Intrapair Birth Weight Difference Research Articles

The Association of Intrapair Birth-Weight Differences With Internalizing and Externalizing Behavior Problems

Problem behaviors are of increasing public health concern. Twin studies have revealed substantial genetic and environmental influences on children's behavior, and examining birth-weight difference could allow the identification of the specific contribution of multiple non-shared prenatal environmental factors. The Twins and Multiple Births Association Heritability Study, a UK, volunteer-based study, recruited mothers of twins aged 18 months to 5 years; 960 twins (480 pairs) were included in the analysis. Twins' mothers answered questions relative to their pregnancy and their twins' characteristics, and completed the Child Behavior Checklist (CBCL) 1½-5. The association between the absolute birth-weight difference and each CBCL scale's score difference was analyzed by means of multiple linear regressions. Expected mean CBCL score differences were calculated. In monozygotic (MZ) twins, statistically and clinically significant associations were found between intrapair birth-weight difference and difference in total problems, internalizing problems, and emotional reactiveness. No significant results were observed neither in dizygotic (DZ) twins when analyzed as a separate group nor in MZ and DZ twins combined. The results of the present study suggest that with increasing the absolute birth-weight difference, the intrapair difference in total problems, internalizing behaviors and emotionality increases, with smaller twins being at major risk for later behavior problems. Moreover, these results suggest a causal association between birth weight and behavior development.

Intrauterine growth characteristics of twins and those twins discordant birthweight

To investigate the intrauterine growth characteristics of twins and birthweight discordant twins (discordant twins). Total of 1010 twin pregnancies (2020 fetuses) with complete delivery records from the Department of Obstetrics and Gynecology, the First and Third Affiliated Hospital of SUN Yat-sen University between January 1, 2000 and July 31, 2010 were studied retrospectively. One handred and ninteen cases (238 fetuses) with intrapair birthweight difference ≥ 25% were determined as the discordant twins group, and the other 891 cases (1782 fetuses) with intrapair birthweight difference < 25% were identified as the concordant twins group. The singleton control group included 4042 singleton pregnancies in the same period. (1) Comparison of clinical data between the twins groups: the birthweight of larger-twin, smaller-twin and intrapair birthweight difference in the discordant twins group and the concordant twins group were (2090 ± 827) g, (1392 ± 592) g, (33.9 ± 9.3)%, and (2408 ± 543) g, (2191 ± 505) g, (8.9 ± 6.5)%, respectively, with significant differences (P < 0.01). The incidence of discordant twins was 11.78% (119/1010). Compared with the concordant twins group, the discordant twins group had higher proportion of monochorionic twins, and higher prevalence of pregnancy complications such as late miscarriage, abnormal umbilical insertion, twin-twin transfusion syndrome and hypertensive disorders in pregnancy (P < 0.05). (2) The characteristics of twin birthweight distribution: 1) In all the 2020 twins, 80.05% (1617/2020) fetuses had birthweight below the 50(th) percentile of the singleton control group, while 23.71% (479/2020) feeuses got birthweight below the 10(th) percentile of the singleton control group. 2) After 19(th) gestational week, the 50(th) and 90(th) percentile of all twins' birthweight were lower than those of singletons. After 38(th) gestational week, the birthweight of singletons kept increasing and reached its peak at 41(th) week, while the birthweight of twins reached its peak at 38(th) week, followed by a decline at 39 weeks, which was even lower than the 10(th) percentile of the singleton control group. 3) The distribution of birthweight of larger- and smaller-twin in the discordant twins group: 65 (54.6%, 65/119) larger-twins and one (0.8%, 1/119) smaller-twin had birthweight above the 50(th) percentile of all twins, while 5 (4.2%, 5/119) larger-twins and 97 (81.5%, 97/119) smaller-twins got birthweight below the 10(th) percentile of all twins. (1) The patterns of birthweight curves for each gestational week are different between twins and singletons. In order to evaluate the growth of twins, birthweight reference for twins should be employed. (2) According to the reference of twins birthweight, the most discordant twins are complicated with fetal growth restriction at least in one twin.

