Malformations in twins and their siblings, Norway, 1967-79

During 1967-79 the population-based Medical Birth Registry of Norway registered 7,660 twin pairs (1% of births) born to 7,596 mothers, who gave birth to 6,608 additional infants (twin siblings). The total rate of malformations among twins (278.1/10,000) was not significantly different than among singletons (302.1/10,000), nor among twin siblings (314.8/10,000). By specific type of defect, twins had significantly higher rates than singletons of central nervous system (CNS) defects (Rate Ratio = 1.8) and cardiovascular defects (RR = 1.5). The twins also had a significantly low rate of congenital hip dislocation (RR = 0.4), which may explain the relatively low incidence of malformations in twins. Like-sex (LS) twins had a slightly higher rate of malformations than unlike-sex (US) twins (RR = 1.1), as well as a higher rate of CNS defects (RR = 3.0). The siblings also had a significantly increased rate of CNS defects compared to singletons (RR = 1.9), but not of cardiovascular defects (RR = 0.9). The results indicate that twins have elevated rates of at least some congenital malformations. The observations about CNS defects suggest common factors that can lead to either like-sex twinning, CNS defects, or both. The increased frequency of cardiovascular defects in twins appears to be associated with the biologic conditions of twinning.