Differences between the events preceding spina bifida and anencephaly

Abstract

It is usually held that there is a time continuum in the formation of monozygotic (MZ) twins which is indexed by their placentation, running from dichorionic to monochorionic diamniotic to monochrorionic monoamniotic and conjoined pairs. There is good evidence that this continuum is characterised by a continuum of predisposition to anencephaly, slightly raised in dichorionic pairs but very high in some sorts of conjoined pairs. Although MZ twins, especially monoamniotic and conjoined pairs, are peculiarly liable to anencephaly, they are not particularly susceptible to spina bifida. Among twin pairs concordant for anencephaly or spina bifida, there are strikingly few concordant in the sense of one twin having anencephaly and the other spina bifida, in contrast with the numbers of pairs concordant for the same malformation. The prevalence of anencephaly in double monster varies with the type of monster, being high in diprosopus. The findings may be explained by the timing of embryonic events.