Small For Gestational Age Twins Research Articles

Small for gestational age in twin pregnancies and the risk of offspring pediatric neurologic morbidity.

Small for gestational age (SGA) singletons are at increased risk for neurodevelopmental abnormalities. Scarce data exist regarding the long-term implications of SGA in twins. We opted to study the association between SGA of one twin and long-term neurologic related morbidity in dichorionic diamniotic twins. A population-based retrospective cohort study including consecutive dichorionic diamniotic twins, born between the years 1991 and 2021 at a tertiary medical center was conducted. Total and subtypes of neurologic related pediatric hospitalizations among SGA versus non-SGA twins were compared. A Kaplan-Meier survival curve was used to compare the cumulative neurologic morbidity incidence, and a Cox proportional hazards model was constructed to adjust forconfounders. The study population included 4222 newborns; 180 (4.3%) were SGA. Rate of long-term neurologic related hospitalizations was comparable between the two groups (8.7 vs. 8.0%, p = 0.755; Kaplan-Meier survival curve Log-rank p = 0.652). Using a Cox proportional hazards model, controlling for gender and birth order, no association was found between SGA and the risk for subsequent neurologic pediatric morbidity of the offspring (Adjusted HR = 1.0, 95% CI 0.6-1.8, p = 0.973). SGA is not associated with an increased risk for long-term pediatric neurologic morbidity in dichorionic diamniotic twins.

Incidence of neonatal morbidity in small-for-gestational-age twins based on singleton and twin charts.

To compare morbidity, as measured by length of stay in the neonatal intensive care unit (NICU), in twin and singleton gestations classified as small-for-gestational age (SGA) according to estimated fetal weight < 10th percentile on twin or singleton growth charts. NICU length of stay was compared in 1150 twins and 29 035 singletons that underwent ultrasound assessment between 35 + 0 and 36 + 6 weeks' gestation. Estimated fetal weight was obtained from measurements of head circumference, abdominal circumference and femur length using the Hadlock formula. Gestational age was derived from the first-trimester crown-rump length measurement, using the larger of the two twins. Singletons and twins were compared in terms of NICU admission rate and length of stay according to classification as SGA by the Fetal Medicine Foundation singleton and twin reference distributions. The overall proportions of twins and singletons admitted to NICU were similar (7.3% vs 7.4%), but twins tended to have longer lengths of stay in NICU (≥ 7 days: 2.4% vs 0.8%; relative risk (RR), 3.0 (95% CI, 1.6-4.4)). Using the singleton chart, a higher proportion of twins were classified as SGA compared with singletons (37.6% vs 7.0%). However, the proportion of SGA neonates entering NICU was similar (10.2% for twins and 10.1% for singletons) and the proportion of SGA neonates spending ≥ 7 days in NICU was substantially higher for twins compared with singletons (3.7% vs 1.4%; RR, 2.6 (95% CI, 1.4-4.7)). When singleton charts are used to define SGA in twins and in singletons, there is a greater degree of growth-related neonatal morbidity amongst SGA twins compared with SGA singletons. Consequently, singleton charts do not inappropriately overdiagnose fetal growth restriction in twins and they should be used for monitoring fetal growth in both twins and singletons. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Longitudinal Child Growth Patterns in Twins and Singletons in the Upstate KIDS Cohort

