Twin registers are wonderful research resources for research applications in medical and behavioral genetics, epidemiology, psychology, molecular genetics, and other areas of research. New registers continue to be launched all over the world as researchers from different disciplines recognize the potential to boost and widen their research agenda. In this article, we discuss multiple aspects that need to be taken into account when initiating a register, from its preliminary sketch to its actual development. This encompasses aspects related to the strategic planning and key elements of research designs, promotion and management of a twin register, including recruitment and retaining of twins and family members of twins, phenotyping, database organization, and collaborations between registers. We also present information on questions unique to twin registers and twin-biobanks, such as the assessment of zygosity by SNP arrays, the design of (biomarker) studies involving related participants, and the analyses of clustered data. Altogether, we provide a number of basic guidelines and recommendations for reflection when planning a twin register.

All same-sex dizygotic (DZ) twins and approximately one-third of monozygotic (MZ) twin pairs have separate placentas, making it impossible to use the number of placentas to determine zygosity. Zygosity determination is further complicated because incorrect assumptions are often made, such as that only DZ pairs have two placentas and that all MZ pairs are phenotypically identical. These assumptions, by twins, their families and health professionals, along with the lack of universal zygosity testing for same-sex twins, has led to confusion within the twin community, yet little research has been conducted with twins about their understanding and assumptions about zygosity. We aimed to explore and quantify understanding and assumptions about zygosity using twins attending an Australian twin festival. We recruited 91 twin pairs younger than 18 years of age and their parents, and 30 adult twin pairs who were all uncertain of their zygosity, to complete one pen and paper questionnaire and one online questionnaire about their assumed zygosity, reasons for their assumptions and the importance of accurate zygosity knowledge. Responses were compared with their true zygosity measured using a genetic test. We found a substantial proportion of parents and twins had been misinformed by their own parents or medical professionals, and that knowledge of their true zygosity status provided peace of mind and positive emotional responses. For these reasons we propose universal zygosity testing of same-sex twins as early in life as possible and an increase in education of medical professionals, twins and families of twins about zygosity issues.

Determining valid zygosity is a basic and important requirement in a twin study, because misdiagnosing zygosity leads to biased results. The Healthy Twin Study has collected data from adult like-sex twins and their families since 2005. In the study, a questionnaire to determine zygosity was developed comprising four questions; one concerning the degree of resemblance, and three concerning the degree of confusion by the resemblance. Among 2,761 individuals (624 twin pairs) of twin and their families, 406 pairs of twins (mean age 38.3, 63.5% women) with both questionnaire and genotype information were selected to examine the validity of the zygosity questionnaire using 16 short tandem repeat markers. We first determined individual zygosity including undetermined category, and then decided the zygosity of a twin pair using a decision tree. Sensitivity of questionnaire diagnosis was 98.8% for monozygotic (MZ) and 88.9% for dizygotic (DZ) twins, and positive predictive value was 97.2% for MZ and 95.0% for DZ. When we compared correctly and wrongly diagnosed twin pairs, misdiagnosed DZ twins (nine pairs) showed striking similarity in stature or obesity even exceeding that of true MZ twins. Our finding suggests that a parsimonious questionnaire method of diagnosing the zygosity will be useful, and adding physical or physiological measurements to a questionnaire of zygosity diagnosis will either confound the correct diagnosis or reduce the efficiency of the study compared with using questionnaire alone or with introducing genotyping.

In twin pregnancy studies, molecular genetic techniques have rarely been used to determine zygosity, despite their known precision and accuracy. The present work aimed to assess the power of discrimination in zygosity assessment, using a set of microsatellite markers that were routinely used for aneuploidy screening by multiplex-PCR in a prenatal context. Rapid aneuploidy screening using a group of 20 microsatellite markers (STRs) located on chromosomes 13, 18, 21 and X has been performed in our lab for over 10 years, with a total of approximately 1,500 samples studied to date. A retrospective analysis of the 257 prenatal samples from multiple pregnancies was carried out. A subset of 14 cases presenting theoretical monozygosity were re-evaluated by the use of biostatistics tools accessed via the ZygProb website. Further monozygosity determination relative to dizygosity was calculated, given an estimated overall error value of 0.093%. The results show that monozygosity had been correctly determined in all our previously studied twins. This work demonstrates that accurate zygosity assessment can be achieved with the same STRs applied in aneuploidy screening with a high power of discrimination and a matching probability of over 99.999999%.

