Death of One Twin Before Birth Leaves Survivor at High Risk for Cerebral Palsy

May 8, 2000 -- British researchers have determined that when one twin dies before birth, the surviving twin is left with a 20% greater risk for cerebral palsy and other brain impairments than when both twins survive. The findings were reported in the May 5 issue of the British medical journal The Lancet.

Experts have known that when one twin dies before birth, risk of cerebral impairment is higher for the surviving twin, according to Mary Jane Platt, MD, senior lecturer in the department of public health at the University of Liverpool, England. "Where the surviving twin is the same sex as the [fetus who died], the risk appears even higher," she tells WebMD on behalf of lead author P.O.D. Pharoah, emeritus professor of public health, at the University. "[The data] indicate that we need a greater understanding of twin development during pregnancy."

Researchers mailed questionnaires to the physicians of all surviving co-twins in England and Wales between 1993 and 1995. They found that the prevalence of cerebral palsy and other cerebral problems was about one in 10 in survivors of same-sex twins. Among different-sex twin survivors, the odds were slightly better.

Stephen T. Chasen, MD, an assistant professor of obstetrics and gynecology in the division of maternal-fetal medicine at Weill Medical College of Cornell University in New York, tells WebMD, "[This study] underscores the fact that a twin pregnancy is not the equivalent of two [single] pregnancies. The outcome of an individual twin can be effected by its co-twin in many ways, including death of its co-twin."

On an emotional level, Sharon Withers, managing editor of Twins Magazine, tells WebMD, "One of the things we know about a surviving twin is that they feel the sense of loss -- even in utero losses. They feel something is missing. Psychologists say it's healthier for the surviving twin if parents try to weave the memory of that twin into the family through occasional discussion, being careful not to enshrine that twin. The message should be: 'We miss your twin, and we love you very much.'"

As a mother with a surviving twin, Mary Slaman-Forsythe tells WebMD, "Since the day they were born, I cried in front of him. I showed him compassion, and he learned to be open with his feelings -- I told him it was okay to cry. I told him that he is a twin, and that his brother is the twinkle in his eyes. We will always be a family of five, and we talk, share, laugh, and cry for Steven every day." Slaman-Forsythe is also founder and president of Twin to Twin Transfusion Syndrome Foundation in Bay Village, Ohio.

"The extraordinary high risk of infant and child mortality and serious mortality in the surviving co-twin of a fetus that died, particularly among same-sex twins, emphasizes the importance of the accurate [tracking throughout the pregnancy]," writes Pharoah.