Endocrinology of Small-for-Gestational-Age Children: Recent Advances

Abstract

Over recent months, the links between prenatal growth restraint and postnatal endocrinology and metabolism have been strengthened and their spectrum has been broadened. Recent progress has come from complementary angles, including the following: (1) Small for gestational age (SGA) and the human genetics of insulin-like growth factor (IGF)-I and its receptor: (a) IGF-I receptor mutations [<citeref rid="ref001">1</citeref>]; (b) single copy of IGF-I receptor gene [<citeref rid="ref002">2</citeref>]; (c) IGF-I gene polymorphisms [<citeref rid="ref003">3</citeref>]. (2) Adrenarche and polycystic ovary syndrome: (a) prenatal and postnatal weight gain: opposite effects on adrenarche in girls and boys [<citeref rid="ref004">4</citeref>]; (b) metformin therapy in low-birth-weight girls to prevent progression from precocious pubarche to polycystic ovary syndrome [<citeref rid="ref005">5</citeref>]. (3) Gynecological and pregnancy complications in women born SGA: (a) hypergonadotropinaemia and small uterus-ovaries [<citeref rid="ref006">6</citeref>]; (b) identification of low maternal birth weight as a risk factor for: (i) gestational diabetes, (ii) pregnancy-induced hypertension (with SGA offspring) [<citeref rid="ref007">7</citeref>, <citeref rid="ref008">8</citeref>]. (4) Growth hormone (GH) therapy for short children born SGA: (a) efficacy of long-term, continuous GH therapy [<citeref rid="ref009">9</citeref>]; (b) normal puberty in short GH-treated SGA children [<citeref rid="ref010">10</citeref>]. Our knowledge of SGA and post-SGA endocrinology and metabolism continues to expand swiftly. Children born SGA may continue to experience SGA consequences or correlates, and SGA adults may confer intergenerational SGA risk. Given the dynamics of this research frontier, it is anticipated that multiple facets of GH therapy in short SGA children will regularly be challenged in the future. May those questions be welcomed and may their responses ultimately lead to optimal GH regimens that benefit not only SGA children themselves but also, in due course, their progeny.