Twin trouble…
The parents of twins conceived either spontaneously or with assisted reproductive technology (ART) suffer more mental health symptoms after delivery and one year later than the parents of single babies, according to new European research.
However, the mothers of ART twins had fewer symptoms of depression before the birth than did mothers of twins conceived spontaneously. “This may be due to better counseling and preparation of infertile couples for twins,” Dr Leila Unkila Kallio, senior consultant in gynaecology and obstetrics at Helsinki University Central Hospital, in Finland, told the conference. “Good mental health during pregnancy may also reflect the couples’ satisfaction with successful treatment and fulfillment of hopes for parenthood.” After their babies were born, fathers of twins in both groups suffered more depression, anxiety, social dysfunction and sleeping problems than fathers of singletons.
The study is the first to investigate the mental health of both mothers and fathers of twins conceived either spontaneously or through ART using their own sperm and eggs, covering the transitional period to parenthood from pre-birth through to one year afterwards. Dr Unkila Kallio said that it showed that psychological wellbeing of prospective parents should be taken into account when deciding how many embryos to implant during ART – as well as the health risks of twin pregnancies to both mothers and babies. “We believe it’s important to reduce multiple pregnancies worldwide by introducing single embryo transfers. Our results on parental mental health of twin parents provide further evidence to support this policy,” said Dr Unkila Kallio.
The researchers studied ART parents of 91 twins and 367 singletons and control parents of 20 twins and 379 singletons (conceived spontaneously) at three time points: in the second trimester of pregnancy (weeks 13-28), when the children were 2 months of age and when they were aged 1 year. Depressive symptoms, anxiety, sleeping difficulties and social dysfunction were measured using a questionnaire. The results showed that in pregnancy ART mothers of twins had a lower incidence of depressive symptoms. Fathers in all groups had similar mental health during the pregnancies.
After delivery and at one year, mothers of twins in both the ART and control group had more symptoms of depression than the mothers of singletons. ART fathers had a higher incidence of depressive symptoms than ART fathers of singletons but their scores were comparable to those of control fathers. “Furthermore, fathers of 2-month old twins in both ART and control groups reported significantly more impaired social dysfunction than fathers of singletons,” said Dr Unkila Kallio. At 1 year, the ART and control fathers of twins also had higher levels of depressive and anxiety symptoms and sleeping difficulties than did the fathers of singletons.
“The mental health of mothers, irrespective of ART, seemed to be resilient to the effects of parity, prematurity or health problems of the newborns,” said Dr Unkila Kallio. “But the control fathers of premature babies (usually twins) had more impaired social dysfunction than ART fathers. Similarly, problematic health of the newborns induced higher levels of anxiety symptoms and sleeping problems in control fathers of twins. Thus, fathers of ART twins seemed to cope better with child-related problems than did the controls.
“It may be that counseling for the option of a twin pregnancy, as well as its medical and psychosocial risks before attending for ART, may have a decisive importance for a couple's ability to realise the consequences of a twin birth and, in the case of a twin pregnancy, to help the couple to adapt to twin parenthood, thus explaining the findings in ART couples. It is possible that many fathers of spontaneous twin pregnancies may lack this knowledge.”
Dr Unkila Kallio concluded: “For some couples it is difficult to overcome the emotional pain that infertility and its treatments bring, even though parenthood is finally achieved. As ART has become more common and ART parents are seen in all well-baby clinics, we need to consider how these parents, especially fathers, could be supported in the best possible way to avoid the harmful effects of hurt self-esteem or feelings of insecurity about parenthood. The present study on mental health of parents with twins is a part of a larger multi-dimensional study, exploring the early environment of babies born by ART.”