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Cerebral palsy in twins and singletons

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Twins are more likely than singletons to have cerebral palsy (CP). Data from a Scottish register (

) have been used to study risk factors for CP among twins and singletons.

In Scotland between 1984 and 1990 there were 442 662 live singleton births and 9248 live twin births (from 4749 twin pregnancies with at least one surviving child). On the Scottish Register of Children with Motor Deficit of Central Origin there were 836 children with CP who were born between 1984 and 1990, and 646 of these children (586 singletons, 57 twins, and three triplets) were included in the analysis. The prevalence of CP among twins was almost five times that among singletons (6.39 vs 1.32 cases of CP per 1000 neonatal survivors). Compared with CP in singletons, CP in twins was more likely to be spastic and bilateral (64.9% vs 48.5%) and less likely to be dyskinetic (7.0% vs 14.5%) or ataxic (1.8% vs 6.1%). Birth order of the twin did not affect the risk of CP but when one twin was either stillborn or died in the neonatal period the risk of CP in the survivor was increased 6.3 fold. Increasing discordance in the birthweights of twins was associated with increase in CP risk, with equal risk to the lighter or the heavier twin. There was a trend towards greater risk in same sex twins. Being born preterm, small-for-dates, and male increased the CP risk for both twins and singletons. At birthweights <1000 g the rate of CP was 2.6 times greater among twins than among singletons. At birthweights of 2500 g or greater the rate was 2.9 times greater among twins. At birthweights between 1000 g and 2000 g, however, the rate among singletons was approximately twice as great as among twins. Rates of CP among twins varied less with birthweight and gestational age than rates among singletons and the increased risk of CP among twins is therefore not simply a consequence of low birthweight and short gestation.

The authors of this paper conclude that being a twin in itself increases the risk of CP and CP may have different causes in twins and singletons.

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