Influence of intrauterine and extrauterine growth on neurodevelopmental outcome of monozygotic twins

Abstract

There have been indications that intrauterine and early extrauterine growth can influence childhood mental and motor function. The objective of the present study was to evaluate the influence of intrauterine growth restriction and early extrauterine head growth on the neurodevelopmental outcome of monozygotic twins. Thirty-six monozygous twin pairs were evaluated at the corrected age of 12 to 42 months. Intrauterine growth restriction was quantified using the fetal growth ratio. The effects of birth weight ratio, head circumference at birth and current head circumference on mental and motor outcomes were estimated using mixed-effect linear regression models. Separate estimates of the between (interpair) and within (intrapair) effects of each measure on development were thus obtained. Neurodevelopment was assessed with the Bayley Scales of Infant Development, 2nd edition, by a psychologist blind to the exposure. A standardized neurological examination was performed by a neuropediatrician who was unaware of the exposures under investigation. After adjustment, birth weight ratio and head circumference at birth were not associated with motor or mental outcomes. Current head circumference was associated with mental but not with motor outcomes. Only the intrapair twin effect was significant. An increase of 1 cm in current head circumference of one twin compared with the other was associated with 3.2 points higher in Mental Developmental Index (95%CI = 1.06-5.32; P < 0.03). Thus, no effect of intrauterine growth was found on cognition and only postnatal head growth was associated with cognition. This effect was not shared by the co-twin.

Cognitive outcome in childhood of birth weight discordant monochorionic twins: the long-term effects of fetal growth restriction

“…Our study results are similar to those of Torche et al ,28 Edmonds et al ,29 Bellido-Gonzalez et al 30 and Goyen et al 31 but are in contrast to the studies by Reolan et al 32 and Stauffer et al 33. Torche et al 28 showed IUGR has effect on children’s cognitive development, as measured by test scores in primary school.…”

“…Goyen et al 31 found that the mean GQ of the lighter twins was lower than the larger twins at the age of 3 years but had only seven discordant MC twins. Reolan et al 32 showed a significant association between postnatal head growth with Mental Developmental Index between 12 and 42 months of age. However, there was sampling bias as only 36 twin pairs recruited out of possible 65 twin pairs.…”

Early postnatal nutrition and programming of the preterm neonate

“…Postnatal dietary undernutrition and concurrent extrauterine growth restriction are associated with adverse consequences, the most notable of which is long-term neurodevelopmental deficits. [22][23][24][25] Improved cognitive performance at 18 months and at 7-8 years has been demonstrated in children who were born preterm and received a nutrient-enriched preterm formula compared to those receiving standard infant formula. 26 However, postnatal over-nutrition, and rapid catch-up growth, also appears to place the preterm infant at risk.…”

Acquisition of motor abilities up to independent walking in very low birth weight preterm infants

“…Em 36 pares de gêmeos monozigóticos, dos quais 58% eram prematuros, não foi detectada influência da restrição do crescimento intrauterino no desenvolvimento motor e mental, avaliado pelas escalas Bayley entre 12 e 42 meses de idade corrigida 22 . Entretanto, vários estudos mostram associação entre o crescimento fetal e pós-natal e o desenvolvimento neurocognitivo.…”