Twins fare better if both are girls

Twins may come into the world a little healthier if they share the womb with a sister rather than a brother, a new study suggests.

Israeli researchers found that among the 2 700 twin pregnancies they studied, the risk of preterm delivery was highest when both twins were male and lowest when both were female.

In addition, the risks of certain complications, such as lower birth-weight and newborn breathing problems, were higher among males and females who had shared the womb with a brother rather than a sister.

The findings, published in the journal Obstetrics and Gynaecology, support the theory that the "male factor" raises the odds of pregnancy complications.

It's known, for example, that boys are more likely than girls to be born prematurely, need a caesarean delivery or have newborn health problems. This latest study suggests that having a male twin may also raise the odds of complications.

How the study was done
However, the differences in risk are small, and the findings should not "panic" parents expecting male or mixed-sex twins, said senior researcher Dr Marek Glezerman, of Rabin Medical Centre and Tel Aviv University.

There are no immediate implications for managing twin pregnancies, Glezerman said. Instead, the findings are interesting because they suggest that the higher risk of problems with male pregnancies stems from a male "disadvantage," rather than a female protective factor.

The study included 2 704 fraternal twin pregnancies; most were male/ female, while 16% were female/female and 14% male/male.

Overall, the risk of preterm birth was highest when both twins were male. Nine% were born before the 31st week of pregnancy, compared with 7.5% of mixed-sex twins and 5.5% of female/ female twin pairs.

The "male factor" also appeared to have an effect on birth size. In general, the study found, baby boys had a lower birth-weight and slower growth rate when they had shared the womb with a brother rather than a sister.

What the study found
Girls showed an apparent disadvantage from having a male co-twin as well. Compared with baby girls who had shared the womb with a sister, they were more likely to have neurological complications or breathing problems from underdeveloped lungs.

Eleven percent of girls from male/female twin pairs developed respiratory distress syndrome, compared with 8% among female/ female pairs. And just over 1% developed convulsions, compared with none of the newborn girls from female/female pairs.

It's possible, according to Glezerman's team, that male sex hormones, such as testosterone, help explain at least some of the risks linked to having a male twin.

These hormones have been found to limit lung development, for instance, and research in animals shows that female twins have higher testosterone levels when they share the womb with a brother.

Future studies, the researchers conclude, should look at whether having a male co-twin has any effects on long-term physical, mental or behavioural development. – (Reuters Health, November 2009)

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Sex of twins may affect outcome