Seasonality in twin birth rates, Denmark, 1936-84

Seasonality in Multiple Maternities

In the 19th century, a series of international statistical congresses introduced common rules for the national demographic registers. This activity contributed to the genesis of statistical research. During the history of twin research, Hellin's law has played a central role because it is an approximately correct association between the rates of multiple maternities. However, it has been mathematically proven that Hellin's law cannot hold exactly. The majority of all studies of Hellin's law are based on empirical rates of multiple maternities. Such studies can never confirm the law, but only identify errors too large to be characterized as random. It is of particular interest to examine why the rates of higher multiple maternities are sometimes too high or too low when Hellin's law is used as a benchmark. However, divergences from the law are often difficult to explain and/or eliminate. Different improvements to the law have been proposed. In this article, we study the seasonality of multiple maternities. We apply Hellin's law to compare the seasonality of twin and triplet rates.

Secular trends in seasonal variation in birth weight

BACKGROUND

Many environmental factors have been shown to influence birth weight (BW) and one of these are season of birth.

AIM

The aim of the present study was to investigate the seasonal variation in BW in Denmark during 1936-1989, and to see if the variation could be explained by sunshine exposure during pregnancy.

METHODS

The study population was selected from the Copenhagen School Health Records Register and included 276 339 children born between 1936 and 1989. Seasonal variation was modeled using a non-stationary sinusoidal model that allowed the underlying trend in BW and the amplitude and phase of the yearly cycles to change.

RESULTS

There was a clear seasonal pattern in BW which, however, changed gradually across the study period. The highest BWs were seen during fall (September - October) from 1936 to 1963, but a new peak gradually grew from the early 1940s during early summer (May - June) and became the highest from 1964 to 1989. The amplitude of the fall peak started at 25.5 (95%CI 24.6; 25.9) grams and gradually disappeared. The amplitude of the early summer peak gradually arose from nothing to a peak of 18.6 (95%CI 17.7; 19.6) grams in the mid 1980s where it started to decrease again. Sunshine did not explain the seasonal variation in BW.

CONCLUSION

There was a clear seasonal pattern in BW in Denmark 1936-1989, which however changed across the study period. Throughout the study period we observed a peak in BW during the fall, but gradually, starting in the early 1940s, an additional early summer peak emerged and became the highest from 1964 and onwards.

Multiple births in sub-saharan Africa: epidemiology, postnatal survival, and growth pattern

The study endeavored to assess the epidemiology, postnatal survival, and growth pattern of multiple births in Sub-Saharan Africa (SSA). It was based on the data of 25 demographic health surveys conducted in the subcontinent since 2008. The records of 213,889 children born in the preceding 59 months of the surveys were included. The multiple birth rate was computed as the number of multiple confinements per 1,000 births. Factors associated with multiple births were identified using logistic regression and their survival pattern was assessed using the Kaplan-Meier method. The multiple birth rate was 17.1 (95% confidence interval: 17.7-16.6) and showed considerable variation across the 25 countries included in the study. Odds of multiple births were significantly increased with advanced maternal age, parity, and maternal height but not with wealth index, age at first birth, and month of birth. At the end of the fourth year of age, the cumulative survival probability was as low as 0.77 in multiple births as compared to 0.93 in their counterparts. The odds of neonatal, infant and under-five mortality were 5.55, 4.39, and 3.72 times increased in multiple births, respectively. Multiple births tend to be malnourished than singletons and the odds of wasting, stunting, and underweight were 1.31, 1.83, and 1.73 times raised, consecutively. Nevertheless, multiple births regain their weight-for-age (WFA) and height-for-age (HFA) deficits by the end of the fourth year of age. Counseling pregnant mothers with multiple gestation to give birth at a health institution and providing close medical follow-up during and after the neonatal period can improve the survival of multiple births.

Statistical analysis of the seasonal variation in the twinning rate

There have been few secular analyses of the seasonal variation in human twinning and the results are conflicting. One reason for this is that the seasonal pattern of twinning varies in different populations and at different periods. Another reason is that the statistical methods used are different. The changing pattern of seasonal variation in twinning rates and total maternities in Denmark was traced for three periods (1855–69, 1870–94, and 1937–84). Two alternative methods of analysis are considered. The method of Walter and Elwood and a trigonometric regression model give closely similar results. The seasonal distribution of twin maternities for the periods in the 19th century showed highly significant departures. For both twin and general maternities, the main peaks can be seen from March to June and a local peak in September. During the spring– summer season the twinning rates were higher than the total birth rates, indicating a stronger seasonal variation for the twin maternities than for the general maternities. For 1937–84, there was a similar, but less accentuated, pattern. Studies of other populations are compared with the Danish results. The more accentuated seasonal variation of twinning in the past indicate that some factors in the past affected women during summer–autumn and around Christmas time, making them more fecund and particularly to be more prone to polyovulation and/or more able to complete a gestation with multiple embryos.

