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Fetal Insulin-Like Growth Factor (IGF)-I, IGF-II, and Ghrelin in Association with Birth Weight and Postnatal Growth in Monozygotic Twins with Discordant Growth

Departments of Pediatrics (B.C.G., C.L.R.), Statistics (R.F.), and Neonatology (P.B.), University of Bonn, 53113 Bonn, Germany; and Department of Obstetrics and Fetal Medicine (A.H., K.H.), University Clinic Hamburg-Eppendorf, 20246 Hamburg, Germany

Address all correspondence and requests for reprints to: Dr. B. Gohlke, Zentrum für Kinderheilkunde, der Universität Bonn, Adenauerallee 119, 53113 Bonn, Germany. E-mail: gohlke-bonn{at}t-online.de.

Objective: To investigate the relative contribution of genetic (fetal) vs. environmental (maternal/placental) factors on growth, we studied monozygotic twins with intertwin birth weight difference.

Patients and Methods: Twenty-seven twins (15 with discordant growth) who have been treated for severe twin-to-twin transfusion syndrome by laser coagulation were studied. Cord blood samples were analyzed for IGF-I, IGF-II, IGF-binding protein-2, and ghrelin. Intertwin difference () of birth weight was correlated to of the parameters analyzed. The weight after 1 yr was correlated with birth weight and all hormones.

Results: The birth weight was positively correlated with IGF-I (r = 0.66; P < 0.0002) and negatively correlated with IGF-binding protein-2 levels (r = –0.68; P < 0.001) but with neither IGF-II nor ghrelin. There was a strong intertwin correlation for all hormones. By comparing the growth in the first year, we found an overall reduction of the relative weight difference between the twins of 57%. ANOVA was used to calculate factors for prediction of postnatal catch-up growth. Besides the birth weight difference (R² = 0.84; P < 0.0001), only ghrelin was of prognostic value for postnatal catch-up growth (R² = 0.94; P = 0.0035).

Conclusion: These data confirm the importance of IGF-I in contrast to IGF-II for fetal weight. Additionally, ghrelin seems to be involved in fetal and probably postnatal growth.

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