Parents of twins report more mental health symptoms than parents of singletons

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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 counselling and preparation of infertile couples for twins," Dr Leila Unkila Kallio told the conference. "The good mental health during pregnancy may also reflect the couples' satisfaction with successful treatment and fulfilment of hopes for parenthood," she added. After birth, fathers of twins in both groups showed more depression, anxiety, social dysfunction and sleeping problems than did 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 well-being 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 is 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, who is a senior consultant in gynaecology and obstetrics at Helsinki University Central Hospital, Helsinki (Finland).

Dr Unkila Kallio and her colleagues 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, when the children were two months old and when they were one year old. Depressive symptoms, anxiety, sleeping difficulties and social dysfunction were measured using the General Health Questionnaire (GHQ36). Mothers and fathers separately had to indicate how much their present state was like or unlike their normal state for a range of symptoms on a scale of 1 to 4 (1 = not at all; 2 = same as usual; 3 = rather more than usual; 4 = much more than usual). The researchers measured differences in the way the symptoms varied between the groups.

During pregnancy, they found that ART mothers of twins had lower mean averages of depressive symptoms than the control mothers of twins (1.18 versus 1.34) but similar levels to the ART and control mothers of singletons (1.14 and 1.26, respectively). 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 (1.30 and 1.34) and anxiety (1.60 and 1.67) than did the mothers of singletons in both groups (1.19 and 1.23 for depression in ART and control mothers, and 1.45 and 1.47 for anxiety).

ART fathers of two-month old twins, had higher mean averages of depressive symptoms than ART fathers of singletons (1.26 vs 1.22) but their scores were comparable to those of control fathers, which were 1.37 for twins and 1.26 for singletons. "Furthermore, fathers of two-month old twins in both ART and control groups reported significantly more impaired social dysfunction than fathers of singletons," said Dr Unkila Kallio. At one 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.

"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. "Concerning fathers, 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 counselling 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, although mothers do participate in maternity clinics services and so may be better counselled and supported," said Dr Unkila Kallio.

"During pregnancy, the fathers had similar mental health in all groups. Being the father of newborn and one-year old twins, irrespective of ART, was associated first with higher averages of depressive symptoms and social dysfunction, later also to sleeping difficulties and anxiety symptoms when compared to singletons. Becoming a father means a big change in man's internal world and in relations to others. Transition to parenthood may be demanding for fathers and especially so for fathers of twins. They often have to bear economical responsibility for the family, as well as responsibility to be more available and to participate in infant care. Fathers usually experience less social support than mothers, and may have difficulties in coping with these increasing demands."

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."

European Society for Human Reproduction and Embryology