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Description : Genetic and Environment factors influencing twinning: Impact on public health and decision making

Tags : Twinning, Genetic factors, Environmental Factors, FSHR genes, SMAD3

Published on : Jul 17, 2023 | Views : 651 | Downloads : 2

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1 Genetics and Environmental Factors Contributing to Twinning: Impact on Public Health Practices and Decision Making Presentation by Sulaimon Olawale ARAROMI Sulaimon Araromi B.Sc.
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OUTLINE Introduction Concept of twinning Types of twinning Genetic factors contributing to twinning Environmental factors contributing to twinning Worldwide incidence of twin births Incidence of twinning in Nigeria Risks and impact of twinning on public health practice Public health interventions and decision making Challenges and future direction Conclusion References 2 Sulaimon Araromi B.Sc.
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INTRODUCTION Twinning, the occurrence of two or more offspring from a single pregnancy, is influenced by both genetic and environmental factors. Twin studies help understand the relative importance of environmental and genetic influences on individual traits and behaviors. This presentation explores the factors that contribute to twinning and their implications for public health practice and decision-making. 3 Sulaimon Araromi B.Sc.
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CONCEPT OF TWINNING Twinning is a process whereby their is occurrence of multiple pregnancies resulting in the birth of two or more offspring at the same time. The phenomenon of two babies born in the same pregnancy, has long been the subject of curiosity since time immemorial. Scientists have documented the phenomenon of twin or other multiple births as far back as the 1809s. There were two types of twins identified by Scottish physician J Matthews Duncan in the 19th century. In 1875 Sir Francis Galton, cousin of Charles Darwin has an idea that was based on the assumption that twins can be used to study heritability of traits and conditions, including intelligence, personality, mental health, physical health, and more. 4 Sulaimon Araromi B.Sc.
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TYPES OF TWINNING 5 Sulaimon Araromi B.Sc. (Images source: twinversity.com)
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TYPES OF TWINNING 6 Sulaimon Araromi B.Sc. (Images source: twinversity.com)
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GENETIC FACTORS CONTRIBUTING TO TWINNING 7 Variations in specific genes, such as the FSH receptor gene and SMAD3 genetic variant rs17293443, have been linked to a higher risk of twinning (Anifowoshe et al.,2019). The FSHR gene codes for the follicle stimulating hormone receptor, which is important in the control of the menstrual cycle and ovulation. Specific changes or polymorphisms in the FSHR gene can impair its activity, resulting in the release of multiple eggs during ovulation. SMAD3 enhance the response of the Ovary to the FSH This egg release may enhance the likelihood of having fraternal (dizygotic) twins. Women who are older than 30 are more likely to hyper-ovulate (Eriksson et al., 2008). Sulaimon Araromi B.Sc.
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8 (Image source: Bcm.edu) Sulaimon Araromi B.Sc.
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ENVIRONMENTAL FACTORS CONTRIBUTING TO TWINNING 9 Various environmental factors can influence twinning rates. Factors such as: Advanced maternal age Parity Genetics & Family history Race and ethnicity Nutrition Use of fertility treatments e.g ART(Assisted Reproductive Technologies) like IVF and IUI- intrauterine insemination, taking drugs like Clomid and Gonadotrophins which stimulate ovulation. Most of the factors, both genetic and environmental, mostly result in dizygotic twins. Why monozygotic twinning occurence in humans is unknown because it is thought to be a random occurrence. Sulaimon Araromi B.Sc.
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WORLDWIDE INCIDENCE OF TWIN BIRTHS Since the 1980s, the global twinning rate has increased by one-third, from 9.1 to 12.0 twin deliveries per 1000 deliveries, resulting in around 1.6 million twin pairs per year. Natural twinning rates were already known to be low in East Asia and South America in the 1980s, intermediate in Europe and North America, and high in several African countries (Christiaan Monden et al., 2021). In a study, many countries in Europe, North America, and Asia have seen significant rises in twinning rates. The rise was above 10 percent in 74 of the 112 countries studied. Africa continues to have the greatest twinning rates, but Europe, North America, and Oceania are coming up quickly. Infact, currently, Africa account for more than 50% of all twins deliveries in the world. (Christiaan Monden et al., 2021) 10 Sulaimon Araromi B.Sc.
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INCIDENCE OF TWINNING IN NIGERIA 11 According to studies, Nigeria has the greatest rate of twinning among African countries, with the exception of Benin Republic (Anifowoshe et al., 2019). The frequency of twinning in Nigeria was found to be 6,070 out of 189,178 total births, with 32.1 twins born per 1,000 deliveries. The Yoruba ethnic group in Southwestern Nigeria has a twinning rate of 68.1/1000 births, 21.1/1000 births from Kano, 26.5/1000 births from Calabar, and 28/1000 births from Jos (Mosoro, 1996; Adewale et al., 2018; Bassey et al., 2004). Sulaimon Araromi B.Sc.
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INCIDENCE OF TWINNING IN NIGERIA 12 Igbo-Ora, a town in Oyo state, has been known as the "Twin Capital of the World" due to an unusually high incidence of twin births. The town has an estimated 50 sets of twins per 1,000 live births, which is approximately ten times the global average of around 5 sets per 1,000 live births. According to research, the many births may be caused by the diets of the women in the town. It is believed that Yam and Okra leaves soup consumed by women in Igbo-Ora influence their multiple births. There is no scientific justification yet for the eating habit and numerous births. (npr.org) Sulaimon Araromi B.Sc.
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RISKS & IMPACT OF TWINNING ON PUBLIC HEALTH PRACTICE 13 Twin or multiple births have a variety of medical, healthcare, socio-emotional, psychological, and developmental implications and consequences for families, healthcare providers, and society as a whole. Some of these risks and impacts are listed below: Intensive prenatal care Gestational diabetes (for the mother) Risk in labor and delivery Neonatal complications such as preterm birth and low birth weight Perinatal morbidity and mortality Hypertension Preeclampsia Acute polyhydramnios (Esteves-Pereira AP et al.,2021; Ionio, C et al.,2019) Sulaimon Araromi B.Sc
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PUBLIC HEALTH INTERVENTIONS AND DECISION MAKING 14 By considering the genetic and environmental factors and also considering the risks associated with twinning, public health policy makers can develop targeted interventions to support families with twins, enhance maternal and child health , and promote healthy development. Here are some key areas where public health can intervene: Education and awareness Prenatal screening and monitoring Access to quality healthcare services Evidence based guideline and protocols specific to twin pregnancies Health provider training and education Support networks and resources Data collection and research Sulaimon Araromi B.Sc.
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CHALLENGES AND FUTURE DIRECTIONS Despite advances in our understanding of twinning, there are still problems. Factors such as restricted access to specialized treatment, socioeconomic inequality, and the possible long-term health effects for twins all need to be addressed further. Future directions should focus on addressing these problems through interdisciplinary collaboration, promoting equal access to care, and performing extensive research to study the impacts of twinning. 15 Sulaimon Araromi B.Sc.
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CONCLUSION 16 A complex interaction of genetic and environmental factors influences twinning. Understanding these determinants is essential for public health practitioners and policymakers who want to formulate and implement successful policies to promote the health and well-being of twins and their families. We may improve public health practice and decision-making in this critical area by considering the special requirements of twins, implementing evidence-based interventions, and supporting research and surveillance. Sulaimon Araromi B.Sc.
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REFERENCES 17 Abass, Anifowoshe. (2019). Frequency of Twinning in Nigeria: A Review. 78-88. Adewale FB, Ashimi A, Oyewopo OA. Trends of multiple birth at federal medical centre bida, Northcentral Nigeria. Trop J Obstet Gynaecol [serial online] 2018 [cited 2023 Jul 5];35:68-72. Available from: https://www.tjogonline.com/text.asp?2018/35/1/68/229864 Bassey EA, Abastsiattai AM, Udoma EJ, Asuquo EE. Outcome of twin pregnancy in Calabar Nigeria. J Med Sci 2004;3:13–5. Burbridge D. Francis Galton on twins, heredity and social class. Br J Hist Sci. 2001 Sep;34(122 Pt 3):323-40. doi: 10.1017/s0007087401004332. PMID: 11700679. Eriksson AW, Fellman J. Seasonal variation of livebirths, stillbirths, extramarital births and twin maternities in Switzerland. Twin Res 2000;3: 189–201. Esteves-Pereira AP, da Cunha AJLA, Nakamura-Pereira M, Moreira ME, Domingues RMsm, et al. (2021) Twin pregnancy and perinatal outcomes: Data from ‘Birth in Brazil Study’. PLOS ONE 16(1): e0245152. https://doi.org/10.1371/journal.pone.0245152 Francis G. Inquiries into Human Faculty and its Development. London: Macmilan & Co; 1875. History of Twins; pp. 155–73. [Google Scholar] Ionio, C., Mascheroni, E., Colombo, C., & Lista, G. (2019). Prenatal Attachment in Twin Pregnancy. IntechOpen. doi: 10.5772/intechopen.79365 Mosuro AA. Twining rates in southwest Nigeria. Niger J Sci 1996;30:39-45. Sahu M, Prasuna JG. Twin Studies: A Unique Epidemiological Tool. Indian J Community Med. 2016 Jul-Sep;41(3):177-82. doi: 10.4103/0970-0218.183593. PMID: 27385869; PMCID: PMC4919929. https://raisingchildren.net.au/pregnancy/health-wellbeing/twin-pregnancy/twins Sulaimon Araromi B.Sc.
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18 Sulaimon Araromi B.Sc.