Genetic and environmental factors affecting birth size variation: a pooled individual-based analysis of secular trends and global geographical differences using 26 twin cohorts

Background

The genetic architecture of birth size may differ geographically and over time. We examined differences in the genetic and environmental contributions to birthweight, length and ponderal index (PI) across geographical-cultural regions (Europe, North America and Australia, and East Asia) and across birth cohorts, and how gestational age modifies these effects.

Methods

Data from 26 twin cohorts in 16 countries including 57 613 monozygotic and dizygotic twin pairs were pooled. Genetic and environmental variations of birth size were estimated using genetic structural equation modelling.

Results

The variance of birthweight and length was predominantly explained by shared environmental factors, whereas the variance of PI was explained both by shared and unique environmental factors. Genetic variance contributing to birth size was small. Adjusting for gestational age decreased the proportions of shared environmental variance and increased the propositions of unique environmental variance. Genetic variance was similar in the geographical-cultural regions, but shared environmental variance was smaller in East Asia than in Europe and North America and Australia. The total variance and shared environmental variance of birth length and PI were greater from the birth cohort 1990-99 onwards compared with the birth cohorts from 1970-79 to 1980-89.

Conclusions

The contribution of genetic factors to birth size is smaller than that of shared environmental factors, which is partly explained by gestational age. Shared environmental variances of birth length and PI were greater in the latest birth cohorts and differed also across geographical-cultural regions. Shared environmental factors are important when explaining differences in the variation of birth size globally and over time.

Associations between birth size and later height from infancy through adulthood: An individual based pooled analysis of 28 twin cohorts participating in the CODATwins project

BACKGROUND

There is evidence that birth size is positively associated with height in later life, but it remains unclear whether this is explained by genetic factors or the intrauterine environment.

AIM

To analyze the associations of birth weight, length and ponderal index with height from infancy through adulthood within mono- and dizygotic twin pairs, which provides insights into the role of genetic and environmental individual-specific factors.

METHODS

This study is based on the data from 28 twin cohorts in 17 countries. The pooled data included 41,852 complete twin pairs (55% monozygotic and 45% same-sex dizygotic) with information on birth weight and a total of 112,409 paired height measurements at ages ranging from 1 to 69 years. Birth length was available for 19,881 complete twin pairs, with a total of 72,692 paired height measurements. The association between birth size and later height was analyzed at both the individual and within-pair level by linear regression analyses.

RESULTS

Within twin pairs, regression coefficients showed that a 1-kg increase in birth weight and a 1-cm increase in birth length were associated with 1.14-4.25 cm and 0.18-0.90 cm taller height, respectively. The magnitude of the associations was generally greater within dizygotic than within monozygotic twin pairs, and this difference between zygosities was more pronounced for birth length.

CONCLUSION

Both genetic and individual-specific environmental factors play a role in the association between birth size and later height from infancy to adulthood, with a larger role for genetics in the association with birth length than with birth weight.

Association between birthweight and later body mass index: an individual-based pooled analysis of 27 twin cohorts participating in the CODATwins project

Background

There is evidence that birthweight is positively associated with body mass index (BMI) in later life, but it remains unclear whether this is explained by genetic factors or the intrauterine environment. We analysed the association between birthweight and BMI from infancy to adulthood within twin pairs, which provides insights into the role of genetic and environmental individual-specific factors.

Methods

This study is based on the data from 27 twin cohorts in 17 countries. The pooled data included 78 642 twin individuals (20 635 monozygotic and 18 686 same-sex dizygotic twin pairs) with information on birthweight and a total of 214 930 BMI measurements at ages ranging from 1 to 49 years. The association between birthweight and BMI was analysed at both the individual and within-pair levels using linear regression analyses.

Results

At the individual level, a 1-kg increase in birthweight was linearly associated with up to 0.9 kg/m2 higher BMI (P < 0.001). Within twin pairs, regression coefficients were generally greater (up to 1.2 kg/m2 per kg birthweight, P < 0.001) than those from the individual-level analyses. Intra-pair associations between birthweight and later BMI were similar in both zygosity groups and sexes and were lower in adulthood.

Conclusions

These findings indicate that environmental factors unique to each individual have an important role in the positive association between birthweight and later BMI, at least until young adulthood.

Genetic and environmental effects on body mass index from infancy to the onset of adulthood: an individual-based pooled analysis of 45 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) study

BACKGROUND

Both genetic and environmental factors are known to affect body mass index (BMI), but detailed understanding of how their effects differ during childhood and adolescence is lacking.

OBJECTIVES

We analyzed the genetic and environmental contributions to BMI variation from infancy to early adulthood and the ways they differ by sex and geographic regions representing high (North America and Australia), moderate (Europe), and low levels (East Asia) of obesogenic environments.

DESIGN

Data were available for 87,782 complete twin pairs from 0.5 to 19.5 y of age from 45 cohorts. Analyses were based on 383,092 BMI measurements. Variation in BMI was decomposed into genetic and environmental components through genetic structural equation modeling.

RESULTS

The variance of BMI increased from 5 y of age along with increasing mean BMI. The proportion of BMI variation explained by additive genetic factors was lowest at 4 y of age in boys (a(2) = 0.42) and girls (a(2) = 0.41) and then generally increased to 0.75 in both sexes at 19 y of age. This was because of a stronger influence of environmental factors shared by co-twins in midchildhood. After 15 y of age, the effect of shared environment was not observed. The sex-specific expression of genetic factors was seen in infancy but was most prominent at 13 y of age and older. The variance of BMI was highest in North America and Australia and lowest in East Asia, but the relative proportion of genetic variation to total variation remained roughly similar across different regions.

CONCLUSIONS

Environmental factors shared by co-twins affect BMI in childhood, but little evidence for their contribution was found in late adolescence. Our results suggest that genetic factors play a major role in the variation of BMI in adolescence among populations of different ethnicities exposed to different environmental factors related to obesity.

Genetic and environmental influences on height from infancy to early adulthood: An individual-based pooled analysis of 45 twin cohorts

Height variation is known to be determined by both genetic and environmental factors, but a systematic description of how their influences differ by sex, age and global regions is lacking. We conducted an individual-based pooled analysis of 45 twin cohorts from 20 countries, including 180,520 paired measurements at ages 1-19 years. The proportion of height variation explained by shared environmental factors was greatest in early childhood, but these effects remained present until early adulthood. Accordingly, the relative genetic contribution increased with age and was greatest in adolescence (up to 0.83 in boys and 0.76 in girls). Comparing geographic-cultural regions (Europe, North-America and Australia, and East-Asia), genetic variance was greatest in North-America and Australia and lowest in East-Asia, but the relative proportion of genetic variation was roughly similar across these regions. Our findings provide further insights into height variation during childhood and adolescence in populations representing different ethnicities and exposed to different environments.

