Cerebral palsy and multiple births.

Abstract

Aim-To compare the birthweight specific prevalence of cerebral palsy in singleton and multiple births.

Prematurity and twinning

“…Twinning has been recognized as a risk factor for CP for at least a century [15]. The CP rate per 1000 is 2.3 in singleton survivors, 12.6 in twins and 44.8 in triplets, demonstrating an increased risk in higher order multiple pregnancies [16]. Thus CP is at least five times more frequent among twins than singleton.…”

Fetal Death Registration in Multiple Births: Anomalies and Clinical Significance

“…These abnormalities in the surviving fetus, almost invariably, have been reported in monochorionic twin pregnancies (Anderson et al, 1990;Baker & Doering, 1982;Grafe, 1993;Hoyme et al, 1981;Scheller & Nelson, 1992;Schinzel et al, 1979). The risk of cerebral palsy in the surviving twin of a co-twin that died in utero is about 1 in 10 (Grether et al, 1993;Pharoah & Cooke, 1996;Pharoah & Adi, 2000). It has been hypothesized that the early demise of an embryo or fetus that is unrecognized or unregistered is the cause of many congenital anomalies, including cerebral palsy, in singleton births (Pharoah, 2005).…”

Intrauterine Growth and Cerebral Palsy in Twins: A European Multicenter Study

“…Intrauterine Growth and Cerebral Palsy in Twins births (Grether et al, 1993;King & Johnson, 1995;Liu et al, 2000;Nelson & Ellenberg, 1995;Petterson et al, 1993;Pharoah & Cooke, 1996;Stanley et al, 2000b;Williams et al, 1996;Yokoyama et al, 1995). However, only some of these studies reported CP rates by gestational age (Liu et al, 2000;Pharoah & Adi, 2000;Scher et al, 2002;Williams et al, 1996;Yokoyama et al, 1995).…”

“…Twins and higher order multiples are at greater risk of neurological morbidity than singletons. Thus, the prevalence of CP ranges from 7 to 12 per 1000 survivors in twins, compared with one to two in singletons (Grether et al, 1993;Petterson et al, 1993;Pharoah & Cooke, 1996;Williams et al, 1996;Yokoyama et al, 1995). The higher rate of CP in twins can not be entirely attributable to the higher proportion of low birthweight and preterm infants among twins, because the risk of CP in twins is also higher in normal birthweight twins compared to singletons of similar birthweight (Grether et al, 1993;Pharoah & Cooke, 1996;Williams et al, 1996).…”

“…Thus, the prevalence of CP ranges from 7 to 12 per 1000 survivors in twins, compared with one to two in singletons (Grether et al, 1993;Petterson et al, 1993;Pharoah & Cooke, 1996;Williams et al, 1996;Yokoyama et al, 1995). The higher rate of CP in twins can not be entirely attributable to the higher proportion of low birthweight and preterm infants among twins, because the risk of CP in twins is also higher in normal birthweight twins compared to singletons of similar birthweight (Grether et al, 1993;Pharoah & Cooke, 1996;Williams et al, 1996). Other factors specific to multiple pregnancy, such as twin-twin transfusion and intrauterine death of a cotwin in a monochorionic pregnancy, may also contribute to the excess risk of CP in twins (Blickstein, 2002;Pharoah & Adi, 2000;Scher et al, 2002).…”