Is Growth-Discordance in Twins a Substantial Risk Factor in Adverse Neonatal Outcomes?

To evaluate whether growth discordance is an independent risk factor in the neonatal outcome of the smaller twin, all medical records of twin pregnancies delivered between 26 and 41 weeks during a 5-year period (January 2004-December 2008) were reviewed. Among the 49 selected twins, weight discordance was 15-20% in 7 infants, 21-30% in 16 infants, 31-40% in 16 infants and > 40% in 10 infants. No significant differences between the four groups were found with regards to obstetric complications and neonatal disease. Occurrence of birthweight below the 10th percentile and rate of admission to the neonatal intensive care unit significantly increased as intra-pair birthweight difference increased (p = .03). The > 40% discordant group had a significantly lower gestational age (p = .03), lower birthweight (p = .007) and a significantly higher mortality rate (4/10 versus 3/39 p = .04) in comparison with the other discordant groups. Multiple logistic regression analysis showed that birthweight was the single independent and consistent factor associated with elevated risks of mortality. For every 250 g increase in birthweight, the risk for mortality decreased by about 84% [RR 0.16(CI 0.00-0.70)]. Gestational age was the most reliable predictor for major neonatal complications. For every 1-week increase in gestational age a significant decreased risk for all outcomes was found. Discordance alone should not be considered as a predictor for adverse neonatal outcome. Neonatal outcome in discordant twins appears to be related to gestational age and birthweight rather than to the degree of discordance.

Antenatal factors associated with birth weight of twins and risk factors for discordant twins

Objective To investigate the antenatal influencing factors associated with birth weight of twins and the risk factors for the occurrence of discordant twins. Methods Totally, 834 twins delivered at the Third Affiliated Hospital from January 2000 to December 2009 and the First Affiliated Hospital of SUN Yat sen University, from January 2000 to June 2009, were recruited in the study. The diagnosis criteria of discordant twins was intrapair birth weight difference more than 25%. Antenatal factors on birth weight were retrospectively investigated among twins and discordant twins respectively with Logistic analysis. Results （1） There were several factors associated with birth weight of twins, including maternal age, conceptive style, chorionicity, gestational diabetes mellitus and placental cord insertion （P = 0. 021, 0. 000, 0. 000, 0. 012 and 0. 017, respectively）. While hypertensive disorder in pregnancy, parity and fetal gender differences were not associated with the birth weight of twins （P〉0.05）. Hypertensive disorder in pregnancy （OR =2.600, 95% CI：1. 566 4. 316） and monochorionicity （OR=1.833, 95% CI：1.010-3.582） were risk factors of discordant twins. All 834 twin pregnancies were divided into 4 groups according to rnateral age, 〈25 yrs （n =69）, 25-30 yrs （n= 312）, 30-35 yrs （n=325） and ≥35 yrs （n=128）. The average birth weight of twins were （2205±483） g, （2347±406） g, （2381±439） g and （2352±455） g. Significant difference was found bewteen every two groups （P〈0.05） except that between the 30-35 yrs and ≥35 yrs group （P〉0.05）. Among twins of different gender （n=270）, the average birth weight of boys and girls were （2416±514） g and （2322±488） g, and that of female twins （n=272） and male twins （n 292） were （2301±418） g and （2381±428） g. Significant difference was shown between every two groups （P〈0.05） except that between the male twins and male fetus of twins of different gender （P〉0.05）. Conclusions The fetal birth weight of twins decreases remarkably when maternal age 〈 25, or monochorionicity twins, or complicated with marginal or velamentous placental cord insertion or female pairs. However, birth weight of twins would increase if the pregnancy conceived by assisted reproductive technology or complicated with gestational diabetes mellitus. Twin pregnancy complicated with hypertensive disorder in pregnancy or monoehorionicity should alert the clinicians of discordance twins. Key words: Twins; Birth weight; Risk factor