Measurement and comparison of individual external doses of high-school students living in Japan, France, Poland and Belarus-the 'D-shuttle' project

Twelve high schools in Japan (of which six are in Fukushima Prefecture), four in France, eight in Poland and two in Belarus cooperated in the measurement and comparison of individual external doses in 2014. In total 216 high-school students and teachers participated in the study. Each participant wore an electronic personal dosimeter 'D-shuttle' for two weeks, and kept a journal of his/her whereabouts and activities. The distributions of annual external doses estimated for each region overlap with each other, demonstrating that the personal external individual doses in locations where residence is currently allowed in Fukushima Prefecture and in Belarus are well within the range of estimated annual doses due to the terrestrial background radiation level of other regions/countries.

Birth defects after assisted reproductive technology according to the method of treatment in Japan: nationwide data between 2004 and 2012

OBJECTIVES

The purpose of the present study was to analyze birth defects (congenital anomalies) after assisted reproductive technology (ART) according to the method of treatment, namely in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and frozen-thawed embryo transfer (FET).

METHODS

Individual lists of all ART pregnancies resulting in birth defects from birth year 2004 to 2012 presented in the annual reports by the Japan Society of Obstetrics and Gynecology were used as the initial sources of information. Relative risks (RRs) with the corresponding 95 % confidence intervals (CIs) were calculated with IVF as the reference group when calculating RR of ICSI for IVF, and with FET as the reference group when calculating the RR of fresh embryo transfer for FET.

RESULTS

In total, 2725 stillbirths or live births with birth defects were analyzed. The prevalence of birth defects was slightly yet significantly higher in ICSI compared with IVF throughout the study period (RR = 1.15, 95 % CI 1.02-1.29) and in the 2004-2006 period (RR = 1.26, 95 % CI 1.00-1.58). The prevalence of birth defects was significantly higher for fresh embryo transfer compared with FET in the 2004-2006 period (RR = 1.39, 95 % CI 1.12-1.72). The prevalence of birth defects in multiple births was significantly lower in fresh embryo transfer compared with FET (RR = 0.70, 95 % CI 0.55-0.90, live births of 2007-2012).

CONCLUSIONS

The present descriptive epidemiological study suggests that the impacts of different ART methods on birth defects might differ.

Tai chi improves cognitive and physical function in the elderly: a randomized controlled trial

[Purpose] To investigate the effect of Tai Chi on cognitive and physical function in the elderly. [Subjects and Methods] A randomized trial design was used. A total 150 subjects were enrolled and were divided into Tai Chi and control groups. Subjects in the Tai Chi group participated Tai Chi for 6 months, and subjects in the control group participated in other non-athletic activities. [Results] There were no differences between the groups in the one leg standing time with eyes open, left grip strength, or the Frontal Assessment Battery at bedside after 3 and 6 months of intervention. The Mini-Mental State Examination scores after 3 and 6 months were higher in the Tai Chi group than in the control group. The right grip strength after 3 months increased more in the Tai Chi group than in the control group. Both the 5-m high walking speed and 10-m normal walking speed were significantly lower after 3 and 6 months of Tai Chi practice. [Conclusion] These results suggest that regular Tai Chi practice may improve cognitive and physical function in the elderly.

An overview of human handedness in twins

There has been a long-standing debate on the complex correlation between the development of human hand preference and brain lateralization. Handedness, used as a proxy for cerebral lateralization, is a topic of considerable importance because of its potential to reveal the mechanisms of the underlying pathophysiology of problems related to brain development or cognitive systems. Twin studies, which represent an important method of research in human genetics, would provide valuable suggestions to the studies on the relationship between lateralization and cognitive systems. Many studies have been performed using twin subjects; however, the results are inconsistent, partly because of sample size, background assumptions, data limits or inaccuracies, incorrect zygosity classification, and/or lack of birth histories. In summary, within the long history and large number of twin studies performed on handedness, a surprisingly large number of controversial findings have been reported, suggesting the complicated nature of this phenotype. In this mini review, the wide variety of twin studies on human handedness performed to date are introduced.

Fatal child maltreatment associated with multiple births in Japan: nationwide data between July 2003 and March 2011

OBJECTIVES

The purpose of the present study is to clarify the impact of multiple births in fatal child maltreatment (child death due to maltreatment).

METHODS

The national annual reports on fatal child maltreatment, which contain all cases from July 2003 to March 2011, published by the Ministry of Health, Labor and Welfare of Japan, were used as the initial sources of information. Parent-child murder-suicide cases were excluded from the analyses. Multiple births, teenage pregnancy and low-birthweight were regarded as the exposed groups. The relative risks (RRs) and their 95 % confidence intervals (CIs) were estimated using the data from the above reports and vital statistics. These analyses were performed both including and excluding missing values.

RESULTS

Among 437 fatal child maltreatment cases, 14 multiple births from 13 families were identified. The RRs of multiple births per individual were 1.8 (95 % CI 1.0-3.0) when including missing values and 2.7 (95 % CI 1.5-4.8) when excluding missing values. The RRs of multiple births per family were 3.6 (95 % CI 2.1-6.2) when including missing values and 4.9 (95 % CI 2.7-9.0) when excluding missing values. The RR tended to be much lower than the RR of teenage pregnancy (RR 12.9 or 22.2), but slightly higher than the RR of low-birthweight (RR 1.4 or 2.9).

CONCLUSIONS

Families with multiple births had elevated risk for fatal child maltreatment both per individual and per family unit. Health providers should be aware that multiple pregnancies/births may place significant stress on families and should provide appropriate support and intervention.

Maternal age and birth defects after the use of assisted reproductive technology in Japan, 2004-2010

BACKGROUND

Older mothers are becoming more common in Japan. One reason for this is the widespread use of assisted reproductive technology (ART). This study assesses the relationship between maternal age and the risk of birth defects after ART.

METHODS

Nationwide data on ART between 2004 and 2010 in Japan were analyzed. Diseases that were classified as code Q00-Q99 (ie, congenital malformations, deformations, and chromosomal abnormalities) in the International Classification of Diseases, tenth edition, were selected. There were 219,185 pregnancies and 153,791 live births in total ART. Of these, 1943 abortions, stillbirths, or live births with birth defects were recorded. Percentage of multiple birth defects in total birth defects, the prevalence, crude relative risk and 95% confidence interval per 10,000 pregnancies and per 10,000 live births were analyzed according to the maternal age class (ie, 25-29, 30-34 (reference), 35-39, and 40+ years).

RESULTS

Multiple birth defects were observed among 14% of the 25-29 year old class, and 8% among other classes when chromosomal abnormalities were excluded. The prevalence of chromosomal abnormalities per pregnancy and per live birth became significantly and rapidly higher in mothers in the age classes of 30-35 and 40+ years. Nonchromosomal birth defects per pregnancy decreased linearly with advanced maternal age, while the number of nonchromosomal birth defects per live birth formed a gradual U-shaped distribution. The prevalence per pregnancy of congenital malformations of the nervous system was significantly lower with advanced maternal age. The relative risk per live birth was significant regarding congenital malformations of the circulatory system for a maternal age of 40+ years. Some other significant associations between maternal age and birth defects were observed.

CONCLUSION

Maternal age is associated with several birth defects; however, older maternal age in itself does not produce noticeable extra risk for nonchromosomal birth defects overall.

