Skip to main content Accessibility help
Hostname: page-component-59b7f5684b-vcb8f Total loading time: 0.427 Render date: 2022-09-28T00:34:03.449Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": false, "useSa": true } hasContentIssue true

The Northwestern University Twin Study. VIII: On the Causes and Care of Multiple Pregnancy

Published online by Cambridge University Press:  01 August 2014

L.G. Keith*
Department of Obstetrics and Gynecology, Northwestern University Medical Schooland Prentice Women's Hospital and Maternity Center, Chicago
M.W. Method
David Grant Medical Center, Travis Air Force Base, California
O.R. Depp
Presently, Department of Obstetrics and Gynecology, Jefferson Medical College, Philadelphia, Pennsylvania
D.M. Keith
Center for the Study of Multiple Birth, Chicago, Illinois, USA
333 East Superior Street, Suite 476, Chicago, IL 60611, USA


HTML view is not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Recent clinical literature on the causes of twin pregnancy and specific areas of antenatal care are reviewed. Controversial aspects of clinical management are discussed.

Research Article
Copyright © The International Society for Twin Studies 1988



1.Ameli, S, Keith, LG, Depp, OR, Hobart, J (1986): The Northwestern University Triplet Study. II: Triplet pregnancies delivered between 1981-86. Presented at the 5th International Congress on Twin Studies, Amsterdam, The Netherlands, 09 15-19.Google Scholar
2.Beazley, JM, Underhill, RA (1971): Confinement date unknown. Nursing Times 67:14141417.Google ScholarPubMed
3.Benson, M, Keith, L, Keith, D (1983): The etiology of twins. In Leventhal, JM (ed): Current Problems in Obstetrics and Gynecology. Chicago: Year Book Medical Publishers, vol. 6, no. 8.Google Scholar
4.Berger, GS, Keith, LG, Ellis, R, Depp, R (1981): The Northwestern University Multihospital Twin Study. III: Obstetric characteristics and outcome. In Gedda, L, Parisi, P, Nance, WE (eds): Twin Research 3: Twin Biology and Multiple Pregnancy. New York: Alan R Liss, pp 207215.Google Scholar
5.Björo, K Jr, Björo, K (1985): Disturbed intrauterine growth in twins: Etiological aspect. Acta Genet Med Gemellol 34:7379.CrossRefGoogle Scholar
6.Braine, MDS, Heimer, CB, Wortis, H, Freedman, AM (1966): Factors associated with impairment of the early development of prematures. Monographs of the Society for Research in Child Development 31 (4, Serial no. 106).CrossRefGoogle ScholarPubMed
7.Caputo, DV, Goldstein, KM, Taub, HB (1979): The development of prematurely born children through middle childhood. In Field, TM, Sostek, AM, Goldberg, S, Shuman, HH (eds): Infants Born at Risk: Behavior and Development. New York: Spectrum Publications.Google Scholar
8.Chervenak, FA, Johnson, RE, Berkowitz, RL, Hobbins, JC (1983): Intrapartum external version of the second twin. Obstet Gynecol 62:160165.Google ScholarPubMed
9.Chitkara, U, Berkowitz, GS, Levine, R, Riden, DJ, Fagerstrom, RM Jr, Chervenak, FA, Berkowitzt, RL (1985): Twin pregnancy: Routine use of untrasound examinations in the prenatal diagnosis of intrauterine growth retardation and discordant growth. Am J Perinatol 2:4954.CrossRefGoogle Scholar
10.Clarkson, JE, Buckfield, PM, Herbison, GP (1982): The outcome of twin pregnancies in Dunedin, 1968-1978. Aust NZ J Obstet Gynaecol 22:127131.CrossRefGoogle ScholarPubMed
11.Corney, G, Thompson, B, Campbell, DM, MacGillivray, I, Seedburgh, D, Timlin, D (1979): The effect of zygosity on the birth weight of twins in Aberdeen and Northeast Scotland. Acta Genet Med Gemellol 28:253360.Google ScholarPubMed
12.Derom, K, Bakker, E, Vlietinck, R, Derom, R, Van den Berghe, H, Thiery, M, Pearson, P (1985): Zygosity determination in newborn twins using DNA variants. J Med Genet 22:279282.CrossRefGoogle ScholarPubMed
13.DeFries, JC, Fulker, DW (1985): Multiple regression analysis of twin data. Behav Genet 15: 467473.CrossRefGoogle ScholarPubMed