To investigate childhood growth patterns in twins and to determine whether they show the same signs of excess growth as singletons born small-for-gestational age (SGA), which may confer future cardiometabolic risk. In the Upstate KIDS cohort of infants delivered from 2008 through 2010, we compared height, weight, and body mass index (BMI) z-scores at 0-3 and 7-9years of age, as well as risk of rapid weight gain (RWG) in infancy and overweight/obesity beginning at 2years, among appropriate-for-gestational age (AGA) twins (n=1121), AGA singletons (n=2684), and two groups of SGA twins: uncertain SGA twins (<10th percentile for birthweight by a singleton reference but >10th% by a population-based twin birthweight reference; n=319) and true SGA twins (<10th% by a population-based twin reference; n=144). Compared with AGA twins, both SGA twin groups had lower weight and BMI z-scores at both time points. By 7-9years, both groups caught up in height with AGA twins. Compared with AGA singletons, z-score differences decreased between 0-3 and 7-9years for uncertain SGA and true SGA twins, though true SGA twins had the lowest z-scores for all measures. During infancy, twins were more likely to display RWG compared with AGA singletons (RR=2.06 to 2.67), which may reflect normal catch-up growth, as no twin group had higher prevalence of overweight/obesity at either time point. Though twins had lower height, weight, and BMI z-scores at birth and into toddlerhood, differences were reduced by 7-9years, with no evidence of pathological growth and no group of twins showing elevated risk of overweight/obesity.

Comparing child growth between small-for-gestational age twins and singletons in the upstate KIDS cohort

Twins have an increased risk of being small-for-gestational-age (SGA) at birth compared to singletons, but little is known about their growth in childhood. It’s hypothesized that the maternal-fetal unit may become less capable of sustaining optimal growth in twin fetuses starting around 32 weeks indicating that some smaller birth size may be due to adaptation. Whether SGA twins show the same postnatal growth patterns as singletons born SGA, who may be growth-restricted, is unknown.

Should singleton birth weight standards be applied to identify small-for-gestational age twins?: analysis of a retrospective cohort study

BackgroundTwin birth weight percentiles are less popular in clinical management among twin pregnancies compared with singleton ones in China. This study aimed to compare the incidence and neonatal outcomes of small for gestational age (SGA) twins between the use of singleton and twin birth weight percentiles.MethodsThis was a retrospective cohort study of 3,027 pregnancies with liveborn twin pairs at gestational age of > 28 weeks. The newborns were categorized as SGA when a birthweight was less than the 10th percentile based on the singleton and twin references derived from Chinese population. Logistic regression models with generalized estimated equation (GEE) were utilized to evaluate the association between SGA twins and neonatal outcomes including neonatal unit admission, neonatal jaundice, neonatal respiratory distress (NRDS), neonatal asphyxia, ventilator support, hypoxic ischemic encephalopathy (HIE), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intracranial hemorrhage (ICH), culture-proven sepsis, neonatal death within 28 days after birth as well as the composite outcome.ResultsThe incidence of SGA was 33.1 % based on the singleton reference and 7.3 % based on the twin reference. Both of SGA newborns defined by the singleton and twin references were associated with increases in neonatal unit admission, neonatal jaundice and ventilator support. In addition, SGA newborns defined by the twin reference were associated with increased rates of BPD (aOR, 2.61; 95 % CI: 1.18–5.78) as well as the severe composite outcome (aOR, 1.93; 95 % CI: 1.07–3.47).ConclusionsThe use of singleton birth weight percentiles may result in misdiagnosed SGA newborns in twin gestations and the twin birth weight percentiles would be more useful to identify those who are at risk of adverse outcomes.

Predictive Accuracy of Singleton Versus Customized Twin Growth Chart for Adverse Perinatal Outcome: A Cohort Study.

Background: Fetal growth of twins differs from singletons. The objective was to assess the fetal growth in twin gestations in relation to singleton charts and customized twin charts, respectively, followed by a comparison of the frequency of neonatal complications in small-for-gestational-age (SGA) twins. Methods: We performed an analysis of twin pregnancies with established chorionicity with particular emphasis on postnatal adverse outcomes in newborns classified as SGA. Neonatal birth weight was comparatively assessed using both singleton and twin growth charts with following percentile estimation. Using a statistical model, we established the prediction strength of neonatal complications in SGA twins for both methods. Results: The dataset included 322 twin pairs (247 cases of dichorionic and 75 cases of monochorionic diamniotic gestations). Utilization of twin-specific normograms was less likely to label twins as SGA—nevertheless, this diagnosis strongly correlated with risk of observing adverse outcomes. Using a chart dedicated for twin pregnancies predicted newborn complications in the SGA group with higher sensitivity and had better positive predictive value regarding postnatal morbidity. Conclusions: Estimating twin growth with customized charts provides better prognosis of undesirable neonatal events in the SGA group comparing to singleton nomograms and consequently might determine neonatal intensive care prenatal approach.

