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The risk for specific defects among twins compared to singletons was studied using data collected by the Spanish Collaborative Study of Congenital Malformations (ECEMC). A total of 136 twins had a major and/or minor congenital defect. The overall rate of congenital defects in twins (2.37%) did not deviate significantly from the rate in singletons (2.21%). Like-sex (LS) and male-male (MM) twin pairs had a slightly higher rate of birth defects than unlike-sex (US) and female-female (FF) pairs, respectively. Defects of the central nervous system, cardiovascular system and genitourinary system were significantly more frequent in LS twins than in singletons, with relative risks of 2.8, 2.5 and 1.6, respectively. No significantly increased risk was found among US twins. Among defects of the central nervous system, the rates of anencephaly, encephalocele and hydrocephaly were significantly higher in total and LS twins; however, no significantly increased risk for spina bifida was observed when compared to singletons. MM twins were also 1.9 times more likely to have hypospadias, but the risk among males of male-female (FM) pairs was decreased.
We examined the placentas of 182 like-sexed live-born twins: 73 placentas (40.1%) were monochorionic and 109 (59.9%) were dichorionic. All twin pairs with monochorionic placentas were monozygotic (MZ), but 28.9% of pairs with dichorionic placentas were MZ. Analysis of birth weights demonstrated that dichorionic and dizygotic (DZ) twins were heaviest, and suggested that the chorion status is a more important determinant of birth weight than zygosity. Vascular anastomoses were identified only in monochorionic placentas and occurred in 79.5% of cases. All placentas with deep anastomoses had superficial anastomoses. A higher proportion of velamentous and marginai insertions of the umbilical cord in monochorionic placentas (27.4%) compared to dichorionic placentas (13.8%) supports the belief that lateral placental growth is greatest in twin gestations in which the embryos are initially most closely apposed — The theory of trophotropism.
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