Skip to main content

Couples’ psychological adjustment to twin parenthood: mode of conception (spontaneous versus assisted reproduction) and gender differences

  • Iva Tendais (a1), Bárbara Figueiredo (a1), Catarina Canário (a1) and David A. Kenny (a2)

To examine whether mode of conception and gender are associated with parents’ psychological adjustment across the transition to twin parenthood.


There is limited knowledge on the psychological adjustment of couples to twin parenthood during pregnancy and early postpartum, especially for fathers. The available research suggests that first-time mothers of twins conceived by assisted reproduction techniques (ART) may experience lower psychosocial well-being than mothers of spontaneously conceived (SC) twins.


A total of 41 couples expecting twins, 25 of whom conceived spontaneously and 16 conceived by assisted reproduction techniques, completed measures of depressive and anxiety symptoms, marital relationship, attitudes to sex, and attitudes to pregnancy and the baby.


ART parents showed a decline in marital relationship quality, no changes in attitudes to pregnancy and the baby and no changes in attitudes to sex over the postpartum. In contrast, SC parents did not change their perception of the marital relationship, reported more positive attitudes to pregnancy and the baby, and more positive attitudes to sex over the postpartum. Compared with the other groups (SC mothers and fathers, ART fathers), ART mothers exhibited a higher increase in depressive and anxiety symptoms from pregnancy to postpartum and only anxiety symptoms exhibited a decline trend over the postpartum. These findings suggest that ART parents may experience more psychological difficulties during the transition to twin parenthood than SC parents. ART mothers, in particular, appear to be more at risk of high levels of postpartum depressive symptoms.

Corresponding author
Author for correspondence: Iva Tendais, School of Psychology, Department of Applied Psychology, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal. E-mail:
Hide All

Present address: Epidemiology Research Unit, Instituto de Saúde Pública, Universidade do Porto, Faculdade de Medicina, Rua das Taipas no. 135, 4050-600 Porto, Portugal.


Present address: Faculdade de Psicologia e Ciências da Educação, Universidade do Porto, Portugal.

Hide All
Baor, L, Bar-David, J Blickstein, I (2004) Psychosocial resource depletion of parents of twins after assisted versus spontaneous reproduction. International Journal of Fertility and Women’s Medicine 49, 1318.
Baor, L Soskolne, V (2010) Mothers of IVF and spontaneously conceived twins: a comparison of prenatal maternal expectations, coping resources and maternal stress. Human Reproduction 25, 14901496.
Beck, CT (2002) Releasing the pause button: mothering twins during the first year of life. Qualitative Health Research 12, 593608.
Blondel, B, Kogan, MD, Alexander, GR, Dettani, N, Kramer, MS Macfarlane, A (2002) The impact of the increasing number of multiple births on the rates of preterm birth and low birthweight: an international study. American Journal of Public Health 92, 13231330.
Child, TJ, Henderson, AM Tan, SL (2004) The desire for multiple pregnancy in male and female infertility patients. Human Reproduction 19, 558561.
Choi, Y, Bishai, D Minkovitz, CS (2009) Multiple births are a risk factor for postpartum maternal depressive symptoms. Pediatrics 123, 11471154.
Colpin, H, Munter, AD, Nys, K Vandemeulebroecke, L (1999) Parenting stress and psychosocial well-being among parents with twins conceived naturally or by reproductive technology. Human Reproduction 14, 31333137.
Cox, JL, Holden, JM Sagovsky, R (1987) Detection of postnatal depression: development of the Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150, 782786.
Ellison, MA Hall, JE (2003) Social stigma and compounded losses: quality-of-life issues for multiple-birth families. Fertility and Sterility 80, 405414.
Figueiredo, B, Mendonça, M Sousa, R (2004) Versão portuguesa do Maternal Adjustment and Maternal Attitudes (MAMA) [Portuguese version of the maternal adjustment and maternal attitudes (MAMA)]. Psicologia, Saúde & Doenças 5, 3151.
Hammarberg, K, Fisher, JR Wynter, KH (2008) Psychological and social aspects of pregnancy, childbirth and early parenting after assisted conception: a systematic review. Human Reproduction Update 14, 395414.
Hjelmstedt, A, Widström, A-M, Wramsby, H Collins, A (2004) Emotional adaptation following successful in vitro fertilization. Fertility and Sterility 81, 12541264.
Kalland, M, Fagerlund, Å, von Koskull, M Pajulo, M (2016) Families First: the development of a new mentalization-based group intervention for first-time parents to promote child development and family health. Primary Health Care Research & Development 17, 317.
Kashy, DA, Donnellan, MB, Burt, SA McGue, M (2008) Growth curve models for indistinguishable dyads using multilevel modeling and structural equation modeling: the case of adolescent twins’ conflict with their mothers. Developmental Psychology 44, 316329.
Kenny, DA, Kashy, DA Cook, WL (2006) Dyadic data analysis. New York: The Guilford Press.
Kumar, R, Robson, KM Smith, MR (1984) Development of a self-administered questionnaire to measure maternal adjustment and maternal attitudes during pregnancy and after delivery. Journal of Psychosomatic Research 28, 4351.
Lorenz, JM (2012) Neurodevelopmental outcomes of twins. Seminars in Perinatology 36, 201212.
McMahon, CA, Tennant, C, Ungerer, J Saunders, D (1999) ‘Don’t count your chickens’: a comparative study of the experience of pregnancy after IVF conception. Journal of Reproductive and Infant Psychology 17, 345356.
Munro, JM, Ironside, W Smith, GC (1990) Psychiatric morbidity in parents of twins born after in vitro fertilization (IVF) techniques. Journal of In Vitro Fertilization and Embryo Transfer 7, 332336.
Pinto, TM, Figueiredo, B, Samorinha, C, Tendais, I Nunes-Costa, R (2017) Paternal adjustment and paternal attitudes questionnaire: antenatal and postnatal Portuguese versions. Assessment 24, 820830.
Pinto, TM, Samorinha, C, Tendais, I, Silva, S Figueiredo, B (2018) Antenatal paternal adjustment and paternal attitudes after infertility treatment. Human Reproduction 33, 109115.
Spielberger, CD, Gorsuch, RL Lushene, RE (1983) The State-Trait Anxiety Inventory: test manual. Palo Alto, CA: Consulting Psychologists Press.
Stein, A, Pearson, RM, Goodman, SH, Rapa, E, Rahman, A, McCallum, M, Howard, LM Pariante, CM (2014) Effects of perinatal mental disorders on the fetus and child. Lancet 15, 18001819.
Tendais, I, Costa, R, Conde, A Figueiredo, B (2014) Screening for depression and anxiety disorders from pregnancy to postpartum with the EPDS and STAI. The Spanish Journal of Psychology 17, E7.
Tendais, I Figueiredo, B (2016) Parents’ anxiety and depression symptoms after successful infertility treatment and spontaneous conception: does singleton/twin pregnancy matter? Human Reproduction 31, 23032312.
Vilska, S, Unkila-Kallio, L, Punamäki, RL, Poikkeus, P, Repokari, L, Sinkkonen, J, Tiitinen, A Tulppala, M (2009) Mental health of mothers and fathers of twins conceived via assisted reproduction treatment: a 1-year prospective study. Human Reproduction 4, 367377.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed