Zemet R, Shulman Y, Hemi R, Brandt B, Sivan E, Kanety H, Mazaki-Tovi S
Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Perinatol. 2018 Jan;38(1):35-40. doi: 10.1038/jp.2017.152. Epub 2017 Oct 19.
Twin pregnancies are characterized by unique pattern of attenuated fetal weight gain during late gestation compared with singleton gestation. The mechanism(s) responsible for regulating twin growth has not yet elucidated. Leptin and adiponectin are two adipocytokines implicated in metabolism and energy balance of fetuses, newborns and adults. Moreover, these hormones have been suggested to play a role in fetal growth. The objective of the study was to determine cord blood adiponectin and leptin in twins and singletons, with and without growth impairment.
This was a case-control study. It included two groups of newborns, matched for gestational age and birth weight percentile: singleton (n=60 newborns) and twins (n=44 newborns). Adiponectin and leptin were determined in cord blood, and compared between the groups according to clinical and demographic characteristics. Non-parametric and parametric statistical methods were employed.
Median adiponectin and leptin concentrations were lower in twins vs singletons (P<0.001 for both comparisons). Among small for gestational age newborns (SGA), median concentration of adiponectin (P=0.04), but not leptin (P=0.1), was lower in twins compared to singletons. In pooled analysis (singleton plus twins), cord blood adiponectin and leptin were strongly correlated with gestational age (P<0.001 and P=0.005, respectively) and birth weight (P<0.001 and P<0.001, respectively). Regression analysis revealed that plurality (P=0.02) was significantly and independently associated with cord blood adiponectin concentrations, after adjustment for confounding variables. Similar regression in which leptin was the independent variable revealed that only birth weight (P=0.01) was significantly and independently associated with cord blood leptin concentrations.
Twin pregnancies are associated with lower cord blood concentrations of adiponectin and leptin compared with singleton gestations. However, only cord blood adiponectin, but not leptin, was lower in SGA neonates. Collectively, these data suggest that adiponectin may be implicated in the mechanism accounting for the growth disparity between twins and singletons.
与单胎妊娠相比，双胎妊娠的特点是妊娠晚期胎儿体重增加模式独特。调节双胎生长的机制尚未阐明。瘦素和脂联素是两种与胎儿、新生儿及成人代谢和能量平衡相关的脂肪细胞因子。此外，这些激素被认为在胎儿生长中起作用。本研究的目的是测定双胎和单胎新生儿脐带血中脂联素和瘦素水平，以及有无生长受限的情况。
这是一项病例对照研究。研究对象包括两组按胎龄和出生体重百分位数匹配的新生儿：单胎（n = 60 例新生儿）和双胎（n = 44 例新生儿）。测定脐带血中脂联素和瘦素水平，并根据临床和人口统计学特征在两组间进行比较。采用非参数和参数统计方法。
双胎新生儿脐带血中脂联素和瘦素的中位数浓度低于单胎新生儿（两项比较 P 均<0.001）。在小于胎龄新生儿（SGA）中，双胎新生儿脂联素的中位数浓度低于单胎新生儿（P = 0.04），但瘦素浓度无差异（P = 0.1）。在汇总分析（单胎加双胎）中，脐带血脂联素和瘦素与胎龄（分别为 P<0.001 和 P = 0.005）及出生体重（分别为 P<0.001 和 P<0.001）密切相关。回归分析显示，在调整混杂变量后，多胎因素（P = 0.02）与脐带血脂联素浓度显著且独立相关。以瘦素为自变量的类似回归分析显示，只有出生体重（P = 0.01）与脐带血瘦素浓度显著且独立相关。
与单胎妊娠相比，双胎妊娠的脐带血脂联素和瘦素浓度较低。然而，SGA 新生儿中只有脐带血脂联素浓度较低，瘦素浓度无差异。总体而言，这些数据表明脂联素可能参与了双胎与单胎生长差异的机制。