C-Peptide and leptin system in dichorionic, small and appropriate for gestational age twins\u2014possible link to metabolic programming?

Children born small for gestational age (SGA) are at increased risk of future glucose intolerance and type 2 diabetes, possibly after due intrauterine metabolic programming. Soluble leptin receptor (SLR) limits leptin access to signal-transducing membrane receptors. The present study examines whether SGA and appropriate for gestational age (AGA) twins differ with regard to their C-peptide, glucose and leptin systems. The markers C-peptide, glucose, fetal leptin, and SLR in cord blood were assessed in children from dichorionic twin pregnancies at delivery. In 32 cases, weight differed by >15% between twins: one demonstrated Intrauterine Growth Retardation (IUGR) (<10th percentile-SGA), while the other did not (AGAI). The other 67 pairs presented appropriate weight for gestational age (AGAII). Placental leptin and placental leptin receptor content were also assessed. Despite the same concentrations of glucose, the SGA twins maintained a higher level of C-peptide [44.48 pmol/l vs. 20.91 pmol/l, p < 0.05] than the AGAI co-twins, higher HOMA index, calculated as [C-peptide] x [Glucose] (p = 0.045), in cord blood, and a higher level of SLR [SGA vs AGAI—mean: 28.63 ng/ml vs. 19.91 ng/ml, p < 0.01], without any differences in total leptin (p = 0.37). However, SGA placentas demonstrated higher leptin level [130.1 pg/100 g total protein vs 83.8 pg/100 g total protein, p = 0.03], without differences in placental leptin receptor (p = 0.66). SGA/IUGR twins demonstrate relative insulin resistance accompanied by decreased fetal and increased placental leptin signaling. We speculate that relative insulin resistance and changes in the leptin system might be the first evidence of processes promoting deleterious metabolic programming for post-natal life.

Twins versus singleton pregnancies: outcomes in small for gestational age late preterm deliveries

Background: Compared to singleton pregnancies, small for gestational age (SGA) and twin gestations experience adverse maternal and neonatal outcomes. Specific data regarding outcomes in late preterm SGA twin gestations are lacking.Objective: This study sought to compare pregnancy outcomes of late preterm (≥34 and <37 weeks) SGA twins versus singletons. In addition, we sought to stratify the comparisons by <10 and <5 percentile categories.Study design: In this retrospective cohort of 1.85 million pregnancies, we identified 10,646 nonanomalous, SGA, late preterm singleton and twin pregnancies. Births at gestational ages <34 and ≥37 weeks were excluded. Multivariate regression analyses and Chi-squared test were used for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.Results: After controlling for race, education, parity, prenatal care, diabetes, and hypertensive disease, twin pregnancies were less likely to experience neonatal death (aOR 0.14; 95% CI 0.03–0.63; p = .01) and intrauterine fetal demise (IUFD) (aOR 0.16; 95% CI 0.08–0.31; p < .001) compared to SGA <10 percentile singletons. Cesarean rates were higher in SGA <10 [percentile twin pregnancies (aOR 3.40; 95% CI 3.01–3.90; p < .001) as were postpartum hemorrhage (aOR 2.01; 95% CI 1.52–2.67; p < .001) and transfusion (aOR 1.54; 95% CI 1.52–2.67; p = .024).Conclusion: Late preterm SGA twin pregnancies were more like to be complicated by cesarean delivery, postpartum hemorrhage, and maternal transfusion compared to singleton pregnancies. However, neonatal death and IUFD were less common in SGA twin gestations.

191: Is there a difference in placental pathology between twins vs. singleton pregnancies complicated by small for gestational age?