Congenital hypothyroidism after assisted reproductive technology in Japan: comparison between multiples and singletons, 2005-2009

Background

The relationship between congenital hypothyroidism (CH) and multiple pregnancy has not been fully studied in Japan.

Methods

Complete nationwide data of assisted reproductive technology (ART) in Japan from 2005 to 2009 presented by the Japan Society of Obstetrics and Gynecology, which include information on CH and birth defects were used for analyses. Diseases were reclassified according to the International Classification of Diseases, tenth edition (ICD-10, 2003 version). The relative risk (RR) and 95% confidence interval (CI) of the incidence rate for CH was calculated with singletons as the reference group. Additional birth defects with CH were examined. The probandwise concordance rate of multiples and recurrence risk ratio were calculated.

Results

There were 18 patients with CH, consisting of 12 singletons and 6 multiples. The incidence rates of CH per 1,000 live births in singletons and multiples are 0.14 (=12/87,145) and 0.31 (=6/19,533), respectively. The incidence rate was more than twofold higher in multiple births than in singleton births, but the difference was not statistically significant (RR=2.2, 95% CI 0.8–5.9). Additional birth defects were present in three patients with CH (17%=3/18). The multiples were affected by other birth defects more frequently (33%=2/6) than the singletons (8%=1/12). The six multiple-births patients were derived from one concordant twin pair, which consisted of two twin patients; three discordant twin pairs, which consisted of three twin patients; and one discordant triplets set, which consisted of one triplet patient. Thus, the probandwise concordance rate was 33.3% (=2/(2+4)). The estimated recurrence risk ratio was 1976 (for the total ART population) or 609 (for the Japanese general population).

Conclusions

CH was more frequent in multiples compared to singletons. A higher percentage of additional birth defects was also observed in multiples compared to singletons. The familial aggregation of CH was suggested.

Concordance rates of birth defects after assisted reproductive technology among 17 258 Japanese twin pregnancies: a nationwide survey, 2004-2009

BACKGROUND

Most twins after assisted reproductive technology (ART) are dizygotic. Analysis of dizygotic twin pairs is useful in assessing familial aggregation in the development of birth defects.

METHODS

Using nationwide post-ART data from the Japan Society of Obstetrics and Gynecology, recurrence risk ratios (RRRs)-defined as probandwise concordance rates of birth defects in twins divided by the prevalence of birth defects in the general population-were calculated as indicators of familial aggregation. Birth defects were then reclassified according to the ICD-10 categories corresponding to codes Q00-Q99. From 2004 to 2009, there were 17 258 twin pregnancies.

RESULTS

At least 1 birth defect was noted in 236 twin pairs: 11 concordant and 225 discordant pairs. Regarding major organ systems, high probandwise concordance rates were observed for congenital malformations of eye, ear, face, and neck (11.8%), cleft lip and cleft palate (10.5%), congenital malformations of the nervous system (9.8%), and other congenital malformations of the digestive system (9.5%). High RRRs were observed for congenital malformations of eye, ear, face, and neck (RRR = 233), specifically other congenital malformations of the ear (RRR = 449); congenital malformations of the great arteries (RRR = 235), specifically those of the patent ductus arteriosus (RRR = 530); and for cleft lip and cleft palate (RRR = 208), specifically cleft palate with cleft lip (RRR = 609). The probandwise concordance rate of any birth defect (8.9%) was nearly identical to the approximated recurrence risk of sib-pairs (8.8%), which assumed multifactorial inheritance.

CONCLUSIONS

The present findings suggest that familial aggregation is a factor in some birth defects.

Nongenetic factors associated with human handedness and footedness in Japanese twin children

OBJECTIVE

The aim of this study is to clarify the factors related to the handedness and footedness of twins using two of the largest databases on Japanese twins available.

METHODS

The first group consisted of 1,131 twin pairs, all school children either 11 or 12 years old (S group), and the second group consisted of 951 twin pairs of different ages (1-15 years) in several maternal associations (M group). All data were gathered using a questionnaire. Factors associated with the handedness or footedness of twin individuals were analyzed by univariate and multivariate logistic analyses.

RESULTS

Multivariate logistic analysis showed that for handedness, birth year (OR=1.02) and neonatal asphyxia (OR=1.62) were selected in the S group, and sex (OR=1.34), the age of twins (OR=1.56), parity (OR=1.31), gestational age (OR=1.58), and family history (OR=1.82) were selected in the M group. for footedness, birth complications (OR=1.37) were selected in the S group, and sex (OR=1.33), the age of twins (OR=1.69), gestational age (OR=1.83), and family history (OR=2.49) were selected in the M group. Factors associated with handedness and footedness specific to twins, such as zygosity, placentation, birth order within twin pairs and the sex of the cotwin, were not found, although being a twin might have some effects.

CONCLUSION

It was concluded that factors that affect handedness or footedness in general, such as sex, birth year, age, parity, neonatal asphyxia, gestational age, birth complications, and family history, seem to have stronger effects on handedness and footedness than being a twin.

Genetic and Environmental Influences on the Handedness and Footedness in Japanese Twin Children

The purpose of this study was to examine the genetic contribution to handedness and footedness in childhood using one of the largest available databases of Japanese twins. The participants were 1131 twin pairs, 1057 males and 1205 females, of 11 or 12 years of age (6th grade of secondary school in the Japanese education system). All data were gathered by questionnaire. The prevalence of left (nonright) handedness was 15% in males and 13% in females. The prevalence of left (nonright) footedness was 13% in males and 11% in females. The similarities between twin pairs, estimated by concordance rates and tetrachoric correlations, suggested a slight genetic effect on male handedness, no genetic effect on female handedness, and no genetic effect on footedness in either sex. Structural equation modeling showed small genetic factors (11%) in male handedness and no genetic factors in female handedness. As to footedness, no genetic factors were observed in either sex. The effects of nonshared environmental factors were large (85%) in males and moderate (44%) in females. Moreover, handedness and footedness tended to be concordant irrespective of sex, with polychoric correlations overr= .70. The results of bivariate genetic analyses were not necessarily satisfactory. For males, no model fit. For females, shared and nonshared environmental factors explained the concordance of handedness and footedness. It was concluded that the genetic effects on handedness and footedness are relatively small, as is their association; moreover, considerably large twin samples are needed to obtain stable and appropriate results.

Analysis of Factors Affecting Birthweight, Birth Length and Head Circumference: Study of Japanese Triplets

The aims of this study were to identify factors associated with birthweight, birth length and head circumference for triplets, and analyze these body size parameters at birth, especially head circumference, according to gestational age. The subjects of this study were 370 mothers and their 1109 triplet children (excluding one stillborn infant) who were born between 1978 and 2002. The gestational age proved to be the strongest contributing factor to birthweight, birth length and head circumference of the triplets. Moreover, sex was a significant factor affecting birthweight, birth length and head circumference. Male neonates had a higher birthweight, longer birth length and greater head circumference than female neonates. Birth order in triplets also had a significant effect on birthweight and head circumference. Lower birth- order neonates had a higher birthweight and greater head circumference. An effect of maternal pregravid body mass index (BMI) on both birth- weight and birth length was observed. The birthweights of triplets born to women whose pregravid BMIs were more than 26.0 kg/m2 weighed an average of 150 g more than those of triplets born to women whose pregravid BMIs were less than 19.8 kg/m2, and the birth length of triplets born to women whose pregravid BMIs were more than 26.0 kg/m2 averaged 1.5 cm longer than those of triplets born to women whose pregravid BMIs were less than 19.8 kg/m2. Concerning head circumference, the median head circumference of male neonates was approximately 0.5 cm longer than female neonates. Compared to singleton neonates, the median head circumference of triplets was almost the same.

