Disparity in fetal growth between twin and singleton gestation: the role of adipokines

Cord blood adiponectin and leptin concentrations in monochorionic twins with selective intrauterine growth restriction and their associations with childhood growth trajectories

BACKGROUND

Being born with intrauterine growth restriction (IUGR) was associated with subsequent health issues later in life. However, the underlying role of adipokines in IUGR is unknown.

OBJECTIVES

To measure the adiponectin and leptin concentrations in the cord blood of monochorionic (MC) twins with selective IUGR (sIUGR) and evaluate their associations with childhood growth trajectories.

METHODS

Cord blood samples were collected from 22 pairs of MC twins with sIUGR and 20 pairs of normal MC twins. Adiponectin and leptin concentrations in cord blood were determined by ELISA. Data regarding perinatal outcomes and infantile growth trajectories from birth to 24 months were obtained.

RESULTS

Only cord blood adiponectin concentrations were associated with IUGR (β -1.51, 95% CI -2.45, -0.57, p = 0.002), and cord blood leptin concentrations were significantly lower in sIUGR twins compared to normal twins (2.8 ± 1.6 vs. 6.4 ± 3.0, p < 0.001). Adiponectin concentrations were negatively associated with height increments from birth to 6 months (β -0.28, 95% CI -0.51, -0.06, p = 0.015). Leptin concentrations were negatively associated with weight at 6 and 24 months (β -0.12 95% CI -0.22, -0.02, p = 0.002; β -0.18 95% CI -0.33, -0.03, p = 0.019) and weight and height increments from birth to 6 months (β -0.17 95% CI -0.29, -0.06, p = 0.020; β -0.40 95% CI -0.81, -0.01, p = 0.037).

CONCLUSION

Cord blood adiponectin concentrations were negatively associated with IUGR but did not predict childhood growth. Cord blood leptin concentrations were inversely associated with weight and height increments in the first 6 months.

Cord blood adiponectin and leptin are associated with a lower risk of stunting during infancy

Undernutrition is responsible for up to 45% of deaths in children under five, with low- and middle-income countries disproportionately affected. Adipokines are known modulators of metabolism and have been linked to growth rates and neurocognition during infancy. We examined the relationship(s) between cord blood adiponectin and leptin and both longitudinal growth and cognition during the first year of life using generalized estimating equations. Infants were classified as underweight (weight-for-age z-score [WAZ]), stunted (height-for-age z-score [HAZ]) or wasted (weight-for-height z-score [WHZ]) using WHOAnthro software. Cord blood adiponectin and leptin levels were highly correlated (r = 0.35, P < 0.0001) and positively associated with birth WAZ (r = 0.34 and r = 0.45, P < 0.0001, respectively). Adipokines were independently, inversely associated with weight gain. Infants in the highest quintile of adipokine production had a lower risk of being stunted, while neither was associated with lower WAZ or WHZ in final adjusted models. Cognition was not found to be independently related to cord blood leptin or adiponectin. The negative association with adipokines and rate of weight gain during infancy may reflect heightened nutritional status at birth rather than a direct hormonal influence. The relationship between leptin or adiponectin and longitudinal length gains suggests that both adipokines may promote linear growth during infancy.

Plasma Adipokines Profile in Prepubertal Children with a History of Prematurity or Extrauterine Growth Restriction

Adipose tissue programming could be developed in very preterm infants with extrauterine growth restriction (EUGR), with an adverse impact on long-term metabolic status, as was studied in intrauterine growth restriction patterns. The aim of this cohort study was to evaluate the difference in levels of plasma adipokines in children with a history of EUGR. A total of 211 school age prepubertal children were examined: 38 with a history of prematurity and EUGR (EUGR), 50 with a history of prematurity with adequate growth (PREM), and 123 healthy children born at term. Anthropometric parameters, blood pressure, metabolic markers and adipokines (adiponectin, resistin, leptin) were measured. Children with a history of EUGR showed lower values of adiponectin (μg/mL) compared with the other two groups: (EUGR: 10.6 vs. PREM: 17.7, p < 0.001; vs. CONTROL: 25.7, p = 0.004) and higher levels of resistin (ng/mL) (EUGR: 19.2 vs. PREM: 16.3, p =0.007; vs. CONTROL: 7.1, p < 0.001. The PREM group showed the highest values of leptin (ng/mL), compared with the others: PREM: 4.9 vs. EUGR: 2.1, p = 0.048; vs. CONTROL: 3.2, p = 0.029). In conclusion, EUGR in premature children could lead to a distinctive adipokines profile, likely associated with an early programming of the adipose tissue, and likely to increase the risk of adverse health outcomes later in life.