Tobacco smoking and twinning

In a case-control study an association was found between mothers' smoking habits and the frequency of dizygotic twinning. As cases were included all twins born in Denmark in 1984 and 1985. A random sample of 1.5% of mothers to singletons, born in the same period were selected as controls. Only live-borns, conceived after no hormonal treatment, were included in the study. The finding may be due to the well-known anti-estrogen effect of smoking.

Dizygotic twinning

The tendency to conceive spontaneous dizygotic (DZ) twins is a complex trait with important contributions from both environmental factors and genetic disposition. Twins are relatively common and occur on average 13 times per 1000 maternities, though the twinning frequency varies over time and geographic location. This variation is mostly attributed to the differences in DZ twinning rate, since the monozygotic twinning rate is relatively constant. DZ twinning is in part under genetic control, with mothers of DZ twins reporting significantly more female family members with DZ twins than mothers of monozygotic twins. Maternal factors such as genetic history, advanced age and increased parity are known to increase the risk of DZ twins. Recent research confirmed that taller mothers and mothers with a high body mass index (30>) are at greater risk of DZ twinning. Seasonality, smoking, oral contraceptive use and folic acid show less convincing associations with twinning. Genetic analysis is beginning to identify genes contributing to the variation in twinning. Mutations in one of these genes (growth differentiation factor 9) are significantly more frequent in mothers of DZ twins. However, the mutations are rare and only account for a small part of the genetic contribution for twinning.

Photoperiodism in humans and other primates: evidence and implications

Most of the anatomical and molecular substrates of the system that encodes changes in photoperiod in the duration of melatonin secretion, and the receptor molecules that read this signal, have been shown to be conserved in monkeys and humans, and the functions of this system appear to be intact from the level of the retina to the level of the melatonin-duration signal of change of season. While photoperiodic seasonal breeding has been shown to occur in monkeys, it remains unclear whether photoperiod and mediation of photoperiod's effects by melatonin influence human reproduction. Epidemiological evidence suggests that inhibition of fertility by heat in men in summer contributes to seasonal variation in human reproduction at lower latitudes and that stimulation of fertility by lengthening of the photoperiod in spring contributes to the variation at higher latitudes. Parallels between the seasonality of human reproduction and seasonal affective disorder suggest that they may be governed by common biological processes. Historical and experimental evidence indicates that human responses to seasonal changes in the natural photoperiod may have been more robust prior to the Industrial Revolution and that subsequently they have been increasingly suppressed by alterations of the physical environment.

Perinatal mortality among twins and singletons in a city in southeastern Brazil, 1984-1996

Analysis of 116,699 deliveries (1062 twin pairs and 115,637 singletons) which occurred from 1984 to 1996 at the largest obstetric center in Campinas, SP, Brazil, provided the following conclusions: 1) despite the low percentage of twin births (0.9%), 10.7% of all early neonatal deaths and 3.5% of all stillbirths were twins. Compared to singletons, the likelihood of stillbirths and early neonatal deaths among twins was 1.9 and 6.5 times greater, respectively. 2) The proportion of twins among early neonatal deaths tended to decrease, probably because of improvements in prenatal and perinatal care. 3) The critical period for early neonatal deaths in singletons and twins lasted for the three first days after birth. 4) The incidence of perinatal deaths among twins was highest among MM pairs, followed by FF pairs, and lowest among MF pairs. 5) There was a trend towards a decrease in the annual rate of early neonatal deaths among both singletons and twins, and of stillbirths among singletons, the latter being more conspicuous among females. 6) The sex ratio of singletons was practically stable among living newborns, but showed strong cyclic variation among early neonatal deaths, and a tendency to increase among stillbirths. Twins who died in the first week, as well as living twins showed a strong increase in their sex ratio from 1984 to 1996. 7) The mean gestational age of singletons was highest among living newborns followed by stillbirths, and was lowest among early neonatal deaths. The mean gestational age of living twins was higher than that of early neonatal deaths, but not different from that of stillbirths. 8) The mean birth weight of singletons and twins was highest among living newborns, followed by stillbirths, and lowest among early neonatal deaths. 9) Apgar scores > or = 7 obtained five minutes after birth are inadequate as a reliable indicator of the clinical condition of the newborn, since almost half of the early neonatal deaths had 5-min Apgar scores varying from 7 to 10.

