age =32.3 ± 2.1 weeks) and premature twins (n = 8; birth weight = 1618 ± 249 g; gestational age = 32.0 ± 2.6 weeks) with comparable demographic and medical status were observed at home at 1 and 8 months corrected age using a 30 min checklist of developmentally facilitative behavior. Mental (MDI) and psychomotor (PDI) indices of the Bayley Scales of Infant Development and Caldwell Home Observations for Measurement of the Environment (HOME) inventories were administered (18 months corrected age). Compared with mothers of premature singletons, mothers of premature twins exhibited fewer initiatives (P &lt; 0.001) and responses (P &lt; 0.01) and were less responsive to positive signals (P &lt; 0.01) and crying (P &lt; 0.01). Unprompted by the infant, twin mothers lifted or held (P &lt; 0.05), touched (P &lt; 0.01), patted (P &lt; 0.05) or talked (P &lt; 0.01) less. Singleton MDIs surpassed twins (119.4 ± 7.7 vs 103.6 ± 7.7; P &lt; 0.01). Maternal verbal behavior and the acceptance of child factor (HOME), both favoring singletons, correlated with MDI (R-square = 0.46, P &lt; 0.0002). Mothers of premature twins exhibited fewer initiatives and responses toward offspring than did mothers of premature singletons. Maternal behavior was predictive of cognitive development. Twin Research (2000) 3, 234–241.

Cross-cultural adaptation and preliminary validation of a zygosity determination questionnaire for twins in Sri Lanka

We report the process of adaptation into Sinhala of a questionnaire given to mothers of twins to determine zygosity. Adaptation and validation was carried out in three stages. Firstly, we used a nominal group to translate the English version and to assess the extent of agreement (consensus measurement) on the appropriateness of the translation and resolve disagreement (consensus development). Secondly we used a qualitative interview with 25 mothers of twins. The three main stems of the translated questionnaire were used as a semi-structured interview, and the responses noted verbatim. These were categorised and analysed, and the translated full questionnaire was then presented as closed questions with fixed choice responses. The categorised responses generated during the qualitative interview were compared with the responses to the fixed choices in the full questionnaire. The third stage was the appraisal of the questionnaire by 17 bilingual parents of twins. The source and translated version of the questionnaire were given to them at least 3 days apart. The responses were rated and the total scores were computed to determine the zygosity. This step was carried out to measure the validity and reliability of the Sinhala version. A perfect correlation between the original and adapted version was obtained, with a kappa of 1. The results suggest that the Sinhala version of the questionnaire is conceptually equivalent to the original questionnaire. Comparison of the zygosity determination by using this adapted questionnaire with results from analysis of genetic markers on Sri Lankan twins is needed for final validation of the translated questionnaire.