Kidney growth in twin children born small for gestational age

Low birth weight (LBW) is associated with adult-onset diseases, including hypertension and renal disease; altered renal development after intrauterine growth restriction (IUGR) may underlie related prenatal programming. No data are available on longitudinal renal growth in twin infants born small for gestational age (SGA). The aim of this prospective longitudinal study was to estimate the renal size during the first 2 years of life in SGA twin infants. The study included 613 children, of which 145 were SGA twins, 141 twins appropriate for gestational age (AGA), 148 matched AGA singletons and 179 matched SGA singletons, classified according to GA into two groups (28-36 and >36 weeks). The SGA children were also classified according to the degree of IUGR: birth weight (BW) <3rd percentile and BW 3rd-10th percentiles. Serial renal ultrasonography (US) for kidney length (KL) measurement was performed at the ages of 36 and 40 weeks corrected age (CA) and 3, 6, 12 and 24 months of age, and KL was related to other anthropometric indices. Twin data were examined both as individuals and as members of twin pairs. A total of 2317 measurements were performed. KL was lower at 40 weeks CA in all the SGA twin subgroups. In the SGA twins with GA >36 weeks, KL increased thereafter and became similar to AGA twins and single AGA control subjects. Among pre-term infants of GA <36 weeks, only those with BW 3rd-10th percentile experienced catch-up in KL, while in those with BW <3rd percentile, KL remained lower than in AGA infants throughout the study period, both in absolute terms and relative to other anthropometric indices. No differences in KL were found between twin SGA and singleton SGA or between twin AGA and singleton AGA infants. Intrapair BW differences were correlated with the intrapair differences in KL. Twin SGA infants born prematurely with BW <3rd percentile are unable to achieve catch-up in KL in the first 24 months of life, and long-term follow-up is recommended.

Intrapair birthweight discordance in twins

Birthweight differences in twin pairs influence their perinatal outcome as well as growth and development. Growth-discordant twins have not been well characterized in our local environment. To determine the frequency of birthweight discordance in live-born twin pairs and document some factors that may influence it. In this cross-sectional study, 104 live-born twin pairs were recruited and their intrapair birthweight differences were determined. Twin pairs whose birthweight difference was 15% or more, using the larger infant as the growth standard, were designated as discordant. The maternal age, parity, and birth order of the heavier twin were noted. The prevalence of birthweight discordance was 28.8% when a 15% cut-off point was used but dropped to 9.6% when a 25% cut-off point was applied. Grand multiparity was associated with a significantly increased risk of delivery of discordant twins. Same-sex twin pairs accounted for 60% of all cases of birthweight discordance. Birthweight discordance is common in twin gestations in Benin City, especially among grand multiparous women.

Chorion Type, Birthweight Discordance and Tooth-Size Variability in Australian Monozygotic Twins