14.Ellis, RF, Berger, GS, Keith, L, Depp, R (1979): The Northwestern University Multihospital Twin Study. II:Mortality of first versus second twins. Acta Genet Med Gemellol 28:347352.CrossRefGoogle Scholar
15.Elwood, JM (1983): Letter to the Editor: The end of the drop in twinning rates? Lancet, 1(8322):470.CrossRefGoogle Scholar
16.Eriksson, A, Fellman, J (1986): Incidence of multiple births in families of triplets. Presented at the 5th International Congiess of Twin Studies, Amsterdam, 09 15-19.Google ScholarPubMed
17.Fabia, J, Drolette, M (1980): Twin pairs, smoking in pregnancy and perinatal mortality. Am J Epidemiol 112:404408.CrossRefGoogle ScholarPubMed
18.Gedda, L, Brenci, G, Gatti, I (1981): Low birth weight in twins versus singletons: Separate entities and different implications for child growth and survival. Acta Genet Med Gemellol 30:18.CrossRefGoogle ScholarPubMed
19.Goldar, DE, Kimberling, WJ (1981): Genetic expectations of polar body twinning. Acta Genet Med Gemellol 30:257266.CrossRefGoogle Scholar
20.Grennert, L, Persson, P-H: On the outcome of twin pregnancies. In Nance, WE, Allen, G, Parisi, P (eds): Twin Research. Clinical Studies. New York: Alan R Liss, pp 109111.Google Scholar
21.Groothuis, JR (1985): Twins and twin families. A practical guide to outpatient management. Clin Perinatol 12:459474.Google ScholarPubMed
22.Grothe, W, Rüttgers, H (1985): Twin pregnancies: An 11-year review. Acta Genet Med Gemellol 34:4959.CrossRefGoogle Scholar
23.Hartikainen-Sorri, A-L (1985): Is routine hospitalization in twin pregnancy necessary? A follow-up study. Acta Genet Med Gemellol 34:189192.CrossRefGoogle ScholarPubMed
24.Hartikainen-Sorri, A-L, Jouppila, P (1984): Is routine hospitalization needed in antenatal care of twin pregnancy? J Perinat Med 12:3134.Google ScholarPubMed
25.Hartikainen-Sorri, A-L, Kauppila, A, Tuyimala, R, Koivisto, M (1983): Factors related to an improved outcome for twins. Acta Obstet Gynecol Scand 62:2325.CrossRefGoogle Scholar
26.Hémon, D, Berger, C, Lazar, P (1979): The etiology of human dizygotic twinning with special reference to spontaneous abortions. Acta Genet Med Gemellol 28:253258.Google Scholar
27.Hémon, D, Berger, C, Lazar, P (1981): Twinning following orai contraceptive discontinuation. Int J Epidemiol 10:319328.CrossRefGoogle Scholar
28.Hémon, D, Berger, C, Lazar, P (1982): Maternal factors associated with small-for-dateness among twins. Acta Genet Med Gemellol 31:241245.CrossRefGoogle ScholarPubMed
29.Hrubec, Z, Robinette, CD (1984): The study of human twins in medical research. N Eng J Med 310:435441.CrossRefGoogle Scholar
30.Iffy, L, Lavenhar, MA, Jakobovits, A, Kaminetzky, HA (1983): The rate of early intrauterine growth in twin gestation. Am J Obstet Gynecol 146:970973.CrossRefGoogle Scholar
31.James, WH (1972): Secular changes in dizygotic twinning rates. J Biosoc Sci 4:427434.Google ScholarPubMed
32.James, WH (1978): The decline in dizygotic twinning rates in Australia. Ann Hum Biol 5:493494.CrossRefGoogle Scholar
33.James, WH (1978): A hypothesis on the declining dizygotic twinning rates in developed countries. Prog Clin Biol Res 24B:8188.Google Scholar
34.James, WH (1980): Sex ratio and placentation in twins. Ann Hum Biol 7:273276.CrossRefGoogle ScholarPubMed
35.James, WH (1980): Gestational age in twins. Arch Dis Child 55:281284.CrossRefGoogle Scholar
36.James, WH (1982): Second survey of secular trends in twinning rates. J Biosoc Sci 14:481497.CrossRefGoogle ScholarPubMed
37.James, WH (1984): Letter to the Editor: Twins. N Eng J Med 58.Google Scholar
38.Kang, KW (1985): Twinan: Twin data analysis program for microcomputers. Acta Genet Med Gemellol 34:113114.CrossRefGoogle ScholarPubMed
39.Kappel, B, Hansen, KB, Moller, J, Faaborg-Andersen, J (1985): Bed rest in twin pregnancy. Acta Genet Med Gemellol 34:6771.CrossRefGoogle Scholar
40.Keith, LG, Newton, WP (1985): Twin gestation. In Sciarra, JW (eds): Gynecology and Obstetrics. Philadelphia: Harper & Row, chap. 25.Google Scholar
