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Using vital statistics in Japan (1995–2008), 154,578 live-born twin pairs (128,236 monozygotic [MZ] and 180,920 dizygotic [DZ]) were identified. The proportion of severe discordance among live-born twin births was twice as high in Japanese than Caucasian infants. There were 1858 MZ and 1620 DZ infant deaths. Computation of the relationship between infant mortality rate and birth weight discordance among the twins was performed. Discordance levels were classified into seven groups: <5%, five groups from 5–9% to 25–29%, and ≥30%.The mortality rate was significantly higher in MZ than DZ twins for discordances except at 5–9% and 10–14%. The lowest rate for MZ twins was at 5–9% (7.5 per 1000 live twins) and significantly increased from 10–14% (9.4) to ≥30% (83.4), while the lowest rate for DZ twins was at <5% (6.7), which significantly increased at 10–14% (8.0) and from 25–29% (12.1) to ≥30% (35.5). The relationship was also computed in two gestational age groups (<28 and ≥28 weeks). For births at <28 weeks, three discordances (after 20–24%) in MZ twins were associated with adverse mortality rate. For births at ≥28 weeks, the same relationship was obtained after 10–14% in MZ and after 20–24% in DZ twins. The relationship from 2002 to 2008 showed that the mortality rates significantly increased after 10–14% for both types of twins. In conclusion, five discordance levels in MZ and three levels in DZ twins were associated with adverse mortality rates.
The infant mortality rate (IMR) among single and twin births from 1999 to 2008 was analyzed using Japanese Vital Statistics. The IMR was 5.3-fold higher in twins than in singletons in 1999 and decreased to 3.9-fold in 2008. The reduced risk of infant mortality in twins relative to singletons may be related, partially, to survival rates, which improved after fetoscopic laser photocoagulation for twin — twin transfusion syndrome. The proportion of neonatal deaths among total infant deaths was 54% for singletons and 74% for twins. Thus, intensive care of single and twin births may be very important during the first month of life to reduce the IMR. The IMR decreased as gestational age (GA) rose in singletons, whereas the IMR in twins decreased as GA rose until 37 weeks and increased thereafter. The IMR was significantly higher in twins than in singletons from the shortest GA (<24 weeks) to 28 weeks as well as ≥38 weeks, whereas the IMR was significantly higher in singletons than in twins from 30 to 36 weeks. As for maternal age, the early neonatal and neonatal mortality rates as well as the IMR in singletons were significantly higher in the youngest maternal age group than in the oldest one, whereas the opposite result was obtained in twins. The lowest IMR in singletons was 1.1 per 1,000 live births for ≥38 weeks of gestation and heaviest birth weight (≥2,000 g), while the lowest IMR in twins was 1.8 at 37 weeks and ≥2,000 g.
Data for sets of multiples under 16 years of age were obtained from the population censuses of Japan in 1990 and 1995. These numbered 147,188 twin pairs, 1410 sets of triplets, 59 sets of quadruplets, and 3 sets of quintuplets in 1990, with the corresponding numbers in 1995 being 141,354, 2,211, 136 and 12, respectively. The total number of sets of multiples was 148,660 in 1990 and 143,713 in 1995. Twinning, triplet, quadruplet and quintuplet rates were estimated for each age. Rates of monozygotic twins and triplets remained constant age by age up to 15 years, while the dizygotic twinning rate, and rates of di- and tri-zygotic triplets decreased over the same period. Quadruplet and quintuplet rates also decreased. The accuracy of estimating number of multiples from census data is discussed using data on vital statistics.
