| E1. Colpin, Munter, Nys, Vandemeulebroeck(2000) Belgium.23
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Objective: to study the pre- and postnatal determining factors of parenting stress. Participants: women expecting twins (n=40). Design: prospective cohort. Data collection: 27 pregnancy weeks and 1 year after birth. Results: personal well-being and the prenatal support of the spouse were predictors of stress in women one year after birth. |
| E2. Ellison, Hall (2003) United States.24
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Objective: to identify the areas of the quality of life of mothers which showed the greatest impact due to the birth of twins. Participants: women with: 1 - one child per conception (n=10), 2 - twins with low risk at birth (n=12), ages between 4 and 5 or 9 and 10 years old, 3 - twins with high risk at birth with ages between 1 and 5 (n=11), 4 - one child (n=4) or twins (n=6) conceived via medically assisted conception (MAC) with ages between 8 months and 11 years old. Design: focal group, discussion points: stress and family needs, social support, health of the children, marital satisfaction and impact on the self of the woman. Results: birth had higher impact on: marital satisfaction, family needs, stress and maternal depression. Almost all areas of quality of life were more affected for mothers of twins. |
| E3. Tully, Moffit, Caspi (2003) United Kingdom.25
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Objective: to compare parental adjustment, parenthood and the behavior of children of families with different types of conception. Participants: mothers, twins, and professors of these conceived by in vitro fertilization (IVF) or ovary induction (OI) (n=121) and naturally (n=121). Design: cross-sectional. Data collection: when the twins were 5 years old. Results: no significant differences were identified between the groups, with the exception of parent behavior. The mothers who conceived naturally revealed higher inconsistency with regard to discipline. |
| E4. Glazebrook, Sheard, Cox, Oates, Ndukwe (2004) United Kingdom.26
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Objective: to analyze parental stress and psychosocial well-being of primiparous women who conceived multiples by IVF. Participants: primiparous women in 18th week of pregnancy: 1 - simple pregnancy by IVF (n=95), 2 - twin pregnancy by IVF (n=36), 3 - simple pregnancy by natural conception (n=129). Design: Prospective cohort. Data collection: 18th week of pregnancy, 6 weeks and 12 months after labor. Children who were born of twin pregnancy weighed less at birth, were more preterm, and remained on average more days in the hospital. Women with twin children presented higher values of parental stress; however, parental stress was considered abnormally high in all three groups. Women who were mothers of twins were less satisfied with their work outside of home and worked fewer hours. |
| E5. Ellison, Hotamisligil, Lee, Rich-Edwards, Pang, Hall (2005) United States.27
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Objective: to determine if psychosocial risks in families that conceived via MAC were associated with the number of children per pregnancy. Participants: women who conceived after MAC: 1 - one child (n=128), 2 - twins (n=111), 3 - triplets (n=10). Design: cross-sectional. Data collection: 12 and 48 months after labor. Results: the birth of multiples increased psychosocial risks and was associated with needs of families, decrease in quality of life, social stigma, and maternal depression. |
| E6. Olivennes, Golombok, Ramogida, Rust and Follow-up team (2005) United Kingdom.28
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Objective: to establish the nature and scope of the difficulties of parents and the development of twins conceived by resorting to MAC.
Participants: mother and child(ren) conceived via MAC: 1 - one child (n=344), 2 - twin children (n=344). Design: cross-sectional. Data collection: children between 2 and 5 years old. Results: the percentage of mothers with twins with paid work was lower; they had more parental stress and depression; they had more difficulty and less pleasure in their relationships with their children; and they were less willing to have more children. No differences were noted in marital satisfaction and sexual interest, but sexual activity was less frequent in mothers of twins. Twins had lower scores in language, fine motor adaptive skills, and social interaction. |
| E7. Findler, Taubman-Ben-Ari, Jacob (2007) Israel.29
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Objective: to analyze the contributions to the temper of the baby, attachment to the mother, and support of the maternal grandmother in mental health and marital adaptation of women. Participants: Mothers of twins: 1 - term babies (n=78), 2 - preterm (n=70). Design: prospective cohort. Data collection: 3 weeks and one year after hospital discharge. Results: the mental health of the mothers was associated with lower levels of stress, anxiety in the attachment and good marital adaptation. The primiparous mothers of term twins showed better mental health than the ones who already had children or who had preterm twins. The support of the maternal grandmother promoted training to help the mother to deal with the temper of the children, and it was a more significant contributing factor in preterm situations. |
| E8. Golombok, Olivennes, Ramogida, Rust, Freeman and follow-up team. (2007) United Kingdom/France.30
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Objective: to understand the difficulties of parenthood focusing on the psychological and social-emotional well-being of the parents and on the development of triplets who were born after IVF/intracytoplasmic sperm injection (ICSI). Participants: Mothers and children in families with children conceived via IVF/ICSI: 1 - one child (n=30), 2 - twin children (n=15), 3 - triplets (n=10). Design: cross-sectional. Data collection: children between 2 and 3 years old. Results: women who had more than one child per pregnancy showed higher levels of parental stress, and mothers of multiples reported lower frequency of sexual relations. Twins and triplets also had lower scores in language. |
| E9. Sheard, Cox, Oates, Ndukwe Glazebrook (2007) United Kingdom.31
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Objective: to explore the impact of the birth of multiples via IVF on the mental health of the mother. Participants: primiparous women who conceived via IVF: 1 - one child per conception (n=119), 2 - twins (n=49), 3 - triplets (n=7). Design: cross-sectional. Data collection: 6 weeks after birth. Results: children in multiple births weighed less at birth, were more preterm and remained on average more days at the hospital. A strong correlation was observed between the temper of the children and depression, and depression was also higher in mothers of multiples after labor. The mothers of multiples more often reported problems with topics such as being tired, stressed and depressed. The mothers who conceived an only child spoke more of how well they felt. |