Genetic and Environmental Influences on Finger-Sucking and Nail-Biting in Japanese Twin Children

The purpose of this study was to clarify the genetic contribution to finger-sucking and nail- biting in childhood using the largest databases available on Japanese twins. The subjects were 1131 pairs of 12-year-old twin children, consisting of 1057 males and 1205 females. All data were gathered by maternal questionnaire, and responses to the questionnaire were checked in the medical interview. The prevalence of finger-sucking between 0 to 2 years was 40% in males and 43% in females (p = .0053). The prevalence of nail-biting up until the age of 12 years was 28% in males and 26% in females (nonsignificant). Concordance rates and polychoric correlations were all higher in monozygotic pairs than in dizygotic pairs, irrespective of the sex combination. Univariate and bivariate genetic analyses using structural equation modeling was performed. The results showed that the proportion of total phenotypic variance attributable to genetic influences was 66% in males and 50% in females for finger-sucking, and 50% in both males and females for nail-biting. A co-occurrence of finger-sucking and nail-biting was observed in 17.7% of males (tetrachoric correlation: r = .40) and 15.7% of females (r = .32), which was attributed partly to common genetic or environmental factors. The proportion of total shared variance explained by genetic factors was 67%.

Comparison of Obstetric and Birthweight Characteristics Between the Two Largest Databases of Japanese Twins Measured in Childhood

The purpose of this study is to compare obstetric and birthweight data of twin children from the two largest databases in Japan to estimate the difference between them in sample collection. The first group consisted of 1131 twin-pair school applicants, and the second group consisted of members' children from several maternal associations devoted to twins and included 951 pairs. All data were gathered by questionnaire. The mean birth years of the twins in these two databases were 1979 and 1995 respectively. The percentage of mothers treated with ovulation-stimulating drugs or in-vitro fertilization was markedly higher in the maternal associations group. Gestational age was around 1 week less in the maternal associations group, whereas birthweight according to gestational weeks and intrapair relative birth weight difference as a percentage according to zygosity showed little difference between both groups. We conclude that the obstetric and birthweight feature data from both groups should be considered to construct twin growth charts based on the methods of sample selection.

Population-Based Database of Multiples in Childhood of Ishikawa Prefecture, Japan

A new type of population-based database of multiples in childhood at the prefecture level was initiated in 2004 in Ishikawa Prefecture, Japan. We conducted an exhaustive search for demographic information concerning families with multiples, family support provided by governmental and medical institutions by mailed questionnaire, and at the same time tried to organize a human network to support such families. This registry aims not only to aid research on human genetics and maternal and child health, but also to contribute to the development of welfare programs for families with multiples.

Twin Database of the Secondary School Attached to the Faculty of Education of the University of Tokyo

This article profiles the historical twin databases of the secondary education school attached to the Faculty of Education at the University of Tokyo. The school was established in 1948. Every year, about 50 pairs of twins of all sex and zygosity combinations and aged 11 to 12 years take an examination, and about 10 to 20 pairs are admitted based on the results. Three independent datasets exist: one for applicants (11–12 years), one for students (12–18 years), and one for graduates (18–72 years). These three historical databases and research perspectives are introduced herein.

Genetic and Environmental Influences on Stuttering and Tics in Japanese Twin Children

The purpose of this study was to clarify the genetic contribution to stuttering and tics in childhood using the largest databases of Japanese twins. The subjects were 1896 pairs of twin children consisting of 1849 males and 1943 females with a mean age of 11.6 years (3 years to 15 years). All data were gathered by questionnaire. The prevalence of stuttering was 6.7% in males and 3.6% in females (p < .0001). The prevalence of tics was 6.8% in males and 4.1% in females (p = .0021). Concordance rates and polychoric correlations were all higher in monozygotic pairs than in dizygotic pairs irrespective of sex combination. Structural equation modeling showed that the proportion of total phenotypic variance attributable to genetic influences was 80% in males and 85% in females for stuttering, and 28% in males and 29% in females for tics. Moreover, co-occurrence between stuttering and tics was observed in 0.8% of males (tetrachoric correlation: r = .18) and 0.5% of females (r = .31), which was attributed partly (nearly 10% of total genetic variance of each trait) to the common genetic factors, with genetic correlation of r = .32.

The Tokyo Twin Cohort Project: Overview and Initial Findings

The Tokyo Twin Cohort Project (ToTCoP) is a large-scale longitudinal study of 5 years based on 1619 pairs of infant twins reared together. The purpose of the study is to construct a population-based twin registry in Japan and to investigate human growth and development and twin themselves. It covers behavioral, neurological, physical and environmental variables measured by questionnaire, home visiting and brain imaging technology. The full registry contains over 47,000 multiple births collected from the Basic Resident Register, and the targeted population is 3070 probable twins of 0 to 2 years old. Preliminary analysis of the entry questionnaire data showed no serious sampling biases. Descriptive statistics of parental characteristics (parental age, gestation age, parity and placentation, maternal weight, parenting stress) and children's characteristics (body size at birth, 4 and 10 months of age, milk consumption, and sleeping and social behavior) and their correlations, genetic and environmental contributions and correlations are reported.

A Comparison of Twin Birthweight Data From Australia, the Netherlands, the United States, Japan, and South Korea: Are Genetic and Environmental Variations in Birthweight Similar in Caucasians and East Asians?

Birthweight has implications for physical and mental health in later life. Using data from Caucasian twins collected in Australia, the Netherlands and the United States, and from East Asian twins collected in Japan and South Korea, we compared the total phenotypic, genetic and environmental variances of birthweight between Caucasians and East Asians. Model-fitting analyses yielded four major findings. First, for both males and females, the total phenotypic variances of birthweight were about 45% larger in Caucasians than in East Asians. The larger phenotypic variances were mainly attributable to a greater shared environmental variance of birth- weight in Caucasians (ranging from 62% to 67% of variance) than Asians (48% to 53%). Second, the genetic variance of birthweight was equal in Caucasians and East Asians for both males and females, explaining a maximum of 17% of variance. Third, small variations in total phenotypic variances of birthweight within Caucasians and within East Asians were mainly due to differences in nonshared environmental variances. We speculate that maternal effects (both genetic and environmental) explain the large shared environmental variance in birthweight and may account for the differences in phenotypic variance in birthweight between Caucasians and East Asians. Recent molecular findings and specific environmental factors that are subsumed by maternal effects are discussed.