We aimed to compare placental lesions and neonatal outcome associated with abnormal fetal growth in dichorionic-diamniotic (DCDA) twins vs. singleton pregnancies complicated by small for gestational age (SGA). The medical records and placental pathologic reports of all singleton pregnancies complicated by SGA, and DCDA twins in which one of the neonates was SGA, delivered between 2008-2017, were reviewed. SGA was defined as birthweight ≤ 10th percentile. Placental diameters were recorded. Placental lesions were classified to maternal and fetal vascular malperfusion (MVM and FVM) lesions (Figure 1). Results were compared between the SGA singleton group and the SGA neonate of the twins group. Composite adverse neonatal outcome was defined as one or more early neonatal complications. As compared to the SGA twins group (n=66), the SGA singleton group (n=500) was characterized by lower maternal age, lower rates of preeclampsia (p=0.010, for both), higher gestational age (34.9±3.1 vs. 37.7±2.6 weeks, respectively, p<0.001) and higher birth weights (2181±451 vs. 1578±455 gr, respectively, p<0.001). Placental villous changes related to MVM lesions and composite placental MVM lesions were more common in the SGA singleton group as compared to the SGA twins (58.6% vs. 31.8%, p<0.001; 62% vs. 45.4%, p=0.040, respectively), see table. By multivariate logistic regression analysis, the SGA singleton group was found to be independently associated with composite MVM lesions (aOR=2.44, 95% CI 1.29-4.61, p=0.006) and villous lesions of MVM (aOR=3.6, 95% CI 1.9-7.0, p<0.001). Composite adverse neonatal outcome was more common in the SGA twins as compared to the SGA singleton group (83.3% vs. 51.2%, p<0.001). Placental MVM lesions are associated with the development of SGA in singleton pregnancies but not in DCDA twins. Development of asymmetric growth in twins is probably related to constrain intrauterine environment rather than abnormal placentation, as in singleton pregnancy complicated with SGA.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Placental abnormalities differ between small for gestational age fetuses in dichorionic twin and singleton pregnancies

ObjectiveTwin fetuses grow slower during the third trimester compared with singletons. However, the extent to which the relative smallness of twins is the result of placenta-mediated factors similar to those associated with fetal growth restriction in singletons remains unclear. Our aim was to address this question by comparing placental findings between small for gestational age (SGA) twins and SGA singletons. MethodsRetrospective cohort study of all SGA non-anomalous newborns from singleton and dichorionic twin pregnancies in a single tertiary referral center between 2002 and 2015. SGA was defined as birth weight <10th percentile for gestational age according to sex-specific national reference charts. Placental findings were compared between SGA twins and SGA singletons and were classified into lesions associated with maternal vascular malperfusion, fetal vascular malperfusion, placental hemorrhage and chronic villitis. ResultsA total of 532 SGA twins and 954 SGA singletons met the inclusion criteria. SGA twins had a higher mean placental weight (371 ± 103 g vs. 319 ± 107, p < 0.001) and a lower fetal-placental ratio (6.0 ± 2.5 vs. 6.7 ± 3.2, p < 0.001) compared with SGA singletons. Compared with SGA singletons, SGA twins were less likely to have any placental pathology (aOR 0.37, 95%-CI 0.29–0.46), hypercoiled cord (aOR 0.45, 95%-CI 0.33–0.61), placental weight<10th% (aOR 0.13, 95%-CI 0.08–0.20), maternal vascular malperfusion pathology (aOR 0.24, 95%-CI 0.18–0.30) and fetal vascular malperfusion pathology (aOR 0.62, 95%-CI 0.48–0.82). By contrast, SGA twins had higher odds of a marginal or velamentous cord insertion compared with SGA singletons (aOR 13.82, 95%-CI 10.44–18.30). Similar significant associations were observed in subgroups of SGA fetuses with a birth weight below the 5th and 3rd percentile for gestational age. ConclusionsOur findings illustrate that the mechanisms underlying reduced fetal growth in dichorionic twins differ from those involved in singletons, and may provide support to the hypothesis that smallness in dichorionic twins may be more benign than in singletons.