| E10. Sydjo, Wadsby, Sydsjo, Selling (2008) Sweden.32
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Objective: to analyze the differences in marital relations and in parenthood in primiparous couples. Participants: 1 - Mothers (n=86) and fathers (n=79) of one child, 2 - mothers (n=13) and fathers (n=13) of twins conceived by IVF and 3 - mothers (n=157) and fathers (n=144) of one child conceived naturally. Design: cross-sectional. Data collection: 5 years after birth. Results: only in families of twins were no more children born. The largest decrease between the two assessments took place in parents of twins. Considering the subscales, the significant differences between the groups were: for men, sexual relations and parenthood; for women, sexual relations, parenthood, conflict resolution, equality of roles, and life conception. |
| E11. Taubman-Ben-Ari, Findler, Bendet, Stanger, Ben-Shlomo, Kuint (2008) Israel.33
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Objective: to examine the contribution of psychological and social factors in the marital adaptation to the birth of twins. Participants: Mothers of: 1 - twins (n=88), 2 - one child per conception (n=82). Design: cross-sectional integrated to a cohort study. Data collection: one month after birth. Results: for marital adaptation, there was a contribution of: good financial situation; primiparous; less stress, anxiety and avoidance in the attachment; and support of the grandparents. Negatively correlated were the difficulties that the mother had with the temper of the child(ren), considering it difficult. |
| E12. Damato, Anthony, Maloni (2009) United States.34
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Objective: to determine the relationship between parental stress, social support and sense of competence, and the mood of mothers with twins. Participants: mothers of twins (n=162). Design: cross-sectional. Data collection: in the 2 first years after birth. Results: competence and parental anguish were related to maternal mood. Low parent competence was associated with negative mood, less anguish and higher parent competence to positive mood. |
| E13. Choi, Bishai, Minkovitz (2009) United States.35
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Objective: to assess the relationship between the birth of multiples and symptoms of depression in mothers. Participants: Mothers of: 1 - one child (n=7293), 2 - more than one child (n=776) by conception. Design: cross-sectional integrated to a longitudinal study. Data collection: 9 months after birth. Results: mothers of multiples were more prone to symptoms of depression, parental being stress regarded as one of the main causes. |
| E14. Vilska, Unkila-Kallio, Punamäki, Poikkeus, Repokari, Sinkkonen, Tiitinen, Tulppala (2009) Finland.36
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Objective: to assess the mental health of fathers and mothers of twins. Participants: couples who conceived: 1 - one child (n=270), 2 - twins (n=55) by MAC, 3 - one child (n=251), 4 - twins (n=11) naturally. Design: prospective cohort. Data collection: 2nd quarter of pregnancy, 2 months and 1 year after birth. Results: women who conceived via MAC had fewer symptoms of depression during pregnancy. Mothers and fathers of twins, 2 months after birth, had higher levels of anxiety and depression that were sustained one year after birth, but mothers of twins conceived via MAC had fewer symptoms of anxiety than other mothers of twins. Sleep difficulties as well as social dysfunction were more common in parents of twins. |
| E15. Baor, Soskolne (2010) Israel.37
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Objective: to assess stress in primiparous mothers of twins considering prenatal expectations and coping mechanisms. Participants: mothers of twins who conceived: 1 - naturally (n=98), 2 - with IVF (n=88). Design: prospective cohort. Data collection: between the 33rd and 36th week of pregnancy and 6 months after birth. Results: the rate of C-sections was higher in twin conceptions by IVF, the babies were preterm, with lower weight and more neonatal complications. Women who conceived via IVF had more positive prenatal expectations, poorer coping mechanisms and higher levels of stress 6 months after birth. The mother’s expectations did not have the power to predict the mother’s stress. |
| E16. Taubman-Bem-Ari, Findler, Kuint (2010) Israel.38
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Objective: to examine the factors that contributed to personal growth of mothers after the birth of preterm twins. Participants: mothers of: 1 - one term child (n=75), 2 - term twins (n=72), 3 - preterm twins (n=64). Design: prospective cohort. Data collection: first weeks and 1 year after birth. Results: mothers of preterm twins were subjected to higher stress, had worse mental health, noticed the temper of the children as more difficult, showed more negative feelings about their children and received more support from their mothers. However, they experienced higher personal growth and this was positively associated with marital adaptation. In the other two groups, personal growth was associated with the perceived support of the maternal grandmother. |
| E17. Bolch, Davis, Umstad, Fisher (2012) Australia.39
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Objective: to investigate the experiences of mothers with twin children with special needs. Participants: mothers with twins between 12 months and 6 years old with a history of admissions to the Neonatal Intensive Care Unit (NICU) (n=10). Design: thematic analysis. Data collection: interview. Results: they expressed concern with the difficulties of having more than one child and with their health needs. They reported practical and psychological problems. |
| E18. Baor, Soskolne (2012) Israel.40
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Objective: to assess levels of maternal stress after the birth of twins considering social resources. Participants: mothers of twins conceived via IVF (n=88). Design: prospective cohort. Data collection: 3rd trimester of pregnancy, 6 months after birth. Results: clinical levels of maternal stress were identified in 41% of the sample. Social support and professional activity were more significant in the experience of maternal stress. |
| E19. Lutz, Burnson, Hane, Samuelson, Maleck, Poehlmann (2012) United States.41
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Objective: to assess the influence of family support on maternal stress.
Participants: mothers with preterm children: 1 - one child per conception (n=123), 2 - twins (n=27). Design: prospective cohort. Data collection: 3rd trimester of pregnancy, 24 months after birth. Results: only functional support resulted in a factor of protection. The mothers of twins reported higher stress levels. |