AbstractChorion type is an important variable that can affect the prenatal environment of monozygotic (MZ) twin pairs, leading to differences in growth and development. In particular, vascular anastomoses between monochorionic (MC) MZ twin pairs can lead to an imbalance in nutrition between co-twins. One objective of this study was to determine whether maternal reports, hospital records or birthweight discordances found in MZ co-twins provide reliable indications of monochorionicity. The other objective was to test the hypotheses that in MZ twin pairs of known chorion type, MC twin pairs would show greater birthweight differences and greater within-pair variability in permanent tooth size than dichorionic (DC) twin pairs, reflecting greater differences in intrauterine environment between MC MZ pairs. Birthweights and tooth size data were recorded for 170 pairs of MZ Australian twins enrolled in an ongoing study of dentofacial growth and development. Chorion type based on maternal reports was compared with that based on hospital records for a subsample of 68 pairs of these MZ twins. Maternal reports were found to be unreliable for determining chorion type and hospital records often did not provide enough information to be certain about chorionicity. For 27 twin pairs with confirmed chorion type, associations were tested between birthweight discordances in MZ twin pairs and chorion type, and also between intrapair variances for tooth size and chorion type. A significant association was noted between birthweight discordance and chorion type (p&lt;.05), with greater discordances occurring more often in MC twin pairs. Although significant heterogeneity of intrapair variances for tooth size was found in only 5 of 48 comparisons, intrapair variances for crown dimensions were greater significantly more often in MC pairs than DC pairs (p&lt;.05). Our findings indicated that neither maternal reports nor often hospital records can be relied upon for information on chorion type. However, when analyses were performed on data for MZ twin pairs of known chorion type, we found evidence of a significant association between intrapair birthweight differences and chorion type and also between intrapair variances of dental crown measurements and chorion type. Consistent with our hypotheses, large birthweight discordances were found to occur more often in MC twin pairs than DC twin pairs, and intrapair variances for tooth size in MC twin pairs exceeded those in DC twin pairs more often than expected due to chance.

Chorion Type, Birthweight Discordance and Tooth-Size Variability in Australian Monozygotic Twins

Chorion type is an important variable that can affect the prenatal environment of monozygotic (MZ) twin pairs, leading to differences in growth and development. In particular, vascular anastomoses between monochorionic (MC) MZ twin pairs can lead to an imbalance in nutrition between co-twins. One objective of this study was to determine whether maternal reports, hospital records or birthweight discordances found in MZ co-twins provide reliable indications of monochorionicity. The other objective was to test the hypotheses that in MZ twin pairs of known chorion type, MC twin pairs would show greater birthweight differences and greater within-pair variability in permanent tooth size than dichorionic (DC) twin pairs, reflecting greater differences in intrauterine environment between MC MZ pairs. Birthweights and tooth size data were recorded for 170 pairs of MZ Australian twins enrolled in an ongoing study of dentofacial growth and development. Chorion type based on maternal reports was compared with that based on hospital records for a subsample of 68 pairs of these MZ twins. Maternal reports were found to be unreliable for determining chorion type and hospital records often did not provide enough information to be certain about chorionicity. For 27 twin pairs with confirmed chorion type, associations were tested between birthweight discordances in MZ twin pairs and chorion type, and also between intrapair variances for tooth size and chorion type. A significant association was noted between birthweight discordance and chorion type (p < .05), with greater discordances occurring more often in MC twin pairs. Although significant heterogeneity of intrapair variances for tooth size was found in only 5 of 48 comparisons, intrapair variances for crown dimensions were greater significantly more often in MC pairs than DC pairs (p < .05). Our findings indicated that neither maternal reports nor often hospital records can be relied upon for information on chorion type. However, when analyses were performed on data for MZ twin pairs of known chorion type, we found evidence of a significant association between intrapair birthweight differences and chorion type and also between intrapair variances of dental crown measurements and chorion type. Consistent with our hypotheses, large birthweight discordances were found to occur more often in MC twin pairs than DC twin pairs, and intrapair variances for tooth size in MC twin pairs exceeded those in DC twin pairs more often than expected due to chance.

Birth Weight and Creatinine Clearance in Young Adult Twins

Previous studies have shown that low birth weight (LBW) is a risk factor for renal impairment in adult life. The effects of LBW and renal function were studied by using twins, which allows distinguishing among fetoplacental, maternal, and genetic influences. Perinatal data were obtained at birth, and absolute creatinine clearance (not corrected for body surface area) was measured at a mean age of 25.6 yr in 653 individuals. Twins were considered both as individuals and as members of twin pairs. Statistical analyses were performed with and without adjusting for gestational age, zygosity, gender, age, body mass index, glucose level, BP, and smoking status. Creatinine clearance was 4 ml/min lower in twins with LBW (<2500 g) than in twins with a high birth weight (P < 0.04, adjusted). Intrapair birth weight difference correlated positively with the intrapair difference in creatinine clearance equally in monozygotic and dizygotic twins (r = 0.35, P < 0.0001; r = 0.43, P < 0.0001, respectively). This suggests that fetoplacental factors are related to renal function and that genetic factors are less important. There was no significant difference in creatinine clearance between twins who both had LBW as compared with twins who both had a high birth weight. This may suggest that maternal factors, which influence the relation between LBW and renal function, are less important. LBW is related to a lower creatinine clearance at adult age. This relationship is probably due to fetoplacental factors. Surprising, genetic and maternal factors seem less important.