Impact of customized growth curves on screening for small for gestational age twins

ObjectiveThe choice of a growth curve determines the screening for small-for-gestational-age (SGA) fetuses and little data is available on SGA twins. Our aim was to evaluate small-for-gestational-age (SGA) detection rate in twin pregnancies and assess whether the use of a customized curve allowed better identification of SGA fetuses. Study designRetrospective study including all twins between 2010 and 2013. Two groups were formed: the SGA and the non-SGA group. Four curves were compared: Hadlock’s curve, a customized curve, EPOPé M0 and EPOPé M1. We defined a composite neonatal complication criterion (transfer to intensive care unit, respiratory distress and death). Result472 fetuses were included with a 34.3% prevalence of SGA. Hadlock’s curve showed better sensitivity for the detection of SGA <10th percentile (67.3% vs. 63%, 59.9% and 57.4% respectively). Diagnostic Odd Ratio were comparable for the detection of SGA. For the composite variable, there was a significant difference between the 2 groups using a customized curve adjusted for fetal sex (EPOPé M1). ConclusionThe EPOPé (M0 and M1) and customized curves do not improve screening for SGA infants below the 10th percentile. The reduced effectiveness of customized curves can be related to the greater impact of placentation or cord insertion on the potential for fetal growth.

Prognostic value of umbilical and cerebral Doppler in fetal growth restriction: comparison of dichorionic twins and singletons.

ObjectiveTo compare the prognostic value of fetal Doppler in dichorionic twins and singletons by measuring the interval between diagnosis of an abnormal Doppler flow and birth in fetuses who are small for gestational age (SGA).DesignComparative retrospective study using a prospectively collected database.SettingA level 3 maternity unit in France.PopulationFetuses from singleton and dichorionic pregnancies who are SGA (vascular or unexplained), defined by an abdominal circumference (AC) measurement below the 10th percentile and confirmed by a birth weight below the 10th percentile.MethodsFisher's exact and Chi-2 tests were used to compare frequencies, and the Mann-Whitney-Wilcoxon test was used to compare medians in non-Gaussian distributions.Main outcome measuresBoth neonatal outcomes and intervals between the first Doppler abnormality and birth were compared in the groups of dichorionic twins and singletons.ResultsObstetric and neonatal outcome were similar in the 104 SGA dichorionic twins and 170 SGA singletons. Abnormalities of umbilical artery Doppler, regardless of type, appeared at the same frequency in both groups (52.9%) but were identified earlier in twins (25 versus 28 weeks, p = 0.02). Among fetuses with abnormal Doppler flow, the interval between the finding and birth was significantly longer in the twins than the singletons (44 vs 15 days, p<0.01).ConclusionsThe prognostic value of an abnormal Doppler finding for the course of a pregnancy may be different in dichorionic twins and singletons. The management of women carrying SGA twins and the information provided to them should take these results into account.

422: Poor detection of small for gestational age and discordant growth among twins irrespective of body mass index: a multicenter Study

