Malformations in twins were studied with the use of a Medical Birth Registry covering nearly all births in Sweden, 1973-1981. A total of 15,427 infants marked twins were identified and the malformation diagnoses were analyzed, comparing rates with the overall rates in the same data source. Problems in ascertainment and interpretation are discussed. No excess of neural tube defects was seen, but hydrocephaly was diagnosed more often in twins than in singletons. This can be partly, but not completely, explained by a higher rate of low-weight infants among twins. An excess was noticed in twins in the rates of cardiac defects, spine defects, gut atresias – notably esophageal and anal atresia – and severe kidney malformations. These are components of the so-called VACTERL syndrome – the last component (limb reductions) being more common in twins than in singletons, though statistical significance was not reached. A relation between monozygotic twinning and this syndrome is tentatively suggested.