Risk Factors for Twinning with Special Reference to Chorionicity

Title: Risk Factors for Twinning with Special Reference to Chorionicity – A Hospital Based Study

Authors: Lekshmi Murukesan, Mayadevi Brahmanandan, Sujamol Jacob

DOI: https://dx.doi.org/10.18535/jmscr/v5i6.200

Abstract

Background: The rise in the incidence of twin pregnancies all over the world is not only due to assisted reproductive techniques but also due to various other risk factors. Twin pregnancy is associated with increased risk of maternal and fetal complications which in turn increases financial, emotional and social cost to the twins themselves and their families.

Materials and Methods: A clinical non-interventional ‘nested’ case control study was conducted in a tertiary care centre over a period of 1 year. To study the risk factors, all the required data were collected by personal interview of mothers.

Results: Nearly one third of twins were monochorionic twins. Dichorionic twins were found to be more in higher socio-economic groups, maternal age > 25 years, advanced parity and infertility treatment, especially ovulation induction with clomiphene citrate.

Conclusions: Epidemiological studies on twins helps us in better understanding the phenomenon of childbirth.

Key Words: Chorionicity, Monochorionic, Dichorionic, Twins.

References

1. Bulmer MG. The biology of twinning in man. The biology of twinning in man. 1970.

2. Smits J, Monden C. Twinning across the developing world. PLoS One. 2011 Sep 28;6(9): e25239.

3. Taffel SM. Health and demographic characteristics of twin births: United States, 1988. Vital and health statistics. Series 21, Data on natality, marriage, and divorce. 1992 Jun (50):1-7.

4. Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM, Sutton PD. Births: final data for 2000.

5. Gardner MO, Goldenberg RL, Cliver SP, Tucker JM, Nelson KG, Copper RL. The origin and outcome of preterm twin pregnancies. Obstetrics & Gynecology. 1995 Apr 1;85(4):553-7.

6. Dera A, Breborowicz GH, Keith LO. Twin pregnancy–physiology, complications and the mode of delivery. Arch Perinat Med. 2007;13(3):1673-5.

7. Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams Obstetrics 23rd Edition, 2010.

8. Akinboro A, Azeez MA, Bakare AA. Frequency of twinning in southwest Nigeria. Indian Journal of Human Genetics. 2008 May;14(2):41.

9. Keith L, Ellis R, Berger GS, Depp R, Filstead W, Hatcher R, Keith DM. The Northwestern University multihospital twin study: I. A description of 588 twin pregnancies and associated pregnancy loss, 1971 to 1975. American journal of obstetrics and gynecology. 1980 Dec 1;138(7):781-9.

10. Guttmacher AF. An analysis of 573 cases of twin pregnancy: II. The hazards of pregnancy itself. American Journal of Obstetrics and Gynecology. 1939 Aug 31;38(2):277-88.

11. Sandra E, Yip R. Increasing trends in plural births in the United States. Obstetrics & Gynecology. 1995 Feb 1;85(2):229-32.

12. Lynch A, McDuffie R, Murphy J, Faber K, Leff M, Orleans M. Assisted reproductive interventions and multiple birth. Obstetrics & Gynecology. 2001 Feb 28;97(2):195-200.

13. Tilahun T, Araya F, Tura G. Incidence and risk factors of twin pregnancy at Jimma University Specialized Hospital, Southwest Ethiopia. Epidemiology: Open Access. 2015;5(2).

14. Ananth CV, Chauhan SP. Epidemiology of twinning in developed countries. In Seminars in perinatology 2012 Jun 30 (Vol. 36, No. 3, pp. 156-161). WB Saunders.

15. Ghai V, Vidyasagar D. Morbidity and mortality factors in twins. An epidemiologic approach. Clinics in perinatology. 1988 Mar;15(1):123-40.

16. Korsak VS. Incidence and some perinatal problems of multiple pregnancies in a central referral hospital, Addis Ababa. Ethiopian medical journal. 1989 Oct;27(4):217-21.

17. Musili F, Karagja JG. Multifoetal pregnancies at a maternity hospital in Nairobi. East African medical journal. 2009;86(4).

18. Obiechina NJ, Okolie VE, Eleje GU, Okechukwu ZC, Anemeje OA. Twin versus singleton pregnancies: the incidence, pregnancy complications, and obstetric outcomes in a Nigerian tertiary hospital. International journal of women's health. 2011; 3:227.

19. BULMER MG. The effect of parental age, parity and duration of marriage on the twinning rate. Annals of Human Genetics. 1959 May 1;23(4):454-8.

20. Derom C, Derom R, Vlietinck R, Berghe HV, Thiery MI. Increased monozygotic twinning rate after ovulation induction. The Lancet. 1987 May 30;329(8544): 1236-8.

Corresponding Author

Mayadevi Brahmanandan

Email- This email address is being protected from spambots. You need JavaScript enabled to view it.