Comparison of Obstetric and Birthweight Characteristics Between the Two Largest Databases of Japanese Twins Measured in Childhood

AbstractThe purpose of this study is to compare obstetric and birthweight data of twin children from the two largest databases in Japan to estimate the difference between them in sample collection. The first group consisted of 1131 twin-pair school applicants, and the second group consisted of members' children from several maternal associations devoted to twins and included 951 pairs. All data were gathered by questionnaire. The mean birth years of the twins in these two databases were 1979 and 1995 respectively. The percentage of mothers treated with ovulation-stimulating drugs or in-vitro fertilization was markedly higher in the maternal associations group. Gestational age was around 1 week less in the maternal associations group, whereas birthweight according to gestational weeks and intrapair relative birth weight difference as a percentage according to zygosity showed little difference between both groups. We conclude that the obstetric and birthweight feature data from both groups should be considered to construct twin growth charts based on the methods of sample selection.

Association of birth weight with osteoporosis and osteoarthritis in adult twins.

Twin studies present a unique opportunity to examine the association of birth weight with adult life phenotypes in a design that naturally accounts for maternal factors and a range of early environmental factors, which might potentially bias the association. In this study, we explored the association of birth weight with osteoporosis (OP) and osteoarthritis (OA), in a large national cohort of female twins. Intra-pair differences between the reported birth weight of the twins (n=4008) were examined for an association with: (i) intra-pair differences in bone mineral density (BMD) and bone mineral content (BMC) at the lumbar spine, hip and forearm using linear regression; and (ii) osteoarthritis status in pairs discordant for radiographic disease at the hand, hip and knee using matched logistic regression. The confounding influences of height and weight were taken into account. The mean age of the twins was 47.5+/-12.3 yr. Intra-pair differences in birth weight were significantly associated with BMD at the spine (P=0.047), total hip (P=0.016) and femoral neck (P<0.001), but not at the forearm (P=0.245). These were entirely explained by the birth weight association with height and weight. The associations of intra-pair differences in birth weight and BMC were highly significant (P<0.001) at all sites, but were partly explained by adjustment for adult height and weight. We found no clear association between intra-pair birth weight differences and OA in twins discordant for any of the radiographic OA phenotypes at any site. Bone mass and especially BMC are highly associated with birth weight. These associations are accounted for mainly by environmental factors that are independent of maternal factors such as gestational age, maternal smoking and nutrition, and are largely mediated by skeletal size and particularly adult height. Birth weight does not appear to be a major influence on the later development of radiographic OA in women.

Birth weight and body composition in young women: a prospective twin study

The intrauterine environment may be critical for the development of obesity. Alternatively, the same genetic factors may influence both birth weight and adult body composition. We evaluated the association between birth weight and adult body composition in female twins, which allowed us to control for maternal and genetic influences. Of 447 twin pairs randomly selected from the East Flanders Prospective Twin Survey, 238 pairs, aged 18-34 y, participated. Adult body mass, height, and lean body mass were measured, and the body mass index (BMI), waist-to-hip ratio, and sum of skinfold thicknesses were calculated. The twins were considered as individuals and pairs. When the twins were considered as individuals, twins who were heavier at birth were taller (3.3 cm/kg greater birth weight) and slightly heavier (1.13 kg/kg greater birth weight) as adults than were lighter twins. They also had more lean body mass and less subcutaneous and abdominal fat at birth. Pairwise comparison showed that for every level of intrapair birth weight difference (> or = 5%, > or = 10%, and > or = 15%), the twin who was heavier at birth was taller in adult life (0.8, 1.2, and 2.0 cm, respectively). When the intrapair birth weight difference exceeded 15%, the heavier twin was also heavier (3.1 +/- 6.08 kg) as an adult than her much lighter sister. Birth weight accounts for some of the differences in adult body composition between twins.