It is generally held that there are genetic factors for dizygotic (DZ) twinning, but the pattern of inheritance is far from clear.

We report on a rare pedigree with three sets of spontaneous DZ female twin births in three successive generations. To our knowledge no similar pedigrees have been reported in literature.

Zygosity determination in three pairs of twins was performed with ABO, MN and Rh blood groups from erythrocytes and with STR analysys from samples of saliva.

In our pedigree, the direct trasmission of the DZ twinning through the maternal line seems show an autosomal dominant pattern of inheritance. We believe that the inheritance of DZ twinning appears to be recessive in most case and autosomal dominant only in rare instances. It is plausible with the hypothesis that the expression of the dizygotic twinning trait in a mother shows a genetic heterogeneity.

Precision of zygosity determination in twins can be improved by the use of modern methods of DNA analysis. The clinical application of 4 single- (SLS) and 2 multi-locus (MLS), and 6 PCR (polymerase chain reaction) systems for zygosity determination in 12 twin pairs with oral clefts was compared with regard to the quality and quantity of sample material required and the probability of error in monozygosity determination. PCR systems proved to be superior to SLS or MLS, as DNA sampling is much more convenient, while its level of accuracy still fulfils clinical requirements. For this reason, PCR systems should be considered a basic method in modern clinical twin research.

Most population studies of twins estimate the number of monozygotic (MZ) and dizygotic (DZ) pairs by Weinberg's differential rule. This rule assumes that within the DZ twins the numbers of unlike-sexed (U) and like-sexed (L) twins are equal. The literature on the validity of Weinberg's rule is still controversial. In this prospective population-based study (EFPTS) of 2,589 twin pairs, of whom 2,577 were of known zygosity and placentation, the estimates of Weinberg's rule agree well with the results of direct zygosity determination.

Recent clinical literature on the causes of twin pregnancy and specific areas of antenatal care are reviewed. Controversial aspects of clinical management are discussed.

For 173 pairs of like-sex adult twins, self-assessment of zygosity was verified by laboratory diagnosis. Seventeen percent of twins who were very likely monozygous (MZ) believed themselves dizygous (DZ), frequently citing two placentas at their delivery as “evidence.” We suggest that twins be asked what leads them to their assessment of their own zygosity. For 93% of Caucasian and 89% of American Black like-sex twins in our sample, DZ twins could be differentiated based on six polymorphic markers retrievable from frozen sera. MZ twins who believe themselves DZ can be considered “environmentally DZ, genetically MZ” twins, and might be used to study genetic and environmental influences on the treatment of twins and on twins' choices of social characteristics.

Following previous formulations of a model of qualitative analysis of twin population data independent of zygosity, a new Bayesian approach has been developed. The present model can be applied to any qualitative genetic trait in twin population data, provided no specific source of variation be introduced by the twin condition, and allows not only estimation of the frequencies of mono- and dizygosity as well as the gene frequencies, but also verification of the trait's mode of inheritance.

The Budapest Twin Register recorded 88.6% of the 1739 multiple births that occurred between 1970 and 1974. Of these, 31.2% were male-female pairs. Based on the examination of the placenta (19.8% monochorial) and of genetic markers, 406 pairs proved to be monozygotic and 645 dizygotic. Sex ratio of twins at birth showed a female preponderance (1000 F: 1009 M) in comparison to singletons (1000 F: 1071 M). Average birth weight of the twins was 2101 g. The frequency of stillbirths was about four times higher in twins than in singletons, twice as high in monozygotic than in dizygotic twins, and 2.4 times higher among second than first-born twins.