Birth weight of twins: 1. The fetal growth patterns of twins and singletons

Distributions of birth weights of twins and singletons born at three southeastern Brazilian hospitals were compared after adjustment for gestational age, its quadratic and cubic terms, sex, type of pregnancy, as well as their interactions. The pattern of twin fetal growth rate was retarded in comparison to that of singletons, regardless of the socioeconomic level of the examined population, but the gestational age at which this retardation started seems to be correlated to the income of the mothers. In all cases, after 28 weeks of gestation, female fetal growth was slightly but consistently lower than that of males.

No obvious spatial clustering of twin births in Sweden between 1973 and 1990

The aim of this work was to ascertain whether spatial clustering of twin deliveries occurred in Sweden between 1973 and 1990. Since 1973, the Medical Birth Registry (MBR) has gathered information on all births in Sweden. Between 1973 and 1990, there were 17,067 twin deliveries. The MBR records data on pregnancies, deliveries, and the neonatal period, including parturients' domicile. To test the hypothesis that atmospheric pollution from refuse incinerators increases the incidence of twin deliveries, the periods before and after the commissioning of 14 such plants were compared. There was no apparent increase in the number of parishes or municipalities having a relative excess of twin deliveries. In the vicinity of one plant, there was a significantly increased number of twin deliveries, whereas in another, there was a significant decrease. There was no spatial clustering when the incidences of twin delivery were compared among parishes, municipalities, and areas near incinerators.

Investigation on seasonality of twin births in Brazil

The hypothesis of seasonality of twin births was investigated in two important maternity hospitals in the State of São Paulo, Brazil. The study included 1,386 twin births that occurred among 154,699 deliveries from 1984 to 1993. No evidence of seasonality has been detected either for the twin birth rate considered as a whole or for dizygotic twinning rate. The distributions of these rates fitted well sinusoidal regression curves but the cyclic trend did not correspond to any specific season.

The epidemiology of multiple pregnancies

Over the last decades the frequency of multiple births has been on the decline in most developed countries. This trend, however, has been restricted to dizygotic twins, while monozygotic rates have remained stable or risen slowly. In more recent years, however, the fall in multiple dizygotic birth rates has ceased and a slight increase is observed. This trend and the increased frequency of triplets or higher-order births, registered from the early 1980s onwards, are essentially related to treatments for infertility. No single risk factor, such as maternal age, parity, oral contraceptive use, or declining fertility rates can explain the overall declining trends. In this paper we review the descriptive epidemiology and the main risk factors for multiple pregnancies.

Low twinning rate and seasonal effects on twinning in a fertile population, the Hutterites

This paper analyzes from the mid 18th century to 1987 the birth records of the "Dariusleut," one of the three subgroups of the Hutterite population. The aim of this study is to describe several aspects of the twinning rate in a fertile population. The overall rate of twinning was 0.90%: 103 twins among all 11,492 maternities. The rate peaked at the 7th birth order and at the maternal age of 40 years and over. Until the mid 19th century when the Hutterites lived in Russia, the twinning rate was higher (1.5%), and it decreased during the migration period in the second half of the 19th century (0.7%). After the group had settled in the USA and Canada, the population maintained a twinning rate of 1.0% until 1965. After 1965 the rate decreased to 0.7%, partly due to a decline in fertility among women aged 30 years and over. There was a significant seasonal variation: the twinning rate decreased to 0.5% in May-July compared to 1.2% for the other three seasons during the years up to 1965 (P < 0.01), while more recent mothers did not show such a seasonal variation. The incidence of twin births in this population seems to have been influenced by environmental factors, which would change their effect seasonally and secularly.

Trends in multiple births in Italy: 1955-1983

On the basis of the numbers of single and multiple births routinely collected by the Central Institute of Statistics, trends in multiple births in Italy over the period 1955-1983 were analyzed. Between 1955 and 1983 the frequency of multiple births declined by about 25% (from 12.6/1000 deliveries to 9.6/1000 deliveries). The downward trend was constant until the early 1970s when rates tended to level off and increase slightly. This finding was largely attributable to trends in dizygotic rates, monozygotic births being approximately constant over the period considered. Multiple birth rates rose till age 35-39, being more than two times higher in this age group than in teenagers, but flattened off in the subsequent strata of age: this finding was constant over the period considered. Despite the general decreasing trend, the regional differences persisted largely unchanged, multiple birth rates being about 30% higher in Southern (and less developed areas) of the country than in the North of Italy. Geographic differences were limited to dizygotic pregnancies, monozygotic rates being constant (about 4/1000 pregnancies) in various areas.