ObjectiveTo determine the rate of identification of small for gestational age (SGA) or discordant growth among twins and if the detection varies with maternal body mass index (MBMI).Study DesignAnalysis of all non-anomalous liveborn twins, without twin-twin transfusion syndrome, and ultrasound before 22 weeks, delivered at 3 academic tertiary centers over 5 years. MBMI at 1st prenatal visit was categorized into 3 groups: non-obese < 30, obese 30-39.9 and morbidly obese > 40 kg/m2. SGA was defined as birthweight <10th percentile for gestational age (GA) and discordance as >20% difference in ultrasound estimated fetal weights or birthweights. We also sub-analyzed for detection of birthweights < 5% for GA. Chi-square test for independence was used to compare the 3 groups.ResultsOf the 848 twins delivered, 363 (43%) met inclusion criteria. While 62% were non-obese, 27% were obese and 11% were morbidly obese. Overall, before delivery SGA was detected in only 31% of twin A and 27% of twin B. About one-half (48%) of discordant twins were identified in the antepartum period.The rate of chorionicity was similar in all 3 groups, as was the incidence of SGA and detection rate of SGA for twin A and twin B. Results were similar for newborns with birthweight < 5% for GA. Identification of discordant growth did not differ significantly (Table).Tabled 1ConclusionIrrespective of maternal BMI, the majority of SGA twins were undetected before birth. Future studies should focus on alternative techniques to improve the detection rate of sub-optimal growth among twins. ObjectiveTo determine the rate of identification of small for gestational age (SGA) or discordant growth among twins and if the detection varies with maternal body mass index (MBMI). To determine the rate of identification of small for gestational age (SGA) or discordant growth among twins and if the detection varies with maternal body mass index (MBMI). Study DesignAnalysis of all non-anomalous liveborn twins, without twin-twin transfusion syndrome, and ultrasound before 22 weeks, delivered at 3 academic tertiary centers over 5 years. MBMI at 1st prenatal visit was categorized into 3 groups: non-obese < 30, obese 30-39.9 and morbidly obese > 40 kg/m2. SGA was defined as birthweight <10th percentile for gestational age (GA) and discordance as >20% difference in ultrasound estimated fetal weights or birthweights. We also sub-analyzed for detection of birthweights < 5% for GA. Chi-square test for independence was used to compare the 3 groups. Analysis of all non-anomalous liveborn twins, without twin-twin transfusion syndrome, and ultrasound before 22 weeks, delivered at 3 academic tertiary centers over 5 years. MBMI at 1st prenatal visit was categorized into 3 groups: non-obese < 30, obese 30-39.9 and morbidly obese > 40 kg/m2. SGA was defined as birthweight <10th percentile for gestational age (GA) and discordance as >20% difference in ultrasound estimated fetal weights or birthweights. We also sub-analyzed for detection of birthweights < 5% for GA. Chi-square test for independence was used to compare the 3 groups. ResultsOf the 848 twins delivered, 363 (43%) met inclusion criteria. While 62% were non-obese, 27% were obese and 11% were morbidly obese. Overall, before delivery SGA was detected in only 31% of twin A and 27% of twin B. About one-half (48%) of discordant twins were identified in the antepartum period.The rate of chorionicity was similar in all 3 groups, as was the incidence of SGA and detection rate of SGA for twin A and twin B. Results were similar for newborns with birthweight < 5% for GA. Identification of discordant growth did not differ significantly (Table).Tabled 1 Of the 848 twins delivered, 363 (43%) met inclusion criteria. While 62% were non-obese, 27% were obese and 11% were morbidly obese. Overall, before delivery SGA was detected in only 31% of twin A and 27% of twin B. About one-half (48%) of discordant twins were identified in the antepartum period.The rate of chorionicity was similar in all 3 groups, as was the incidence of SGA and detection rate of SGA for twin A and twin B. Results were similar for newborns with birthweight < 5% for GA. Identification of discordant growth did not differ significantly (Table). ConclusionIrrespective of maternal BMI, the majority of SGA twins were undetected before birth. Future studies should focus on alternative techniques to improve the detection rate of sub-optimal growth among twins. Irrespective of maternal BMI, the majority of SGA twins were undetected before birth. Future studies should focus on alternative techniques to improve the detection rate of sub-optimal growth among twins.