Estimation of the contribution of assisted and non-assisted reproductive technology fertility treatments to multiple births during the past 30 years in Japan: 1979-2008

The effect of assisted reproductive technology (ART) and non-ART ovulation stimulation fertility treatment on the number and rate of multiple live births from 1979-2008 in Japan was estimated using two independent data sources, ART statistics and vital statistics. Japanese ART statistics presented by the Japan Society of Obstetrics and Gynecology between 1989 and 2008 were gathered and reanalyzed. The number and rates of ART between 1984 and 1988 were interpolated using an approximation formula, using the values from 1983, when the first ART baby was born in Japan, and the 1989-1992 values. The number of ART multiples between 1979-1982 was set as equal to zero. The minimum (or maximum) number of non-ART iatrogenic multiple births was estimated by subtracting the maximum (or minimum) ART multiples from the total iatrogenic multiples, which was estimated by vital statistics assuming that spontaneous multiple-birth rates according to maternal age class would be constant. There was an overall increase in the non-ART multiple births during the 30-year period, whereas ART multiples tended to increase from 1983 to 2005, and then rapidly decreased thereafter. The number or percentage of ART multiples was almost consistently lower than that of non-ART multiples. The percentage of non-ART multiples (33%) among the total multiples was estimated to be about three times more than the ART multiples (11-12%) in 2008. Given the medical and social impact of multiple births, it is imperative to construct a hospital-based monitoring system for fertility treatments, specially non-ART fertility treatments and multiple births.

Effective multidisciplinary treatment for ovarian granulosa cell tumor with multiple metastases--a case report

Ovarian granulosa cell tumor (GCT) is among the ovarian sex-cord stromal tumors that are classified as borderline malignancies. We report a case of GCT with multiple metastases for which multidisciplinary treatment including surgery, chemotherapy and radiotherapy was effective. A 41-year-old woman underwent left salpingo-oophorectomy because of an ovarian tumor in 2004. Final pathology confirmed a granulosa cell tumor adult type, FIGO Stage IC. In 2008, tumorectomy of the lower abdominal wall metastases was also performed. After three cycles of BEP chemotherapy for metastases of the right lung, liver, paraaortic lymph node and rectus, surgical resection was performed in 2009. In 2010, local radiation was performed for the first lumbar vertebral metastasis. Ovarian GCTs exhibit slow growth but if the surgical stage is IC or higher, there is the possibility of recurrence. It is important to treat recurrent tumors with the combination of surgery, chemotherapy, and radiation therapy.

Estimation of the contribution of assisted and non-assisted reproductive technology fertility treatments to multiple births during the past 30 years in Japan: 1979-2008

The effect of assisted reproductive technology (ART) and non-ART ovulation stimulation fertility treatment on the number and rate of multiple live births from 1979-2008 in Japan was estimated using two independent data sources, ART statistics and vital statistics. Japanese ART statistics presented by the Japan Society of Obstetrics and Gynecology between 1989 and 2008 were gathered and reanalyzed. The number and rates of ART between 1984 and 1988 were interpolated using an approximation formula, using the values from 1983, when the first ART baby was born in Japan, and the 1989-1992 values. The number of ART multiples between 1979-1982 was set as equal to zero. The minimum (or maximum) number of non-ART iatrogenic multiple births was estimated by subtracting the maximum (or minimum) ART multiples from the total iatrogenic multiples, which was estimated by vital statistics assuming that spontaneous multiple-birth rates according to maternal age class would be constant. There was an overall increase in the non-ART multiple births during the 30-year period, whereas ART multiples tended to increase from 1983 to 2005, and then rapidly decreased thereafter. The number or percentage of ART multiples was almost consistently lower than that of non-ART multiples. The percentage of non-ART multiples (33%) among the total multiples was estimated to be about three times more than the ART multiples (11-12%) in 2008. Given the medical and social impact of multiple births, it is imperative to construct a hospital-based monitoring system for fertility treatments, specially non-ART fertility treatments and multiple births.

Effect of maternal age and fertility treatment on the increase in multiple births in Japan: vital statistics, 1974-2009

Background

The present study used vital-statistics data to estimate the effect of maternal age and fertility treatment on the number and rate of multiple live births in Japan from 1974 through 2009.

Methods

Japanese vital statistics published by the Ministry of Health, Labour and Welfare from 1974 to 2009 were gathered and reanalyzed with regard to maternal age class and plurality of live births. The numbers of spontaneous and iatrogenic multiple births during 1977–2009 were estimated, with the assumption that spontaneous multiple-birth rates according to maternal age class would be constant and equal to those of baseline values, ie, the means between 1974 and 1976.

Results

During the 25-year period, multiple-birth rates according to maternal age class increased after the late 1980s. This tendency was obvious in women aged 35 to 39 years. The estimated numbers of iatrogenic multiple births remained nearly constant in women aged 20 to 24 years and greatly increased in women aged 30 to 34 and 35 to 39 years. The rate (per 1000 live births) of iatrogenic multiple births gradually increased from 0.7 (1977) to 1.3 (1986), then rapidly and markedly increased from 1.3 (1986) to 11.4 (2005), and finally decreased to 8.1 (2009). The estimated maximum percentage of iatrogenic multiple births was 50.0%, in 2004 and 2005.

Conclusions

The rapid increases in Japan in the number and rate of multiples born to women older than 30 years are likely due to iatrogenic rather than spontaneous multiple births.

[Life course genetic epidemiologic study based on longitudinal twin-family data: a new perspective]

Family-based life course epidemiology is the approach to clarify long-term effects of accumulations and chains of biological and social risk exposures in one's life trajectory, namely, before and during conception, infancy, childhood, young adulthood and later adult life. Both genetic and environmental factors are considered. One of the theoretical rationales is the 'developmental origin of health and disease (DOHaD)' hypothesis. According to this theory, the causes of adult diseases are attributed to predictive adaptive responses and biological programming or epigenetic changes during a critical period of early life. If the environment later in life after birth is different from what is predicted, a mismatch has happened, leading to the development of a disease. This theory is supported by many epidemiologic studies, animal experiments, and evolution theory of biology. Longitudinal twin-family data are very powerful and useful information in the family-based life course genetic epidemiologic study.

The effect of an increase in the rate of multiple births on low-birth-weight and preterm deliveries during 1975-2008

BACKGROUND

Despite the rapid increase in the rate of multiple births due to the growth of reproductive medicine, there have been no epidemiologic studies of the secular trends in the impact of multiple births on the rates of low-birth-weight and preterm deliveries in Japan.

METHODS

Japanese vital statistics for multiple live births were obtained from the Ministry of Health, Labour and Welfare and reanalyzed. With singletons as the reference group, an analysis was performed of secular trends in relative risk and population attributable risk percent of low-birth-weight (<2500 grams), very-low-birth-weight (<1500 grams), and extremely-low-birth-weight (<1000 grams) deliveries, using 1975-2008 vital statistics, and of preterm deliveries (ie, before 37, 32, and 28 weeks), using 1979-2008 vital statistics.

RESULTS

The rate of multiple births doubled during the past 2 decades, and about 2% of all neonates are now multiples. The population attributable risk percent tended to increase during the same period for all variables, and was approximately 20% in 2008.