The Influence of Zygosity and Chorion Type on Fat Distribution in Young Adult Twins Consequences for Twin Studies

AbstractAn adverse intra-uterine environment has been associated with abdominal fat distribution in singletons. Twins often have a low birth weight and a short gestation. Therefore, they may have an increased risk to develop abdominal obesity. Furthermore, monozygotic monochorionic twins (MZ MC) have a larger intra-pair birth weight difference compared to monozygotic dichorionic twins (MZ DC). If adult anthropometry is programmed in utero, this may affect the intra-pair correlations in adulthood and, consequently, also the results from the classic twin method to estimate genetic and environmental influences. In the present study, we compared the absolute values, the intra-pair differences, and the intra-pair correlations of body mass, height, BMI, and abdominal fat distribution of 424 MZ MC, MZ DC and dizygotic (DZ) twin pairs (aged 18–34 yrs). DZ, MZ DC and MZ MC twins did not differ for most anthropometric characteristics. Only MZ women tended (p = 0.03) to accumulate more abdominal fat compared to DZ twins. Overall, the contribution of zygosity and chorion type to adult anthropometry was rather low (≤ 1.7%). Although the intra-pair birth weight difference of MZ MC pairs (10.5% in men, 12.3% in women) was significantly larger compared to that of MZ DC pairs (6.9% and 9.2% resp.), the intra-pair differences in adult anthropometry were similar for both MZ twin types. Also the intra-pair correlations of MZ MC and MZ DC pairs were strikingly alike, suggesting no significant influence of the prenatal environment on adult concordance. In conclusion, the substantial difference in the prenatal environment of MZ MC and MZ DC twins did not result in a difference in intra-pair concordance of adult anthropometry and fat distribution. Therefore, we suggest that the chorion type of MZ twins does not bias the twin design and the estimation of the genetic contribution to adult anthropometry.

The influence of zygosity and chorion type on fat distribution in young adult twins consequences for twin studies.

An adverse intra-uterine environment has been associated with abdominal fat distribution in singletons. Twins often have a low birth weight and a short gestation. Therefore, they may have an increased risk to develop abdominal obesity. Furthermore, monozygotic monochorionic twins (MZ MC) have a larger intra-pair birth weight difference compared to monozygotic dichorionic twins (MZ DC). If adult anthropometry is programmed in utero, this may affect the intra-pair correlations in adulthood and, consequently, also the results from the classic twin method to estimate genetic and environmental influences. In the present study, we compared the absolute values, the intra-pair differences, and the intra-pair correlations of body mass, height, BMI, and abdominal fat distribution of 424 MZ MC, MZ DC and dizygotic (DZ) twin pairs (aged 18-34 yrs). DZ, MZ DC and MZ MC twins did not differ for most anthropometric characteristics. Only MZ women tended (p = 0.03) to accumulate more abdominal fat compared to DZ twins. Overall, the contribution of zygosity and chorion type to adult anthropometry was rather low (< or = 1.7%). Although the intra-pair birth weight difference of MZ MC pairs (10.5% in men, 12.3% in women) was significantly larger compared to that of MZ DC pairs (6.9% and 9.2% resp.), the intra-pair differences in adult anthropometry were similar for both MZ twin types. Also the intra-pair correlations of MZ MC and MZ DC pairs were strikingly alike, suggesting no significant influence of the prenatal environment on adult concordance. In conclusion, the substantial difference in the prenatal environment of MZ MC and MZ DC twins did not result in a difference in intra-pair concordance of adult anthropometry and fat distribution. Therefore, we suggest that the chorion type of MZ twins does not bias the twin design and the estimation of the genetic contribution to adult anthropometry.

