Neonatology, Department of Pediatrics, Leiden University Medical Center, Willem-Alexander Children's Hospital, Leiden, The Netherlands.
Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Endocrinol. 2023 Aug 2;189(2):183-189. doi: 10.1093/ejendo/lvad103.
Research suggests that postnatal catch-up growth after fetal growth restriction (FGR) occurs frequently. Yet, postnatal growth in singletons may be influenced by multiple factors. Identical twins with discordant prenatal growth, termed selective FGR (sFGR), can be regarded as a natural experiment eliminating these sources of bias.
Observational cohort study.
Monochorionic twins with sFGR born between 2002 and 2017 (aged 3-17 years) were eligible. Growth measurements (height, weight, head circumference, and body mass index) were performed at follow-up. Detailed growth curves documented by a systematic primary care system in the Netherlands were collected. Measurements were converted to standard deviation scores (SDSs). A mixed-effects model was used to assess within-pair SDS difference and individual height SDS relative to target height SDS.
Forty-seven twin pairs (94 children) were included at a median age of 11 (interquartile range 8-13) years. At the last measurement, smaller twins at birth had a lower height SDS [-0.6 vs -0.3, P < .001, median difference 0.5 (95%CI 0.4-0.7)], lower weight SDS [-0.5 vs -0.1, P < .001, median difference 0.8 (95%CI 0.5-1.0)], and lower head circumference SDS [-0.5 vs 0.2, P < .001, median difference 0.8 (95%CI 0.6-0.9)] compared to larger twins. These differences persisted until the age of 17. Smaller twins showed rapid catch-up growth in the first 2 years and reached their target height range between 8 and 11 years.
Identical twins with discordant prenatal growth maintain a modest but significant difference in height, weight, and head circumference, indicating a persistent, inhibitory effect of an adverse intrauterine environment on childhood growth.
研究表明，胎儿生长受限（FGR）后常有产后追赶性生长。然而，单胎新生儿的生长可能受到多种因素的影响。具有不同产前生长的同卵双胞胎，称为选择性 FGR（sFGR），可以被视为消除这些偏倚来源的自然实验。
观察性队列研究。
符合条件的是 2002 年至 2017 年间出生的具有 sFGR 的单绒毛膜双胞胎（年龄 3-17 岁）。在随访时进行生长测量（身高、体重、头围和体重指数）。从荷兰的一个系统初级保健系统收集了详细的生长曲线。测量值被转换为标准差评分（SDS）。使用混合效应模型评估对双胞胎内 SDS 差异和个体身高 SDS 相对于目标身高 SDS 的个体差异。
47 对双胞胎（94 名儿童）纳入研究，中位年龄为 11 岁（四分位距 8-13 岁）。在最后一次测量时，出生时较小的双胞胎身高 SDS 较低[-0.6 对-0.3，P<0.001，中位数差值 0.5（95%CI 0.4-0.7）]，体重 SDS 较低[-0.5 对-0.1，P<0.001，中位数差值 0.8（95%CI 0.5-1.0）]，头围 SDS 较低[-0.5 对 0.2，P<0.001，中位数差值 0.8（95%CI 0.6-0.9）]。这些差异一直持续到 17 岁。较小的双胞胎在前 2 年迅速追赶生长，并在 8-11 岁之间达到其目标身高范围。
具有不同产前生长的同卵双胞胎在身高、体重和头围方面保持着适度但显著的差异，表明宫内环境不良对儿童生长有持续的抑制作用。