41.Keith, L, Ellis, R, Berger, GS, Depp, R (1980): The Northwestern University Multihospital Twin Study. I: A description of 588 twin pregnancies and associated pregnancy loss, 1971 to 1975. Am J Obstet Gynecol 138:781789.CrossRefGoogle Scholar
42.King, M-C, Friedman, GD, Lattanzio, D, Rodgers, G, Lewis, AM, Dupuy, ME, Williams, H (1980): Diagnosis of twin zygosity by self-assessment and by genetic analysis. Acta Genet Med Gemellol 29:121126.CrossRefGoogle ScholarPubMed
43.Landy, H, Keith, L, Keith, D (1982): The vanishing twin. Acta Genet Med Gemellol 31:179194.CrossRefGoogle Scholar
44.Landy, H, Weiner, S, Corson, S, Batzer, F, Bolonese, R (1986): “The vanishing twin”: Ultrasonographic assessment of fetal disappearance in the first trimester. Am J Obstet Gynecol 155:1419.CrossRefGoogle ScholarPubMed
45.Lazar, P, Berger, C, Hemon, D (1981): Preconceptional prediction of twin pregnancies. In Gedda, L, Parisi, P, Nance, WE (eds): Twin Research 3: Twin Biology and Multiple Pregnancy. New York: Alan R Liss, pp 175181.Google Scholar
46.Lee, CL, Lebeck, LK (1984): Estimating dizygotic/monozygotic ratio of twins by general formula. Am J Clin Pathol 81:654659.CrossRefGoogle ScholarPubMed
47.Leroy, B, Lefort, F, Neveu, P, Risse, RJ, Trevise, P, Jeny, R (1982): Intrauterine growth charts for twin fetuses. Acta Genet Med Gemellol 31:199206.CrossRefGoogle Scholar
48.Leveno, KJ, Santos-Ramos, R, Duenhoelter, JH, Reisch, JS, Whalley, PJ (1980): Sonar cephalometry in twin pregnancy: Discordancy of the biparietal diameter after 28 weeks' gestation. Am J Obstet Gynecol 138:615619.CrossRefGoogle Scholar
49.Lykken, DT (1981): Blood typing and twin zygosity: A comparison of two methods. Acta Genet Med Gemellol 30:293295.CrossRefGoogle ScholarPubMed
50.MacGillivray, I, Campbell, DM (1981): The outcome of twin pregnancies in Aberdeen. In Gedda, L, Parisi, P, Nance, WE (eds): Twin Research 3: Twin Biology and Multiple Pregnancy. New York: Alan R Liss, pp 203206.Google Scholar
51.Magnus, P, Berg, K, Nance, WE (1983): Predicting zygosity in Norwegian twin pairs born 1915-1960. Clin Genet 24:103112.CrossRefGoogle Scholar
52.Mantoni, M, Pedersen, JF (1980): Case report. Monoamniotic twins diagnosed by ultrasound in the first trimester. Acta Obstet Gynecol Scand 59:551553.CrossRefGoogle ScholarPubMed
53.Manlan, G, Scott, KE (1978): Contribution of twin pregnancy to perinatal mortality and fetal growth retardation; reversai of growth retardation after birth. Can Med Assoc J 118:365368.Google ScholarPubMed
54.Marivate, M, Norman, RJ (1982): Twins. Clin Obstet Gynaecol 9:723742.Google ScholarPubMed
55.McCarthy, BJ, Sachs, BP, Layde, PM, Burton, A, Terry, JS, Rochat, R (1981): The epidemiology of neonatal death in twins. Am J Obstet Gynecol 141:252256.CrossRefGoogle ScholarPubMed
56.Minakata, K, Asano, M (1981): A computer calculation of probability of monozygosity for twins. Computer Programs in Biomedicine 13:131138.CrossRefGoogle ScholarPubMed
57.Newman, RB, Gill, PJ, Katz, M (1986): Uterine activity during pregnancy in ambulatory patients: Comparison of singleton and twin gestations. Am J Obstet Gynecol 154:530531.CrossRefGoogle ScholarPubMed
58.Newton, W, Keith, L, Keith, D (1984): The Northwestern University Multihospital Twin Study. IV: Duration of gestation according to fetal sex. Am J Obstet Gynecol 149:655658.CrossRefGoogle Scholar
59.Nylander, PPS (1979a): The twinning incidence in Nigeria. Acta Genet Med Gemellol 28:261263.CrossRefGoogle ScholarPubMed
60.Nylander, PPS (1979b): Perinatal mortality in twins. Acta Genet Med Gemellol 28:363368.CrossRefGoogle ScholarPubMed
61.Nylander, PPS (1981): The factors that influence twinning rates. Acta Genet Med Gemellol 30:189202.CrossRefGoogle ScholarPubMed
62.O'Connor, MC, Arias, E, Royston, JP, Dalrymple, IJ (1981): The merits of special antenatal care for twin pregnancies. Br J Obstet Gynaecol 88:222230.CrossRefGoogle ScholarPubMed
63.Olofsson, P, Rydhstrom, H (1985): Twin delivery: How should the second twin be delivered? Am J Obstet Gynecol 153:479481.CrossRefGoogle ScholarPubMed