Birth weight and body composition in young adult men--a prospective twin study.

To evaluate the association between birth weight and adult body composition in twins, controlling for maternal and genetic influences. Twins were randomly selected from the East Flanders Prospective Twin Survey, a population-based historic twin cohort. Male members of 229 twin pairs between 18 and 34 y of age who participated in the Prenatal Programming Twin Study. Adult body mass, height, BMI, lean body mass, sum of skinfolds and waist-to-hip-ratio. Lean body mass, sum of skinfolds and waist-to-hip-ratio were also adjusted for body mass. Intra-pair difference in adult anthropometric measures between the heaviest and the lightest twin at birth. Per kg increase in birth weight, body mass (4.2 kg), height (3.3 cm), lean body mass (3.1 kg) and to a lesser extent BMI (0.49 kg/m(2)) increased, whereas waist-to-hip-ratio (-1.4%) and sum of skinfolds (-0.11 s.d.) decreased, when adjusted for body mass. In a pair-wise analysis, the heavier twin at birth was taller and heavier as an adult, but, when adjusted for body mass, he had a lower waist-to-hip-ratio, less subcutaneous fat, and more lean body mass, compared to his lighter sib. Intra-pair difference in body composition was associated with intra-pair birth weight difference in monozygotic and dizygotic twins. An adverse intra-uterine environment, as measured by birth weight, is associated with more subcutaneous and abdominal fat and less lean body mass in adulthood. This association is independent of maternal and genetic influences. However, we cannot exclude the existence of genes that act on both birth weight and adult body composition.

Lack of association of fibrinogen, lipoprotein(a), and albumin excretion rate with low birthweight

An excess of cardiovascular morbidity has been related to low birthweight. The aim of this study was to evaluate the relationship between low birthweight and levels of fibrinogen, lipoprotein(a), and albumin excretion rate, which are known risk factors for coronary artery disease. Seventy-two twins, with the same within-pair gender and normal glucose tolerance, were analyzed in order to avoid confounding factors, such as gestational age, birth order, or sex. Twins with the highest birthweights within the couple showed no significant difference of fibrinogen, lipoprotein(a), and albumin excretion rates compared with the twins with the lowest birthweights among the two co-twins. Moreover, no relevant correlation was found between birthweight and intra-pair birthweight differences and fibrinogen, lipoprotein(a), and albumin excretion rates. The lack of correlation between fibrinogen, lipoprotein(a), albumin excretion rate and birthweight, suggests that these factors do not contribute to the link between intrauterine malnutrition and increased cardiovascular risk.

Birth weight and age at menopause in Australian female twin pairs: exploration of the fetal origin hypothesis.

In a twin sample where duration of gestation can be controlled, a specific example of the fetal origins hypothesis concerning association between low birth weight and early age at menopause is explored. The hypothesis is based on the physiologically plausible path from intrauterine growth retardation and reduced numbers of primary follicles to an earlier menopause. The sample comprised 323 Australian female twin pairs where both co-twins had reached menopause naturally and reported on their weight at birth. Regression analysis showed no linear association between the two variables (P = 0.371, r(2) = 0.0009). Intra-pair differences in age at menopause were investigated in the context of relative birth weight of co-twins. In 265 pairs an intra-pair birth weight difference was reported. In monozygotic (MZ) pairs (n = 168) this allowed for control of genetic effects as well as gestation duration. No significant differences dependent on birth weight relative to co-twin were found for age at natural menopause in either MZ or dizygotic (DZ) twin pairs, even in pairs whose birth weights differed markedly. There was some indication that twins with premature ovarian failure were heavier at birth than twins with normal or later menopausal age. We conclude that the hypothesis that lower birth weight is associated with earlier menopause is not supported by our data.

