Cerebral palsy in twins: a national study

Area of Science:

• Perinatology
• Neurology
• Epidemiology

Background:

• Cerebral palsy (CP) is more prevalent in twins than singletons.
• The risk of CP in a surviving twin significantly increases if the co-twin experiences fetal or infant death.
• Like-sex twin pairs are identified as having a particularly high risk for CP.

Purpose of the Study:

• To compare birthweight-specific cerebral palsy prevalence in like-sex versus unlike-sex twins when both survive infancy.
• To present a comprehensive view of CP prevalence based on co-twin survival status.
• To analyze CP risk factors in twin gestations.

Main Methods:

• Data collected from twins born in England and Wales (1994-1995).
• Parental questionnaires identified children with cerebral palsy, hemiplegia, diplegia, or quadriplegia.
• Birthweight-specific CP prevalence rates were calculated for like-sex and unlike-sex twins across various birthweight categories.

Main Results:

• Like-sex twins showed a higher risk of cerebral palsy than unlike-sex twins when both survived, though this difference was not statistically significant.
• The birthweight-specific prevalence of cerebral palsy was significantly lower when both twins survived infancy compared to situations where a co-twin had died.
• Analysis stratified by birthweight revealed specific risk patterns.

Conclusions:

• Like-sex twins face an elevated risk of cerebral palsy, particularly when a co-twin death occurs.
• While zygosity was not determined, monozygosity and monochorionicity are hypothesized as key factors for increased CP risk in like-sex twins.
• Early identification and management of risk factors in twin pregnancies are crucial for reducing CP incidence.