Language assessment of non‐handicapped twins at 5 years of age

The aim of the present study was to determine language levels in twins and singletons born after at least 34 weeks gestation and without identifiable neurological abnormality and to evaluate whether in vitro fertilization (IVF) affects language development in twin pregnancies. A prospective study of a large cohort of all children born between 1 January 2001 and 31 December 2003 was carried out at Gazi University Hospital. All live-born twin pairs in which both twins survived were identified, and a comparable sample of families with pairs of singletons were chosen. The Stanford-Binet Intelligence Scale Form and the translated Turkish form of the Peabody Picture Vocabulary Test were completed at 60 months. Even after excluding the most premature twins and those with diagnosable neurological damage, twins performed worse than singletons on language development tests. Twin girls had better scores than twin boys. A statistically significant difference was found between the scores of term and preterm twins. No significant difference was noted when compared according to birth order. Appropriate for gestational age (AGA) twins did better than small for gestational age (SGA) twins in the test scores. All twin girls did not differ from singleton girls, but all twin boys performed worse than singleton boys. Term twins had similar results with term singletons, but preterm twins had lower scores than preterm singletons. SGA singletons had better scores than SGA twins, while AGA twins and singletons did not differ. When the children were compared with regard to method of conception, IVF children had significantly lower scores on the tests than those in the spontaneous conception group. It is hoped that the present findings could lead to a more precise assessment of children for speech impairment and, above all, to more efficient preventive intervention. Whatever mechanisms are involved, the present results indicate that twins born as a result of IVF, are at a disadvantage in terms of language development in comparison with spontaneously conceived twins.

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.

Fetal Adiponectin and Resistin in Correlation with Birth Weight Difference in Monozygotic Twins with Discordant Growth

Background: Various studies have demonstrated an increased risk for adult diseases in newborns born small-for-gestational-age (SGA). Adiponectin and resistin can be detected in cord blood and are suggested to affect insulin resistance (IR). This might represent a link between metabolic syndrome and SGA birth. Study Design: We investigated the relationship between the adipocytokines and inter-twin birth weight (BW) difference of 31 monozygotic twins with twin-twin transfusion syndrome; in 14 twin pairs BW difference was >15% (1 SGA twin, 1 appropriate-for-gestational-age, AGA, twin). Results: BW and length of all patients were positively related to adiponectin (r = 0.57; p < 0.0001; r = 0.47; p < 0.0001) and to resistin (r = 0.31; p < 0.01; r = 0.35; p < 0.01). In 71% (10/14), the SGA twins showed lower adiponectin concentrations than their AGA co-twins (only 6/14 for resistin). To correct for gestational age we calculated the relationship between the intrapair differences (Δ) of BW and Δ of the hormones. We found ΔBW positively correlated with adiponectin (r = 0.55; p < 0.001) but not with resistin (r = 0.22; p = 0.2). Δadiponectin was positively correlated with Δresistin (r = 0.45; p < 0.01). Conclusion: These data demonstrate that adiponectin and resistin levels are associated with BW with only adiponectin levels being reduced in SGA children independently of gestational age. Prenatally different metabolic status between the twins might predispose the SGA twin to develop IR later in life.

Bone, lean and fat mass of newborn twins versus singletons

Twin gestations are associated with disturbed fetal growth. The aim of this study was to compare body composition measurements of twins to those of singletons. Anthropometric and dual energy X-ray absorptiometry (DXA) measurements were performed in twins and in matched singleton neonates. There were 48 pairs of twins in which 76 infants were appropriate for gestational age (AGA) with birth weights between the 10th and 90th percentile and 20 were small for gestational age (SGA) with birth weights <10th percentiles. Each AGA twin was matched as closely as possible for birth weight to an AGA singleton. Each SGA twin was matched with two cohorts of AGA singletons: one with similar birth weight and one with similar gestation. For AGA twins and their singleton cohort matched for birth weights, profile analysis using repeated measure analysis of variance showed that there were no significant differences in bone, fat and lean mass either as absolute values or as percentage of total weight. This was also the case for body composition of SGA twins compared to singletons matched for birth weight. In contrast, SGA twins have significantly lower absolute amounts of lean with tendency to lower fat and bone mass. For clinically normally grown neonates, with comparable weight, the body composition with respect to bone, fat and lean mass components are similar regardless whether they are products of singleton or twin pregnancies.

