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Second-versus first-born twin: comparison of short- and long-term outcomes

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

An ancient description of the competition between twins for first breath is found in the biblical story of Jacob and Esau (Genesis 25:26) when Jacob pulled his older brother's heel in the hope of becoming firstborn but to no avail. In this study, we sought to evaluate the short and long-term outcomes of twin pairs, comparing between the second- and first-born twin.

Methods

A population-based cohort study, including dichorionic twin deliveries occurring between the years 1991 and 2021 at Soroka University Medical Center. A General estimation equation (GEE) was applied to adjust for confounders. The incidence of offspring’s hospitalizations due to various medical conditions was compared. Kaplan–Meier survival analyses compared cumulative morbidity. Cox proportional hazards models were used to control for confounders.

Results

5507 twin deliveries met the inclusion criteria. Second-born twins had higher rates of cesarean deliveries, statistically significant in the GEE multivariable analysis. More first-twin fetuses were experiencing non-reassuring fetal heart rate patterns, although other obstetrical outcomes as well as mortality rates were comparable between groups. Second twins weighed lower than their older sibling (mean difference 33 g) and were more frequently SGA and low birthweight (1500–2500 g); (p < 0.05). Later during childhood, offspring of twin deliveries experienced notable morbidity due to infectious (23.8–24.1%), respiratory (10.5–10.9%), neurological (7.0–7.8%) and cardiovascular pathologies (1.7–1.9%) during childhood, that was unaffected by birth order.

Conclusion

Other than birthweight differences, the birth order of dichorionic twins is not associated with adverse neonatal health indices, nor does it predict excess risk for morbidity during childhood.

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Data availability

This study’s data are not publicly accessible due to reasons of sensitivity.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. The Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer-Sheva, IL, Israel

    Omri Zamstein & Eyal Sheiner

  2. The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Tamar Wainstock

Authors
  1. Omri Zamstein
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  2. Tamar Wainstock
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  3. Eyal Sheiner
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Contributions

ZO: scientific background, interpretation of results, manuscript writing. WT: data analysis, interpretation of results, manuscript editing. SE: study concept and design, interpretation of results, manuscript revision.

Corresponding author

Correspondence to Omri Zamstein.

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Conflict of interest

The authors declare that they have no conflict of interest.

Financial interest

The authors have no relevant financial interests to disclose.

Ethics approval

Approval for the study (IRB: 0357-19-SOR) was granted by the Ethical Committee of Soroka University Medical Center, Beer-Sheva, Israel, chaired by Prof. Lunenfeld E., on February 12, 2007. The approval was most recently renewed on November 1, 2023.

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Zamstein, O., Wainstock, T. & Sheiner, E. Second-versus first-born twin: comparison of short- and long-term outcomes. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-023-07341-w

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  • DOI: https://doi.org/10.1007/s00404-023-07341-w

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