{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T07:42:30Z","timestamp":1780904550294,"version":"3.54.1"},"reference-count":67,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2024,7,27]],"date-time":"2024-07-27T00:00:00Z","timestamp":1722038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100002301","name":"Estonian Research Council","doi-asserted-by":"publisher","award":["PRG1137"],"award-info":[{"award-number":["PRG1137"]}],"id":[{"id":"10.13039\/501100002301","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002301","name":"Estonian Research Council","doi-asserted-by":"publisher","award":["PRG2248"],"award-info":[{"award-number":["PRG2248"]}],"id":[{"id":"10.13039\/501100002301","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002301","name":"Estonian Research Council","doi-asserted-by":"publisher","award":["PSG669"],"award-info":[{"award-number":["PSG669"]}],"id":[{"id":"10.13039\/501100002301","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>STUDY QUESTION<\/jats:title>\n                  <jats:p>Do the mothers of twins and singletons differ regarding post-partum and old-age mortality?<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>SUMMARY ANSWER<\/jats:title>\n                  <jats:p>Twin deliveries were associated with higher post-partum maternal mortality than singleton deliveries, but the lifetime post-partum mortality risk was similar for mothers of twins and singletons; survival of twinners was higher than survival of the mothers of singletons after the 67th lifespan percentile.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WHAT IS KNOWN ALREADY<\/jats:title>\n                  <jats:p>Twinning is typically associated with higher post-partum maternal mortality. The evidence about whether twinning incurs long-term survival costs of reproduction or is a trait pertinent to long-lived women is scarce and contradictory.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>STUDY DESIGN, SIZE, DURATION<\/jats:title>\n                  <jats:p>The study is based on the data of the Estonian Family Register (operating from 1926 to 1943) and involves 5565 mothers of twins and 119\u00a0613 mothers of singletons born between 1850 and 1899. The subset for comparing maternal lifespans included 1703\u20131884 mothers of twins and 19\u00a0747\u201336\u00a0690 mothers of singletons.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PARTICIPANTS\/MATERIALS, SETTING, METHODS<\/jats:title>\n                  <jats:p>Post-partum maternal mortality was analyzed in the whole sample (including mothers of a single child) by logistic regression. Most of the analyses were performed in samples where each mother of twins was matched against mothers of singletons based on parity (or number of deliveries), urban versus rural and inland versus coastal origin, whether their lifespan was known, date of birth and age at first birth. Lifespans were compared in linear mixed models. Quantile regression was used to analyze age-dependent variations in maternal mortality rates. All models were adjusted for relevant biodemographic covariates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>MAIN RESULTS AND THE ROLE OF CHANCE<\/jats:title>\n                  <jats:p>The twinning rate in the whole sample was 4.4%. During the year after giving birth, maternal mortality for twin deliveries was 0.75% (17\/2273) and 0.37% (449\/122\u00a0750) for singleton deliveries (OR\u2009=\u20092.05, 95% CI\u2009=\u20091.21\u20133.23). However, the lifetime post-partum mortality risk for mothers of twins (0.51%; 28\/5557) and singletons (0.37%; 438\/119\u00a0466) did not differ significantly (OR\u2009=\u20091.38, 95% CI\u2009=\u20090.91\u20131.98). The life spans of the mothers of twins and singletons did not differ in matched samples. Past the 67th lifespan percentile, the odds of survival were significantly higher for mothers of twins than mothers of singletons, as indicated by non-overlapping 95% confidence intervals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>LIMITATIONS, REASONS FOR CAUTION<\/jats:title>\n                  <jats:p>Relatively low number of individuals (22\u00a0802\u201328\u00a0335) with known age at death in matched datasets due to discontinuation of the register after 1943.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WIDER IMPLICATIONS OF THE FINDINGS<\/jats:title>\n                  <jats:p>The finding that mothers of twins had higher odds of old-age survival than mothers of singletons is consistent with the contention that twinners represent a non-random subset of women whose robust phenotypic quality allows them to outlive the mothers of singletons in old age.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>STUDY FUNDING\/COMPETING INTEREST(S)<\/jats:title>\n                  <jats:p>The study was funded by the Estonian Research Council grants PRG1137, PRG2248, and PSG669. The authors declare no competing interests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>TRIAL REGISTRATION NUMBER<\/jats:title>\n                  <jats:p>N\/A.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/humrep\/deae166","type":"journal-article","created":{"date-parts":[[2024,7,27]],"date-time":"2024-07-27T23:40:42Z","timestamp":1722123642000},"page":"2124-2133","source":"Crossref","is-referenced-by-count":3,"title":["Mothers of twins had higher old-age survival than mothers of singletons in Estonian 19th-century birth cohorts"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2600-3002","authenticated-orcid":false,"given":"R","family":"Meitern","sequence":"first","affiliation":[{"name":"Department of Zoology, Institute of Ecology and Earth Sciences, University of Tartu , Tartu, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3191-4556","authenticated-orcid":false,"given":"M","family":"Gortfelder","sequence":"additional","affiliation":[{"name":"Estonian Institute for Population Studies, Tallinn University , Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6900-9842","authenticated-orcid":false,"given":"A","family":"Puur","sequence":"additional","affiliation":[{"name":"Estonian Institute for Population Studies, Tallinn University , Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1442-9903","authenticated-orcid":false,"given":"P","family":"H\u00f5rak","sequence":"additional","affiliation":[{"name":"Department of Zoology, Institute of Ecology and Earth Sciences, University of Tartu , Tartu, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,7,27]]},"reference":[{"key":"2024090414364799900_deae166-B1","doi-asserted-by":"crossref","first-page":"438","DOI":"10.2307\/2409420","article-title":"On the evolution of human brood size","volume":"44","author":"Anderson","year":"1990","journal-title":"Evolution"},{"key":"2024090414364799900_deae166-B2","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s10680-018-9469-1","article-title":"Parity and mortality: an examination of different explanatory mechanisms using data on biological and adoptive parents","volume":"35","author":"Barclay","year":"2019","journal-title":"Eur J Popul"},{"key":"2024090414364799900_deae166-B3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v067.i01","article-title":"Fitting linear mixed-effects models using lme4","volume":"67","author":"Bates","year":"2015","journal-title":"J Stat Soft"},{"key":"2024090414364799900_deae166-B4","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1161\/HYPERTENSIONAHA.120.14860","article-title":"Multi-fetal pregnancy, preeclampsia, and long-term cardiovascular disease","volume":"76","author":"Bergman","year":"2020","journal-title":"Hypertension"},{"key":"2024090414364799900_deae166-B5","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1162\/rest_a_00789","article-title":"Twin birth and maternal condition","volume":"101","author":"Bhalotra","year":"2019","journal-title":"Rev Economics Statistics"},{"key":"2024090414364799900_deae166-B6","doi-asserted-by":"crossref","first-page":"24672","DOI":"10.1038\/srep24672","article-title":"Reduced costs of reproduction in females mediate a shift from a male-biased to a female-biased lifespan in humans","volume":"6","author":"Bolund","year":"2016","journal-title":"Sci Rep"},{"key":"2024090414364799900_deae166-B7","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.maturitas.2019.04.213","article-title":"Female reproductive factors and the likelihood of reaching the age of 90 years. 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