Zygosity as a risk factor for complications and outcomes of twin pregnancy

All of the recorded twin live births in Washington State birth certificates between 1984 and 1988 were used a retrospective cohort study to determine the risk of zygosity on pregnancy complications and birth outcomes (n = 3458). Relative risks comparing different sex (DS) twins to same sex (SS) twins were corrected to relative risks relating dizygotic (DZ) to monozygotic (MZ) twins, using the Weinberg rule. A higher proportion of DS twin pregnancies (3.5%) than SS pregnancies (1.6%) were complicated by gestational diabetes, resulting in an estimated risk for DZ twin pregnancies relative to MZ pregnancies of 8.6 (95% CI = 3.5-21.0). DZ twin pregnancies were at a lower risk for complications of polyhydraminios (RRDZ/MZ = 0.2, 95% CI = 0.1-0.4) and of pyelonephritis, (RRDZ/MZ = 0.3, 95% CI = 0.1-0.8). MZ twins were more likely to have low birthweight and to have shorter gestations. The proportion of first-born babies of MZ twin pairs who died during their first year was similar to that of first twins of DZ pairs; however, the second-born of MZ twins were more likely to die in infancy than were second-born DZ pairs. First twins of DZ pairs were more likely to die of SIDS (sudden infant death syndrome) than the first of MZ twins (RRDZ/MZ = 1.5, 95% CI = 0.4-5.1). In contrast, DZ second-born were less likely to die of SIDS than were MZ second-born twins (RRDZ/MZ = 0.1, 95% CI = 0.1-0.7). DZ twins were less likely to have adverse newborn conditions or malformations. The high risk for gestational diabetes for DZ twin mothers is possibly due to the presence of two placentas which may support the development of greater insulin antagonism than the single placenta in the mother of MZ twins. The reduced risk of DZ relative to MZ twins for selected adverse birth outcomes may result from the increased tendency of MZ twins to be premature.