Twins experience impaired pre-natal and post-natal growth and are often born pre-term, with low birth weight (<2500 g) and are commonly associated with weight discordance- birth weight difference of 15 % or more which is the difference of weight of larger twin from the smaller one1.
When compared to singletons, twins are at an increased risk for2
- IUGR - intrauterine growth restriction
- gestational complications
- preterm birth
- chromosomal abnormalities
- congenital malformations
- perinatal mortality and morbidity.

Twins experience altered pre-natal and post-natal growth as compared to singletons. Due to low birth weight, many are considered small for gestational age (SGA) as compared to singletons, however they show a catch -up growth after birth5.
It is important to note that singleton reference values may not correctly indicate the growth of twins.7
References:
- Atoof F, Eshraghian MR, Mohammad K, Moravveji A, Sharif MR, Mahmoodi M. Two-Year Comparison of Growth Indices of Twins with Dissimilar Weight at Birth (Low Birth Weight vs. Normal Twin).&Iran J Public Health. 2015;44(7):969-978.
- Puccio G, Giuffré M, Piccione M, Piro E, Malerba V, Corsello G. Intrauterine growth pattern and birthweight discordance in twin pregnancies: a retrospective study.&Ital J Pediatr. 2014;40:43. Published 2014 May 5. doi:10.1186/1824-7288-40-43
- Buckler JM, Green M. A comparison of the early growth of twins and singletons.&Ann Hum Biol. 2004;31(3):311-332. doi:10.1080/03014460410001670120
- Liotto N, Roggero P, Giuliani F, et al. How does gestational age affect growth and body composition of preterm twins?.&Pediatr Res. 2020;87(1):57-61. doi:10.1038/s41390-019- 0530-5
- van Dommelen P, de Gunst M, van der Vaart A, van Buuren S, Boomsma D. Growth references for height, weight and body mass index of twins aged 0-2.5 years.&Acta Paediatr. 2008;97(8):1099-1104. doi:10.1111/j.1651-2227.2008.00853.x
- Jelenkovic A, Yokoyama Y, Sund R, et al. Associations between birth size and later height from infancy through adulthood: An individual based pooled analysis of 28 twin cohorts participating in the CODATwins project.&Early Hum Dev. 2018;120:53-60. doi:10.1016/j.earlhumdev.2018.04.004
- Buckler JM, Green M. A comparison of the early growth of twins and singletons. Ann Hum Biol. 2004 May-Jun;31(3):311-32. doi: 10.1080/03014460410001670120. PMID: 15204347
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