64.Osbourne, GK, Patel, NB (1985): An assessment of perinatal mortality in twin pregnancies in Dundee. Acta Genet Med Gemellol 34:193199.CrossRefGoogle ScholarPubMed
65.Papiernik, E (1983): Social cost of twin births. Acta Genet Med Gemell 32:105111.CrossRefGoogle ScholarPubMed
66.Papiernik, E (1986): Personal communication.Google Scholar
67.Papiernik, E, Mussy, MA, Vial, M, Richard, A (1985): A low rate of perinatal deaths for twin births. Acta Genet Med Gemellol 34:201206.CrossRefGoogle ScholarPubMed
68.Parisi, P, Gatti, M, Prinzi, G, Caperna, G (1983): Familial incidence of twinning. Nature 304:626628.CrossRefGoogle ScholarPubMed
69.Persson, P-H, Grennert, L (1979a): Towards a normalization of the outcome of twin pregnancy. Acta Genet Med Gemellol 28:341346.Google ScholarPubMed
70.Persson, P-H, Grennert, L (1979b): The intrauterine growth of the biparietal diameter of twins. Acta Genet Med Gemellol 288:273277.CrossRefGoogle Scholar
71.Philip, AGS (1981): Term twins with discordant birth weights: Observations at birth and one years. Acta Genet Med Gemellol 30:203212.CrossRefGoogle Scholar
72.Pomerance, JJ, Ukrainski, CT, Ukra, T, Henderson, DH, Nash, AH, Meredith, JL (1978): Cost of living for infants weiging 1,000 grams or less at birth. Pediatrics 61:908910.Google ScholarPubMed
73.Powers, W, Miller, T (1979): Bed rest in twin pregnancy: Identification of a criticai period and its cost implication. Am J Obstet Gynecol 134:2329.CrossRefGoogle Scholar
74.Puissant, F, Leroy, F (1982): A reappraisal of perinatal mortality factors in twins. Acta Genet Med Gemellol 31:213219.CrossRefGoogle ScholarPubMed
75.Riese, ML (1980): Assessment of gestational age in twins. Lack of agreement among procedures. J Pediatr Psychol 5:916.CrossRefGoogle ScholarPubMed
76.Schneider, L, Bessis, R, Tabaste, JL, Sarramont, MF, Japhet, N (1979): Foetal twin ultrasound biometry. Acta Genet Med Gemellol 28:299301.Google Scholar
77.Schneider, KTM, Huch, A, Huch, R (1985): Premature contractions: Are they caused by maternal standing? Acta Genet Med Gemellol 34:175178.CrossRefGoogle ScholarPubMed
78.Schwartz, RM, Keith, L, Keith, D (1986): The Nordic contribution to the English language twin literature. Acta Obstet Gynecol Scand 65:599604.CrossRefGoogle Scholar
79.Segai, NL, Bouchard, TJ Jr (1984): Zygosity diagnosis of twins in medical research. Ardi Intern Med 144:15081509.Google Scholar
80.Sehgal, NN (1980): Perinatal mortality in twin pregnancies. Implications for clinical management. Postgrad Med 68:231235.CrossRefGoogle Scholar
81.Starzl, TE (1984): The landmark identical twin case. J Am Med Assoc 251:2572.CrossRefGoogle ScholarPubMed
82.TambyRaja, RL, Ratnam, SS (1984): Factors contributing to a reduction of twin perinatal mortality in Singapore. Acta Genet Med Gemellol 33:2733.CrossRefGoogle ScholarPubMed
83.Tresmontant, R, Héluin, G, Papiernik, E (1983): Cost of care and prevention of preterm births in twin pregnancies. Acta Genet Med Gemellol 32:99103.CrossRefGoogle ScholarPubMed
84.Webster, F, Elwood, JM (1985): A study of the influence of ovulation stimulants and orai contraception on twin births in England. Acta Genet Med Gemellol 34:105108.CrossRefGoogle Scholar
85.Zahálková, M (1979). Clustering of twin births in space and time. Acta Genet Med Gemellol 28: 259260.CrossRefGoogle ScholarPubMed
You have Access

Save article to Kindle

To save this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

The Northwestern University Twin Study. VIII: On the Causes and Care of Multiple Pregnancy
Available formats

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

The Northwestern University Twin Study. VIII: On the Causes and Care of Multiple Pregnancy
Available formats

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

The Northwestern University Twin Study. VIII: On the Causes and Care of Multiple Pregnancy
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *