Twins conceived using assisted reproduction: Parent mental health, family relationships and child adjustment at middle childhood

Kayla N. Anderson, Bibiana D. Koh, Jennifer J. Connor, Ascan F. Koerner, Mark Damario, Martha A. Rueter

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


STUDY QUESTION: Compared with singletons, what isthe parent mental health, parent-child and couple relationship satisfaction, and child adjustment of 6- to 12-year-old assisted reproduction technology (ART) twins and their families? SUMMARY ANSWER: There areno differences between6- and 12-year-old ART twin and singleton families inparent mental health or family relationships; however, twins had significantly fewer behavior and attention problems than singletons in middle childhood. WHAT IS KNOWN ALREADY: When ART twins are younger than 5 years old, parents have more mental health difficulties and poorer parent-child relationship quality, and no differences have been found in ART twin and singletons' psychosocial adjustment. However, studies have only examined the implications of ART twin status in families with infant and toddler aged children. STUDY DESIGN, SIZE, DURATION: A cross-sectional study of 300 6-12-year-old ART children (n = 124 twins and n = 176 singletons) from 206 families at a reproductive endocrinology clinic in the USA. PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients from one clinic with a child born between 1998 and 2004 were invited to participate in an online survey (82% recruitment rate). Participants provided information on each 6- to 12-year-old ART child in the family, and responded to questions on parent mental health, family relationships and child adjustment. MAIN RESULTS AND THE ROLE OF CHANCE: There wereno differences in parent mental health or family relationshipsin families with 6- to 12-year-old ART twins versus singletons. However, twins (M = 2.40, SE = 0.35) had significantly fewer behavior problems than singletons (M = 3.47, SE = 0.36; F(1, 201) = 4.54, b = 1.08, P, 0.05). Twins (M = 1.86, SD = 0.23) also had fewer attention problems than singletons (M = 2.64, SD = 0.23; F(1, 156) = 5.75, b = 0.78, P, 0.05). Results also suggest that full-term twins had significantly fewer attention problems (M = 1.37, SE = 0.33; F(1, 222) = 2.65, P = 0.05) than premature twins (M = 2.32, SE = 0.32, b = 0.95, P, 0.05), full-term singletons(M = 2.25,SE = 0.21,b = 0.88,P, 0.05) and premature singletons (M = 2.84,SE = 0.49,b = 1.47, P = 0.01). There werenosignificant differences between the other groups. LIMITATIONS, REASONS FOR CAUTION: Although the response rate is high (82%) and family demographics are representative of US ART patients, patients are from one US clinic. Responses also are from one family member and may be subject to social desirability biases. Additionally, our data did not include identification of monozygotic and dizygotic twins. WIDER IMPLICATIONS OF THE FINDINGS: Studies on infant and toddler ART twins suggest these families have parents with more mental health difficulties and lower parent-child relationship quality than singleton families. This study indicates the negative effects of twin status may have ameliorated by middle childhood, and twins may even have more optimum psychosocial adjustment than singletons in this developmental period. STUDY FUNDING/COMPETING INTEREST(S): This research is based on a collaborative research effort supported by University of Minnesota Agriculture Experiment Station Project Number MN-52-107, a University of Minnesota Grant-in-Aid of Research, Artistry and Scholarship grant, a University of Minnesota College of Education and Human Development Research Development Investment Grant and the M. Janice Hogan Fellowship. The authors of this article have no commercial or corporate interests to declare.

Original languageEnglish (US)
Pages (from-to)2247-2255
Number of pages9
JournalHuman Reproduction
Issue number10
StatePublished - Jan 1 2014


  • Assisted reproduction technologies
  • Family relationships
  • Mental health
  • Psychosocial adjustment
  • Twins

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