CONCLUSIONS

The public health impact of the rapid increase in multiple births remains high in Japan.

Genetic influences on the difference in variability of height, weight and body mass index between Caucasian and East Asian adolescent twins

OBJECTIVE

Twin studies are useful for investigating the causes of trait variation between as well as within a population. The goals of the present study were two-fold: First, we aimed to compare the total phenotypic, genetic and environmental variances of height, weight and BMI between Caucasians and East Asians using twins. Secondly, we intended to estimate the extent to which genetic and environmental factors contribute to differences in variability of height, weight and BMI between Caucasians and East Asians.

DESIGN

Height and weight data from 3735 Caucasian and 1584 East Asian twin pairs (age: 13-15 years) from Australia, China, Finland, Japan, the Netherlands, South Korea, Taiwan and the United States were used for analyses. Maximum likelihood twin correlations and variance components model-fitting analyses were conducted to fulfill the goals of the present study.

RESULTS

The absolute genetic variances for height, weight and BMI were consistently greater in Caucasians than in East Asians with corresponding differences in total variances for all three body measures. In all 80 to 100% of the differences in total variances of height, weight and BMI between the two population groups were associated with genetic differences.

CONCLUSION

Height, weight and BMI were more variable in Caucasian than in East Asian adolescents. Genetic variances for these three body measures were also larger in Caucasians than in East Asians. Variance components model-fitting analyses indicated that genetic factors contributed to the difference in variability of height, weight and BMI between the two population groups. Association studies for these body measures should take account of our findings of differences in genetic variances between the two population groups.

Breast-feeding rates and related maternal and infants' obstetric factors in Japanese twins

OBJECTIVES

The aims of the present study are to describe the secular trend of breast-feeding rates in Japanese twins in comparison with the general population, and then to clarify the maternal and infants' obstetric factors associated with breast-feeding in twins.

METHODS

Breast-feeding rates from 0 to 6 full months and related maternal and infant obstetric factors were analyzed using 4,023 Japanese twins, consisting of two different volunteer-based twin samples, age 1-15 years, whose birth year ranged from 1968 to 2003. Data were collected through mailed or hand-delivered questionnaires. Obstetric factors that affect full and partial breast-feeding of twins were confirmed using logistic analyses according to birth order in twin pairs, adjusted by birth year.

RESULTS

The full breast-feeding rates of twins were lower than those of the general population. On the other hand, the combined rates of full and partial breast-feeding were close to those of general population, except for the period 1968-1974. The percentage of concordance pares was around 95% for all months. The most influential factor that negatively correlated with breast-feeding from 0 to 6 months was gestational weeks. Higher maternal age at twin birth and the use of an incubator also prevented breast-feeding in the neonatal period.

CONCLUSIONS

The results of the present study for the first time indicated that full breast-feeding of twins has risen recently in Japan, although the rates are still lower than those of the general population. The importance of the gestational weeks for breast-feeding rates was also shown.

[The current situation of older hospitalized patients in a cadre ward in Jilin, China]

OBJECTIVE

The proportion of elderly people and the nation's medical expenditures are rapidly increasing in China. The existence of cadre wards, where retired members of the cadre of the Communist Party of China are hospitalized and receive careful treatment, helps in providing care for the elderly. Elderly retired cadre patients are thought to be more frequently hospitalized and to stay in the hospital longer than elderly non-cadre patients on general hospital wards, and therefore might be expected make an important contribution to the increase in the nation's medical expenditures. However the current situation is not well characterized. The aim of this study was to provide a basis for possible solutions related to the cadre patient burden by determining the circumstances and background of these patients with long hospital stays and investigating their needs.

METHODS

We analyzed the medical records of hospital discharges from a cadre ward from 2000 to 2004, and from general wards in 2004 at a large university-affiliated hospital in Jilin, China. Additionally, a questionnaire survey including an interview concerning needs was carried out in August 2005 for 100 elderly patients on the cadre ward (91% of the total patients on this ward) of the same hospital at that time.

RESULTS

The mean length of hospital stays of patients on the cadre ward decreased by half during the study period, but remained longer than that of patients on general hospital wards. Regression analysis showed that of all the variables measured, the type of ward (cadre vs. general) was the most influential on the mean length of hospital stay. Moreover, patients who were hospitalized more often, males and older individuals showed longer hospital stays. The questionnaire survey showed that there are many patients who could be discharged from the hospital based on their health condition but are not discharged because outside care or welfare services are insufficient, or because there is little information available on social resources.

CONCLUSIONS

Although medical policy, by which elderly retired cadre patients receive careful treatment, may contribute to the longer length of the hospital stay of the patients on the cadre ward, it was thought to be important to construct appropriate discharge plans and a support system after discharge to the community. The results provide important information for solution of medical problems related to elderly retired cadre patients in China.

Twin database of the secondary school attached to the Faculty of Education of the University of Tokyo

This article profiles the historical twin databases of the secondary education school attached to the Faculty of Education at the University of Tokyo. The school was established in 1948. Every year, about 50 pairs of twins of all sex and zygosity combinations and aged 11 to 12 years take an examination, and about 10 to 20 pairs are admitted based on the results. Three independent datasets exist: one for applicants (11-12 years), one for students (12-18 years), and one for graduates (18-72 years). These three historical databases and research perspectives are introduced herein.

The Tokyo Twin Cohort Project: overview and initial findings

The Tokyo Twin Cohort Project (ToTCoP) is a large-scale longitudinal study of 5 years based on 1619 pairs of infant twins reared together. The purpose of the study is to construct a population-based twin registry in Japan and to investigate human growth and development and twin themselves. It covers behavioral, neurological, physical and environmental variables measured by questionnaire, home visiting and brain imaging technology. The full registry contains over 47,000 multiple births collected from the Basic Resident Register, and the targeted population is 3070 probable twins of 0 to 2 years old. Preliminary analysis of the entry questionnaire data showed no serious sampling biases. Descriptive statistics of parental characteristics (parental age, gestation age, parity and placentation, maternal weight, parenting stress) and children's characteristics (body size at birth, 4 and 10 months of age, milk consumption, and sleeping and social behavior) and their correlations, genetic and environmental contributions and correlations are reported.

Population-based database of multiples in childhood of Ishikawa Prefecture, Japan

A new type of population-based database of multiples in childhood at the prefecture level was initiated in 2004 in Ishikawa Prefecture, Japan. We conducted an exhaustive search for demographic information concerning families with multiples, family support provided by governmental and medical institutions by mailed questionnaire, and at the same time tried to organize a human network to support such families. This registry aims not only to aid research on human genetics and maternal and child health, but also to contribute to the development of welfare programs for families with multiples.

A comparison of twin birthweight data from Australia, the Netherlands, the United States, Japan, and South Korea: are genetic and environmental variations in birthweight similar in Caucasians and East Asians?