Bone, lean and fat mass of newborn twins versus singletons

Abstract Aim: Twin gestations are associated with disturbed fetal growth. The aim of this study was to compare body composition measurements of twins to those of singletons. Methods: Anthropometric and dual energy X‐ray absorptiometry (DXA) measurements were performed in twins and in matched singleton neonates. There were 48 pairs of twins in which 76 infants were appropriate for gestational age (AGA) with birth weights between the 10th and 90th percentile and 20 were small for gestational age (SGA) with birth weights &lt;10th percentiles. Each AGA twin was matched as closely as possible for birth weight to an AGA singleton. Each SGA twin was matched with two cohorts of AGA singletons: one with similar birth weight and one with similar gestation. Results: For AGA twins and their singleton cohort matched for birth weights, profile analysis using repeated measure analysis of variance showed that there were no significant differences in bone, fat and lean mass either as absolute values or as percentage of total weight. This was also the case for body composition of SGA twins compared to singletons matched for birth weight. In contrast, SGA twins have significantly lower absolute amounts of lean with tendency to lower fat and bone mass. Conclusion: For clinically normally grown neonates, with comparable weight, the body composition with respect to bone, fat and lean mass components are similar regardless whether they are products of singleton or twin pregnancies.

Placental lesions associated with abnormal growth in twins.

Abnormal growth in one or both twins may contribute to the increased morbidity and mortality observed in twin gestation. Our objective in this retrospective study of all twin pregnancies delivered at our hospital (n = 240) over a 2-year period was to study the relationship between placental lesions and abnormal growth. Standardized placental examinations were performed in 192 cases (80%), which constituted the study population. Two growth abnormalities were studied: discordant growth as defined by > 15% difference in birth weight and small-for-gestational-age (SGA) birth as defined by birth weight less-than the 10th percentile for gestational age. The majority of twin pregnancies with either discordant growth (41/57 cases) or SGA birth (26/35 cases) had dichorionic placentas. In monochorionic placentas studied by injection there was no significant relationship between vascular anastomoses and discordant growth. Placental weight for small discordant and SGA twins was equivalent or increased relative to infant weight, a pattern not suggestive of maternal vascular underperfusion. Eight lesions, five considered to represent chronic placental disease and three considered to represent intrauterine adaptation, were studied as possible predictors of abnormal growth. The overall prevalence of these lesions in twin placentas was less than that seen in singleton births. Concordance between twin placentas for most lesions was higher than would be expected, based on their prevalence in singleton placentas. Two lesions were associated with discordant growth in both univariate and multivariate analyses: peripheral cord insertion (OR 3.6, 95% CI 1.7-7.6) and avascular villi (AV; OR 3.2, 95% CI 1.0-10.3). Three placental lesions were associated with SGA infants at the univariate level: peripheral cord insertion, avascular villi, and maternal vascular underperfusion. Only peripheral cord insertion (OR 9.8, 95% CI 4.1-23.4) and AV (OR 3.7, CI 1.0-13.7) were significant in the multivariate analysis. The relative increase in peripheral cord insertion and AV with abnormal growth was observed for both monochorionic and dichorionic placentas. Subgroups of discordant infants with and without SGA were both associated with peripheral cord insertion while only those with SGA had an increase in AV. Both peripheral cord insertion and AV were increased in the subgroup with SGA but no discordancy. In summary, two placental lesions, peripheral cord insertion indicating a spatially limited intrauterine compartment and AV indicating occlusion of fetal vessels in the placenta, were associated with abnormal growth in twins.

Predicting infant temperament from neonatal reactivity for AGA/SGA twin pairs.

The predictive relation between neonatal reactivity and 12-, 18-, and 24-month temperament was assessed for 22 appropriate-for-gestational-age (AGA)/small-for-gestational-age (SGA) twin pairs. Neonatal reactivity included ratings of visual and auditory orienting responses to a bull's-eye, rattle, bell, voice, and face plus voice combined, as well as alertness. Infant temperament ratings were made of emotional tone, activity, attentiveness, and social orientation to staff during age-appropriate activities in the laboratory. There were no group differences in the neonatal or infant ratings. For AGA twins, a pattern of predictive correlations was obtained between neonatal reactivity and temperament at each age. A similar predictive pattern was not observed for the SGA twins. Group differences in rates of maturation related to stresses associated with intrauterine growth retardation influenced the significance of the neonatal variables for later temperament development.