Using vital statistics, yearly changes in the twinning and triplet rates by zygosity were investigated in the Czech Republic and the Slovak Republic during the period 1972–1995. Monozygotic (MZ) twinning rates in both countries had remained nearly constant (about 3 per 1000 total births) during that period. With a few exceptions, the dizygotic (DZ) twinning rates remained constant from 1972 to 1994, and increased in 1995 for both countries. MZ twinning rates for both countries were the lowest in Europe. As for triplet rates, overall rates increased significantly year by year in the Czech Republic, but not in the Slovak Republic. The triplet rate was significantly higher in 1995 than in the period 1972–1982 for both countries. The MZ triplet rate remained constant during that period in the Czech Republic. The trizygotic (TZ) triplet rates increased 3-fold for the Czech Republic and 4-fold for the Slovak Republic in 1972–1976 and 1992–1995. In the later period, the TZ rate was 1.5-fold higher in the Czech Republic than in the Slovak Republic. The quadruplet rate increased 2.3-fold from 2.9 per million births in 1982–1986 to 6.7 in 1992–1995 in the Czech Republic. The corresponding values were 2.7, 2.20 and 5.9-fold in the Slovak Republic. Both the Czech and the Slovak Republics were not affected by fertility drugs and assisted reproductive techniques until recently.
The purpose of this study was to estimate the number of siblings in each Japanese family with multiple birth children using two sets of census data, from 1990 and 1995. The mean number of siblings for singletons was 2.3 in 1990 (2.4 in 1995), 2.9 (2.9) for one set of twins, 4.6 (4.5) for two sets of twins, and 3.5 (3.3) for one set of triplets. For birth order of multiples, the highest mean sibling number was 4.4 for one set of twins (the middle), 7.5 for two sets of twins (the middle-middle), and 4.3 for one set of triplets (the last). The mean sibling number was slightly higher for like-sexed twins and triplets than in unlike-sexed twins and triplets. The mean sibling number was highest in the Okinawa District, among nine districts (0.4 for singletons, 0.6 for one set of twins, 1.0 for two sets of twins and 0.6 for triplets). The current study of the number of siblings in each family with multiple birth children will help provide data for designing programs to help support multiple-birth families. The method of using census data on multiple births might result in a system to analyze nationwide data on multiple birth children if there is no national registry of multiple births after live births in any country.
Stillbirth rates of triplet births in the whole of Japan were analyzed using vital statistics from 1975 to 1998. Stillbirths were registered at 12 weeks gestation or later. The stillbirth rate was significantly higher in like- than in unlike-sex triplets for 1975–1998. During the 23-year period the stillbirth rate decreased from 342 to 49 per 1000 total births for like-sex and from 195 to 54 for unlike-sex triplets. The decrease in the stillbirth rate in the 23-year period was greater in both like- and unlike-sex triplets than in singleton and twin births. Risk factors for stillbirth in triplets were like-sex, youngest or oldest maternal age groups, shorter gestational age and lower birthweight. It is recommended that the optimum period to give birth for triplet pregnancies is 34–35 weeks of gestation for Japanese women.
Perinatal mortality rates (PMRs) in triplets were analyzed using Japanese Vital Statistics during the period of 1980–1998. The total number of perinatal deaths in triplets was 1051. The PMR significantly decreased from 214 per 1000 births in 1980 to 39 in 1998, a reduction of 82%. PMRs in triplets were 11.1-fold higher in 1980 and 6.9-fold higher in 1998 than in singletons, indicating that PMRs improved more in triplets than in singletons during the last two decades in Japan. The PMR was the highest in the third-born, followed by the second- and the first-born triplets in each period. As for maternal age, the PMR was 1.5–3.7 times higher in the < 25 years of age group than the other age groups. Additionally, the PMR was the lowest for birthweight (BW) ≥ 2000g during the entire period. In addition, the PMR decreased with gestational age (GA) of up to 38–39 weeks and increased thereafter. The effects of BW on the PMR were stronger than the effects of GA. The proportion of perinatal deaths in triplets with extremely low BW (< 1000g) was 74% in 1980–1989 and increased to 82% in 1990–1998. The declining PMR was unlikely to be due to the improvement in BW in triplets. It is likely that it was related to the improved medical management of triplets during the perinatal period and the first week of life. Information obtained in the present study may be useful in counseling pregnant woman about triplet births.