Birthweight has implications for physical and mental health in later life. Using data from Caucasian twins collected in Australia, the Netherlands and the United States, and from East Asian twins collected in Japan and South Korea, we compared the total phenotypic, genetic and environmental variances of birthweight between Caucasians and East Asians. Model-fitting analyses yielded four major findings. First, for both males and females, the total phenotypic variances of birthweight were about 45% larger in Caucasians than in East Asians. The larger phenotypic variances were mainly attributable to a greater shared environmental variance of birthweight in Caucasians (ranging from 62% to 67% of variance) than Asians (48% to 53%). Second, the genetic variance of birthweight was equal in Caucasians and East Asians for both males and females, explaining a maximum of 17% of variance. Third, small variations in total phenotypic variances of birthweight within Caucasians and within East Asians were mainly due to differences in nonshared environmental variances. We speculate that maternal effects (both genetic and environmental) explain the large shared environmental variance in birthweight and may account for the differences in phenotypic variance in birthweight between Caucasians and East Asians. Recent molecular findings and specific environmental factors that are subsumed by maternal effects are discussed.

Genetic and environmental influences on the handedness and footedness in Japanese twin children

The purpose of this study was to examine the genetic contribution to handedness and footedness in childhood using one of the largest available databases of Japanese twins. The participants were 1131 twin pairs, 1057 males and 1205 females, of 11 or 12 years of age (6th grade of secondary school in the Japanese education system). All data were gathered by questionnaire. The prevalence of left (nonright) handedness was 15% in males and 13% in females. The prevalence of left (nonright) footedness was 13% in males and 11% in females. The similarities between twin pairs, estimated by concordance rates and tetrachoric correlations, suggested a slight genetic effect on male handedness, no genetic effect on female handedness, and no genetic effect on footedness in either sex. Structural equation modeling showed small genetic factors (11%) in male handedness and no genetic factors in female handedness. As to footedness, no genetic factors were observed in either sex. The effects of nonshared environmental factors were large (85%) in males and moderate (44%) in females. Moreover, handedness and footedness tended to be concordant irrespective of sex, with polychoric correlations over r = .70. The results of bivariate genetic analyses were not necessarily satisfactory. For males, no model fit. For females, shared and nonshared environmental factors explained the concordance of handedness and footedness. It was concluded that the genetic effects on handedness and footedness are relatively small, as is their association; moreover, considerably large twin samples are needed to obtain stable and appropriate results.

Comparison of obstetric and birthweight characteristics between the two largest databases of Japanese twins measured in childhood

The purpose of this study is to compare obstetric and birthweight data of twin children from the two largest databases in Japan to estimate the difference between them in sample collection. The first group consisted of 1131 twin-pair school applicants, and the second group consisted of members' children from several maternal associations devoted to twins and included 951 pairs. All data were gathered by questionnaire. The mean birth years of the twins in these two databases were 1979 and 1995 respectively. The percentage of mothers treated with ovulation-stimulating drugs or in-vitro fertilization was markedly higher in the maternal associations group. Gestational age was around 1 week less in the maternal associations group, whereas birthweight according to gestational weeks and intrapair relative birth weight difference as a percentage according to zygosity showed little difference between both groups. We conclude that the obstetric and birthweight feature data from both groups should be considered to construct twin growth charts based on the methods of sample selection.

Genetic and environmental influences on stuttering and tics in Japanese twin children

The purpose of this study was to clarify the genetic contribution to stuttering and tics in childhood using the largest databases of Japanese twins. The subjects were 1896 pairs of twin children consisting of 1849 males and 1943 females with a mean age of 11.6 years (3 years to 15 years). All data were gathered by questionnaire. The prevalence of stuttering was 6.7% in males and 3.6% in females (p < .0001). The prevalence of tics was 6.8% in males and 4.1% in females (p = .0021). Concordance rates and polychoric correlations were all higher in monozygotic pairs than in dizygotic pairs irrespective of sex combination. Structural equation modeling showed that the proportion of total phenotypic variance attributable to genetic influences was 80% in males and 85% in females for stuttering, and 28% in males and 29% in females for tics. Moreover, co-occurrence between stuttering and tics was observed in 0.8% of males (tetrachoric correlation: r = .18) and 0.5% of females (r = .31), which was attributed partly (nearly 10% of total genetic variance of each trait) to the common genetic factors, with genetic correlation of r = .32.

Analysis of factors affecting birthweight, birth length and head circumference: study of Japanese triplets

The aims of this study were to identify factors associated with birthweight, birth length and head circumference for triplets, and analyze these body size parameters at birth, especially head circumference, according to gestational age. The subjects of this study were 370 mothers and their 1109 triplet children (excluding one stillborn infant) who were born between 1978 and 2002. The gestational age proved to be the strongest contributing factor to birthweight, birth length and head circumference of the triplets. Moreover, sex was a significant factor affecting birthweight, birth length and head circumference. Male neonates had a higher birthweight, longer birth length and greater head circumference than female neonates. Birth order in triplets also had a significant effect on birthweight and head circumference. Lower birth-order neonates had a higher birthweight and greater head circumference. An effect of maternal pregravid body mass index (BMI) on both birthweight and birth length was observed. The birthweights of triplets born to women whose pregravid BMIs were more than 26.0 kg/m2 weighed an average of 150 g more than those of triplets born to women whose pregravid BMIs were less than 19.8 kg/m2, and the birth length of triplets born to women whose pregravid BMIs were more than 26.0 kg/m2 averaged 1.5 cm longer than those of triplets born to women whose pregravid BMIs were less than 19.8 kg/m2. Concerning head circumference, the median head circumference of male neonates was approximately 0.5 cm longer than female neonates. Compared to singleton neonates, the median head circumference of triplets was almost the same.

Genetic and environmental influences on finger-sucking and nail-biting in Japanese twin children

The purpose of this study was to clarify the genetic contribution to finger-sucking and nail-biting in childhood using the largest databases available on Japanese twins. The subjects were 1131 pairs of 12-year-old twin children, consisting of 1057 males and 1205 females. All data were gathered by maternal questionnaire, and responses to the questionnaire were checked in the medical interview. The prevalence of finger-sucking between 0 to 2 years was 40% in males and 43% in females (p = .0053). The prevalence of nail-biting up until the age of 12 years was 28% in males and 26% in females (nonsignificant). Concordance rates and polychoric correlations were all higher in monozygotic pairs than in dizygotic pairs, irrespective of the sex combination. Univariate and bivariate genetic analyses using structural equation modeling was performed. The results showed that the proportion of total phenotypic variance attributable to genetic influences was 66% in males and 50% in females for finger-sucking, and 50% in both males and females for nail-biting. A co-occurrence of finger-sucking and nail-biting was observed in 17.7% of males (tetrachoric correlation: r = .40) and 15.7% of females (r = .32), which was attributed partly to common genetic or environmental factors. The proportion of total shared variance explained by genetic factors was 67%.

Zygosity misclassification of twins at birth in Japan

Though twinning rates have been rapidly increasing in Japan, the problem of zygosity misclassification at birth has been paid little attention. By analyzing four independent samples, the authors found that at a constant rate about 25-30% of monozygotic twins were misclassified as dizygotic twins at birth. This percentage is in very good accordance with that of monozygotic twins having dizygous placenta. Generally the obstetricians informed twins' parents about their children's zygosity. The number of placentas, as informed by obstetricians, was very strongly associated with zygosity. Concluding, even now many monozygotic twins in Japan may be misclassified as dizygotic at birth by obstetricians based solely on the number of placenta.

