Risk of Stillbirth in Twin Pregnancy Related to Sex and Maternal Age: An Analysis of 90,386 Twin Maternities

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Abstract
Data from the Annual Reports of the Registrar-General for England and Wales (1938-1948) led to the following conclusions. (1) Whereas the sex ratio of stillbirths in single pregnancies increases with maternal age, the sex ratio of twin stillbirths decreases. (2) At all ages stillbrith rates are higher in twins than in single births. The difference is very much greater in younger than in older mothers. (3) For twin births, male stillbirth rates are consistently higher than female rates (particularly in younger mothers). (4) For single births there is little difference between the male and female stillbirth rates of young mothers, but as maternal age increases risk to the male fetus becomes progressively greater than to the female. (5) Stillbirth rates for like-sex pairs are consistently higher than for unlike-sex pairs. (6) At all maternal ages risk to the male fetus, in both like- and unlike-sex pairs, is considerably higher than risk to the female. (7) Unlike-sex twin stillbirth rates are lowest for mothers under 25 yrs., and, as with single births, increase with maternal age. Stillbirth rates for like-sex twins have the same relation to maternal age as those for all twins, and are lowest in the middle of the reproductive period. It is suggested that risk to the fetus in multiple births is directly related to frequency of monozygosity. Support for this view is provided by an analysis of sex specific stillbirth rates in single, twin, and triplet maternities.

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