Abstract
BackgroundSelective intrauterine fetal growth restriction (sIUGR) in monochorionic diamniotic twins, especially types 2&3 with abnormal umbilical artery Doppler, results in increased risk of fetal/perinatal mortality and postnatal disability. We investigate whether the hair metabolome profiles of neonates were associated with the pathophysiological differences across the different clinical forms of sIUGR in twins.MethodsHair samples were collected at delivery from 10 pairs of type 1 sIUGR twins, 8 pairs of types 2&3 sIUGR twins, and 11 pairs of twins without sIUGR. The hair metabolome was characterized using gas chromatography-mass spectrometry.ResultsOur results demonstrated that the hair metabolite profiles of the different sIUGR subclinical forms were associated with the averaged fetal growth rate after 28 weeks of gestation but not with birthweight. The hair profiles were capable of discriminating type2&3 sIUGR twins from twins without sIUGR. In particular, the metabolites 2-aminobutyric acid, cysteine, alanine, and tyrosine all displayed areas under the receiver operating characteristic curve were above 0.9. The metabolic pathway analysis highlighted the associations of sIUGR twins with abnormal umbilical artery flow with increased metabolites from a nutrient depletion pathway, glutathione metabolism, and nerve development.ConclusionThis study offers novel insight into the severity of intrauterine ischemia and hypoxia for T2&3 sIUGR twins, through evaluation of the neonatal hair metabolome.
Highlights
Selective intrauterine fetal growth restriction in monochorionic diamniotic twins, especially types 2&3 with abnormal umbilical artery Doppler, results in increased risk of fetal/perinatal mortality and postnatal disability
Our metabolomic study was designed to differentiate metabolite differences in the neonatal hair metabolome associated with the intrauterine environmental perturbation resulting from abnormal Umbilical artery flow (UAF)
The neonatal hair profile revealed a phenotype of abnormal UAF in twins which included a positive relationship with fetal growth velocity among T1&2&3 Selective intrauterine fetal growth restriction (sIUGR) twin pairs
Summary
Selective intrauterine fetal growth restriction (sIUGR) in monochorionic diamniotic twins, especially types 2&3 with abnormal umbilical artery Doppler, results in increased risk of fetal/perinatal mortality and postnatal disability. The incidence of twin pregnancies is rising significantly. The main reasons for the noticeable rise in twin pregnancies is the increase in delayed childbirth resulting in advanced maternal age at conception, and increased use of assisted reproduction techniques (Multiple pregnancy 2011). Twin pregnancies suffer from a greater incidence of maternal and fetal complications (ACOG Practice Bulletin No 144 2014; DeJesus Allison et al 2012). There is an estimated fivefold increase in fetal mortality and a seven-fold increase in neonatal death compared with singletons, which is primarily due to complications of prematurity. Unequal sharing of the placental and vascular communications between twins leads to a significantly higher risk of various complications in monochorionic (MC) twins compared to dichorionic (DC) twins (Hack et al 2008a; Southwest Thames Obstetric Research C 2012)
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