Characteristics of a Japanese adult twin database of high school graduates

This paper profiles a unique cohort of adult Japanese twins. The database contains more than 700 twin pairs, aged 18 to 66 years, who are all graduates of the secondary school attached to the faculty of education of the University of Tokyo. This school was established in 1948, when the study of twins was burgeoning in Japan, and about 10 to 20 pairs of twins have been admitted there every year to participate in studies on twins in education and in related projects. The zygosity of all twins was determined carefully on the basis of various sources. Data from the perinatal period to adulthood were linkable using ID numbers. Follow-up surveys in the field of medical genetics were performed in 1985, 1989 and 1999. For the third survey, which was sent and received exclusively by mail, the distribution and collection process was also assessed in detail. The response rate was around 40%, which statistically was influenced mainly by previous participation and sex. The limitation of this cohort is its selection bias concerning socioeconomic status and its imbalance in favor of monozygotic pairs.

Breast-feeding and bottle-feeding of twins, triplets and higher order multiple births

OBJECTIVE

This study was performed to determine the rates of breast-feeding and/or bottle-feeding in mothers of twins, triplets and higher order multiple births compared to those in mothers of singletons, and identify factors associated with decision as to breast-feed or bottle-feed.

METHODS

The subjects were 1,529 mothers of twins aged 6 months-6 years and 258 mothers of triplets and higher order multiple births (higher multiples) aged 6 months-6 years (234 mothers of triplets, 20 mothers of quadruplets, 4 mothers of quintuplets). Also, 1,300 subjects were recruited as a control group from mothers of singletons aged 6 months-6 years. Information regarding feeding methods, including exclusive breast-feeding, mixed-feeding and bottle-feeding with formula milk only, and duration of breast-feeding (in months) was collected.

RESULTS

There were significantly higher rates of bottle-feeding in mothers of twins and higher multiples than in mothers of singletons. Duration of breast-feeding in mothers who chose exclusive breast-feeding or mixed-feeding for twins and higher multiples was significantly shorter than those for the singletons. The feeding methods for the twins or higher multiples were not associated with prematurity or low birth weight. However, after adjusting for each associated factor using logistic regression analysis, the decision to bottle-feed was significantly associated with non-cooperation of the husband in childrearing and degree of anxiety that mothers felt when informed of a multiple pregnancy. The odds ratio indicated that mothers who received no cooperation from the husband for childrearing were 1.83 times more likely to choose bottle-feeding as those who received cooperation. Further, the odds ratio indicated that mothers who felt greater anxiety when informed of a multiple pregnancy were 1.73 times more likely to choose bottle-feeding as those who did not feel much anxiety.

CONCLUSION

This study found that establishment and continuation of breast-feeding for twins, triplets and higher order multiple births are much more difficult than for singletons. Further, cooperation of the husband in childrearing and the degree of maternal anxiety when informed of a multiple pregnancy are significant factors affecting the decision to breast-feed or bottle-feed for twins, triplets or higher order multiple births.

Physical growth charts from birth to six years of age in Japanese twins

BACKGROUND

The purpose of this study was to analyze the characteristics of the physical growth of twins in childhood and to present growth charts of Japanese twins.

METHODS

The subjects consisted of 2029 pairs of normally developed Japanese twins. Growth data were obtained by mailed or hand-distributed questionnaires. Factors that affect body weight and height/length at selected ages were analyzed by stepwise regression analysis. Selected percentiles of body weight, height/length, and body mass index were calculated according to sex, and growth curves were drawn using a spline function. The size deficit of the twins compared to the standards for the general population of Japan was calculated.

RESULTS

Gestational age, parity, zygosity, and birth order affected physical growth in varying degrees, although the overall effects themselves were small and mostly disappeared by one year of age. Growth charts of the twins present growth at selected percentiles from birth to 6 years of age according to sex. The size deficit of the twins was largest at birth: more than 20% for weight and approximately 6% for length compared to the 50th percentile of the standard for the general population of Japan. These deficits decreased rapidly in the first 6 to 12 months, and were found to be as low as 0-2% at 4 to 6 years of age.

CONCLUSION

Growth charts specifically for twins are needed, at least for the first 1 to 3 years of age but not beyond the age of 6 years.

Reference birth weight, length, chest circumference, and head circumference by gestational age in Japanese twins

BACKGROUND

Numerous birth weight standards for twins have been reported in western countries, whereas little is in Japan. The aim of this study is to present birth weight, birth length, chest circumference, and head circumference references, clarifying features related to these body size parameters, and to compare our birth weight references with recent report of birth weight norms of Japanese twins using the vital statistics.

METHODS

The subjects consisted of 1,061 twin pairs in total, with birth years ranging from 1968 through 1990. Data was obtained from the Twins Protocol Questionnaire, which asked for information about twins' growth and development in infancy, and the "Maternal and Child Health Handbook," which was presented by Ministry of Health and Welfare. Statistical means, standard deviations, and selected percentiles by gestational age were calculated and smoothed using data that contained at least gestational age and one of the four items.

RESULTS

Birth weight was significantly lighter than that of singletons when three additional parameters, especially chest and head circumference, were not measured. Gestational age was correlated with weight, length, chest circumference, and head circumference, in that order, for both sexes. Compared with singletons, birth weight difference in twins was marked and slight difference was observed as to length, whereas no difference was observed as to chest and head circumference. The present results as to birth weight were consistently similar to the birth weight norms of twins using vital statistics in Japan.

CONCLUSION

Growth standards for twins, especially as to birth weight, are essential to understand and evaluate intrauterine growth of twins.

Zygosity Diagnosis in Young Twins by Questionnaire for Twins' Mothers and Twins' Self-reports

The present study deals with the determination of zygosity in twins of childhood age by simple questionnaire. The subjects were 224 twin pairs and their mothers, consisting of 159 monozygotic and 65 same-sex dizygotic pairs, identified by genetic markers including DNA samples. Mothers of twins responded to 19 questionnaire items dealing with twin similarity in 16 items about physical features and 3 items about the degree of similarity and frequency of being mistaken (confusion of identity) when twins were about 1 year of age. The twins themselves responded to three questionnaire items dealing with only confusion of identity items. The results of stepwise logistic regression analysis were as follows: the total accuracy of the mothers' questionnaire was 91.5% when using only the items dealing with confusion of identity. This accuracy was slightly lower than that obtained by twins' self-reports dealing with nearly the same question items of confusion of identity, answered by both twins separately with 93.3% accuracy. The total accuracy of mothers' questionnaire responses rose to 95.1% when we used all 19 items. In addition to "the frequency of being mistaken", two physical features, namely "shape of fingers" and "shape of eyebrow", were very informative. In conclusion, twin zygosity can be estimated by the use of the mothers' simple questionnaire with sufficient accuracy even in very young twins about 1 year of age.