Frequencies of recurrent multiple maternities were estimated using two sets of census data in Japan in 1990 and 1995. The repeat frequency (RF) of the twinning rate is the frequency of 2 sets of twins among families or couples who have already had 1 set of twins and 2 more siblings. The overall RFs were 9.6 per 1000 couples in 1990 and 9.3 in 1995. The RFs of the monozygotic (MZ) twinning rates were 5.9 per 1000 couples in 1990 and 5.5 in 1995. The RFs of the dizygotic (DZ) twinning rates were 3.7 in 1990 and 3.8 in 1995. For unlike-sexed propositus twins, the RF of MZ twins were 5.0 per 1000 couples in 1990 and 5.5 in 1995. The RF of DZ twins were 5.3 in 1990 and 4.6 in 1995. As for like-sexed propositus twins, the corresponding RFs were 6.2 and 5.5 for MZ twins, and 3.4 and 3.6 for DZ twins, respectively. In mothers who have experienced a twin maternity, the overall RF of twinning was 1.5 to 2 times as high as the average mother's chance of having twins. There was no RF for triplets for both census years. As for geographic variations of the overall RF, the rates in Okinawa (16.2) and Hokkaido (15.3) were significantly higher than those in the Tohoku (8.7), Kanto (8.0) and Kyushu (7.4) districts.
To investigate the effect of social class on the secondary sex ratio, atotal of 7·2 million births in the period 1975–78 in Japan has been tabulated according to the occupation of the head of the household, paternal and maternal ages and birth order. Although the variation in the sex ratio among occupational classes is not statistically significant, the changes observed are compatible with those reported by other authors. Multipleregression analysis revealed that the association of birth order and paternal age with the sexratio is relatively consistent among different occupational classes, while that of maternal age varies substantially among occupational groups, a significant negative regression on maternal age being observed in agricultural workers.
A survey of consanguineous marriages in Japan was conducted in September 1983 using questionnaires. The number of couples studied was 9225, chosen from six widely different areas of Japan. Recommendation by parents or relatives was the most frequent reason for consanguineous marriage, for both husbands and wives, followed by knowledge of the partner by relatives.
The rate of consanguineous marriage on the recommendation of parents or relatives was higher in endogamy, arranged marriages, childhood friends, and groups in which there is external pressure for marriage. It was lower in love match marriages, school, workplace and social gatherings that give opportunities for meeting, and where there was personal marital motivation.
The distribution of consanguineous marriages among spouses and husband's and wife's parents, was analysed using data on 9225 families in six widely different areas of Japan. With two exceptions, the consanguinity rates for husband's and wife's parents are higher in related spouses than in unrelated spouses. The familial aggregation of consanguinity was slightly decreased in more recent marriages, a change which began recently with couples who have abandoned the more traditional Japanese way of life.
A survey of consanguineous marriages in Japan in couples and their parents was conducted in 1983 through questionnaires. The total number of couples studied was 9225; they were chosen from six widely different areas of the country. The kinship coefficient between parents did not decrease with the year of birth. Thus, the recent decline in the frequency of consanguineous marriages in Japan seems to be largely a post-World War II phenomenon. The kinship decreases with marital distance in the parental generation, and socioeconomic class (level of education and occupation) effects are small by comparison with those of the present generation. The rate of consanguinity is significantly higher in the older generation for almost all areas. The kinship between spouses is less than a half of that in parents for the whole of Japan. Geographical variation in the rate of consanguinity is more remarkable in spouses than parental couples.
A survey of consanguineous marriages in Japan was conducted on 1 September 1983, by questionnaires. The total number of couples surveyed was 9225. They were chosen from six widely different areas and the inbreeding coefficients from isonymy and pedigrees were estimated for each area. Random inbreeding remained constant with the marriage year whereas total (F) and non-random (Fn) inbreeding from isonymy and inbreeding from pedigrees (α) decreased with the marriage year in each area. Estimates of genetic microdifferentiation from surnames were obtained; estimates of the reduced variance indicated low microdifferentiation (0·000014-0·000081) in five areas and a higher value in Fukue City (0·0004). The ratio of FST (the average within-group a priori kinship) to α-value ranged from 0·42 in Kawanishi City to 3·9 in Minobu-Cho.
In a nationwide survey, the rate of total consanguineous marriages in Japan decreased from 16% to 3% in the period of 25 years from 1947 (Imaizumi et al., 1975). This tendency continued to 1983, as shown by Imaizumi (1986a) in six sample areas representative of all Japan (Figure 4.1). According to Shinozaki (1961), the rate of consanguinity in Japan for the marriage years from 1912 to 1925 was 22.4%, it then slowly decreased to about half that level (12.3%) for the period 1941 to 1945, and after the Second World War a rapid decrease occurred. The inbreeding coefficient (F) in isolated populations in Japan decreased during the period from 1926 to 1963 (Yanase, 1966), though there remained appreciable variation. From the nationwide survey data of Imaizumi et al. (1975) the mean F value in rural areas in Japan (0.0029) was twice that in urban areas (0.0014), and out of eight districts it was highest in Kyushu (0.0034) and lowest in Hokkaido (0.0009). Similar decreases with time have occurred elsewhere, e.g. in Spain the inbreeding coefficient (F) remained constant during the period from 1900 to 1959 and has decreased consistently over the last two decades (Calderon, 1989).
The decline of the consanguinity rate is usually attributed to higher mobility of the population and therefore a wider choice of possible spouse. This paper investigates the effects of marital distance (between birthplaces), religion, socioeconomic factors, marriage form, and opportunity of meeting on the rate of consanguineous marriages in Japan, and also reports the stated reasons for consanguineous marriages: it summarises results reported elsewhere (Imaizumi, 1986a,b,c, 1987, 1988).
Nation-wide data in Japan on births and prenatal deaths of 16 sets of quintuplets during 1974-1985 were analysed. Among the 16 sets, 3 sets were liveborn, 8 were stillborn, and 5 were mixed, with a stillbirth rate of 0.64 (51/80). Effects of sex, maternal age and birth order on the stillbirth rate were not considered because of the small sample size. Effects of gestational age and birthweight on stillbirth rate were also examined. The mean weight of the 40 quintuplet individuals was 1,048 g.
Nation-wide data in Japan on the 112 sets of conjoined twins from fetal deaths and from postnatal deaths during 1979-1985 were analysed. Female conjoined twins accounted for 60% of cases. The incidence rate of conjoined twins remained Constant except in 1985. Overall incidence rate was 10 per million births. Maternal age effect was found in mothers over the age of 40, where the highest incidence rate was obtained. The incidence rate of conjoined twins increased with birth order. There was no seasonal variation in the time of conception.
The rate of infant mortality of triplet individuals (deaths under one year of age) was computed using 34 sets of triplets born in the first half of 1974. The rates were 8.82%, 9.68%, and 10.34% for the first-, second-, and the third-born triplets, respectively. For males and females the rates were 8.33% and 10.34%, respectively, and the difference was not significant. The rate decreased with gestational age up to 32-35 weeks. For those with heavier weight at birth (≤2,000 g) the rate was lower (0%) than for those with lighter weight (<2,000 g, 8.16%), but the difference is not significant (P = 0.087). Infant mortality rate of triplets decreased with increased monthly expenditure of the household.
The rates of infant mortality of twin individuals were 4.38% and 7.76% for mothers healthy and nonhealthy after delivery, respectively, and the difference is significant at the 0.01 level. The lowest infant mortality rate was seen in the mothers with paid work during pregnancy (4.56%), followed by the mothers engaged only in housekeeping (4.72%) and by those self-employed during the pregnancy (4.99%). Infant mortality rate for MZ twins decreased with increased monthly expenditure of the household, whereas the rate for DZ twins remained constant with expenditure. Socioeconomic factors still affect the infant mortality of twins, and the infant mortality rate can be improved.
Stillbirth rates of MZ and DZ twins in Japan gradually decreased during the period 1960–1967 and in 1974. The stillbirth rates of MZ and DZ twins were 0.270 and 0.224 in 1960, respectively, whereas the corresponding figures in 1974 were 0.135 and 0.099. The stillbirth rate was higher in MZ than DZ twins, in males than females, and in the second- than in the first-born. In both zygosities, the rates were higher in the first birth order than in the second, and then increased with birth order except in the sixth birth or more for MZ twins and for DZ twins born to mothers aged 35–39 years. The shorter the gestational age, the higher the stillbirth rate in both MZ and DZ twins, as expected. Mean gestational age was slightly shorter in MZ than in DZ twins. The decrease of the stillbirth rates can be explained partly by the reduction of twins with higher birth order, where high stillbirth rates of MZ and DZ twins are seen, and the reduction of older mothers.