Outcome of Twin Pregnancies According to Intrapair Birth Weight Differences

In Brief Objective To assess the clinical significance of twin intrapair birth weight differences. Methods This was a retrospective study of twin pregnancy outcomes. Intrapair birth weight differences were stratified into the following six groups: 14% or less, 15–20%, 21–25%, 26–30%, 31–40%, and 41% or more using the larger infant as the growth standard. Statistical analysis was done using the Mantel-Haenzel χ2 test. Results We studied 1370 consecutive women who delivered at Parkland Hospital, Dallas, Texas, between January 1, 1988, and December 31, 1996, and had twin gestations and live births or fetal deaths within 7 days of delivery. Greater birth weight discordance was significantly associated with preterm delivery due to intervention (P < .001). Noncephalic-cephalic presentations and cesarean delivery were also associated with greater discordance (P = .001 and .02, respectively). Neonatal morbidities, including low birth weight, intensive care admission, and respiratory distress, were all associated with higher birth weight discordance. Fetal abnormalities were more common with increased discordance (P < .001). Greater birth weight discordance was also associated with intrauterine fetal death. There were no differences in outcome for the smaller compared with the larger twin of the twin pair. Conclusion Twin birth weight discordance is problematic because severe divergent fetal growth increases the risk of fetal death and leads to obstetric intervention and consequent neonatal morbidity due to prematurity. Birth weight discordancy was associated with both antepartum fetal death and morbidity of prematurity in an analysis of 1370 consecutive twin gestations.

Outcome of twin pregnancies according to intrapair birth weight differences

Objective: To assess the clinical significance of twin intrapair birth weight differences. Methods: This was a retrospective study of twin pregnancy outcomes. Intrapair birth weight differences were stratified into the following six groups: 14% or less, 15–20%, 21–25%, 26–30%, 31–40%, and 41% or more using the larger infant as the growth standard. Statistical analysis was done using the Mantel-Haenzel χ 2 test. Results: We studied 1370 consecutive women who delivered at Parkland Hospital, Dallas, Texas, between January 1, 1988, and December 31, 1996, and had twin gestations and live births or fetal deaths within 7 days of delivery. Greater birth weight discordance was significantly associated with preterm delivery due to intervention ( P < .001). Noncephalic-cephalic presentations and cesarean delivery were also associated with greater discordance ( P = .001 and .02, respectively). Neonatal morbidities, including low birth weight, intensive care admission, and respiratory distress, were all associated with higher birth weight discordance. Fetal abnormalities were more common with increased discordance ( P < .001). Greater birth weight discordance was also associated with intrauterine fetal death. There were no differences in outcome for the smaller compared with the larger twin of the twin pair. Conclusion: Twin birth weight discordance is problematic because severe divergent fetal growth increases the risk of fetal death and leads to obstetric intervention and consequent neonatal morbidity due to prematurity.

Relationship of birth weight to the phenotypic expression of Gilles de la Tourette's syndrome in monozygotic twins.

We studied 16 pairs of monozygotic twins (mean age, 12.8 +/- 1.4 years; age range, 8 to 26 years; sex, 12 male pairs, four female pairs) in whom at least one twin had Gilles de la Tourette's syndrome (TS) to determine the concordance rates for TS and tic disorders and to examine environmental factors accounting for intrapair differences in tic severity. In this cohort, the concordance rate for TS was 56%, and the concordance rate for tic disorders was 94%, supporting a primary genetic basis for TS and tic disorders with a high rate of penetrance for the gene. Thirteen of the pairs had differing birth weights and the lower birth-weight twin had a higher tic score in 12 of these pairs. The magnitude of the intrapair birth-weight difference (BWD) strongly predicted the magnitude of the intrapair tic score difference. The difference in tic severity could not be explained by any postnatal medical events. These findings suggest that crucial events affecting the phenotypic expression of TS occur in utero and that the factors causing the BWD also are related to tic severity.