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Adiponectin and Leptin Concentrations in Dichorionic Twins with Discordant and Concordant Growth

Department of Obstetrics and Gynecology (S.M.-T., Y.Y., A.W., E.Sc., E.Si.) and Institute of Endocrinology (H.K., C.P., R.H.), Sheba Medical Center, Tel-Hashomer, Israel 52621; and Sackler School of Medicine (H.K., E.Sc., E.Si.), Tel Aviv University, Tel Aviv Israel 69978

Address all correspondence and requests for reprints to: Eyal Sivan, MD., Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel 52621. E-mail: eyal.sivan{at}gmail.com.

Context: Discordant twin gestation, in which one fetus is growth restricted, is a unique model that can elucidate the mechanism(s) by which the intrauterine environment affects fetal growth.

Objective: The objective of the study was to determine the cord blood adiponectin and leptin concentrations and evaluate their association with birth weight in dichorionic twins, with and without growth discordance.

Design, Setting, Participants, and Main Outcome Measure: In this cross-sectional study, arterial cord blood adiponectin and leptin concentrations were determined in two groups of newborns: 1) discordant twins, in which one of the twins is growth restricted (small for gestation age and abnormal umbilical arteries Doppler) and the other is appropriate for gestation age (AGA) (n = 14 pairs); and 2) concordant twins, in which both twins are AGA (n = 15 pairs).

Results: Results were: 1) within the discordant twins group, the median adiponectin concentration was significantly lower in the growth-restricted newborns than in their cotwins (P = 0.004); 2) within the concordant twin group, there was no significant difference in the median cord blood adiponectin concentration between the two AGA twins; 3) the median leptin concentration did not differ between the twins pairs in both study groups; 4) a positive correlation between cord blood adiponectin concentrations and both birth weight (r = 0.7, P < 0.001) and gestational age (r = 0.6, P < 0.02) was found only in the small-for-gestational-age newborns; 5) linear regression model revealed that birth weight is independently associated with circulating adiponectin concentration.

Conclusions: Low circulating adiponectin concentrations, previously reported in adults, children, and infants who were born small for gestational age, characterize fetuses with growth restriction and are independently associated with birth weight.