Objective: This study aims to summarize and evaluate the prenatal risk factors that may contribute to the development of cerebral palsy (CP) in twin gestations. Study Design: Observational studies examining CP in multiple gestations were identified in PubMed and systematically reviewed. The contribution of perinatal risk factors to CP and outcome discordancy were summarized. Results: The risk of co-twins both being affected by CP is approximately 10%. Multiples may experience risk factors that are unique to multifetal gestations, including birthweight discordance, twin to twin transfusion (TTTS), and co-twin demise, all of which are more common in monochorionic (MC) and/or monozygotic (MZ) gestations and have been found to increase the risk of CP in at least one co-twin. Conclusion: It is unclear whether specific risk factors or their co-occurrence contribute to discordancy more or less frequently. Many of the identified CP risk factors that are exclusive to twin gestations may co-occur. This co-occurrence of risk factors has the potential to play a role in which co-twin will ultimately develop CP in discordant sets. Epigenetic research focusing on CP is an emerging field and studies involving twins have the potential to offer insight into the etiology of CP in singletons.
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