Low Birth Weight Linked To Early Puberty and Shortened Stature

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MedicalResearch.com Interview with:
Sandra Schulte (candidate Medicine)
University Hospital Bonn
Dept. Ped. Endocrinology and Diabetology

MedicalResearch: What is the background for this study? What are the main

Response: Low birth weight, unfavourable intrauterine conditions and
post-natal catch-up-growth are associated with impaired
growth, accelerated pubertal maturation and metabolic
disturbances later in life. However, normally, study
designs cannot rule out the influence of different genetic
backgrounds and familiar environments between their
subjects and control groups. Therefore, we recruited a
very special study cohort, solely composed of monozygotic
twins. These twins had significant differences in
birthweight, due to twin-to-twin-transfusion-syndrome
(TTTS). Because of irregular placental anastomoses, one
twin, the recipient, receives more blood becoming
hypertensive and polyuric, leading to polyhydramnios and
ultimately congestive heart failure and hydrops fetalis.
In contrast, the donor twin becomes hypovolemic,
hypotensive and oliguric, leading to oligohydramnios and
growth restriction. We followed 30 pairs of these twins
regularly from birth up to this current follow-up at a
mean age of 14.6 years, to examine the impact of a lower
birthweight on auxologic development and pubertal
maturation later in life.

MedicalResearch: What are the main findings?

Response: We could show that a low birthweight had an impact not
only on growth but also on pubertal maturation. In our
twin pairs the initially smaller twins started pubertal
maturation earlier, were farther advanced in Tanner stages
at the clinical examinations, and menarche occurred
earlier in the initially smaller girls. The differences
were most pronounced in those twins with marked
birthweight-differences. Here, in all but one female pair,
the initially smaller twin experienced menarche first. The
already decreased height in some low bw infants might be
additionally diminished by an early start and fast
progression of pubertal maturation. By regarding the
long-term-growth-pattern, we could show that the former
smaller twins lost height to their co-twins during
pubertal maturation. The differing onset of puberty could
not be explained by diverging levels in gonadotropins or
sexual steroids, because we did not find any significant
differences. Instead, we found highly significant
intra-twin correlation coefficients for testosterone in
male pairs and even for pulsatile gonadotropins in all
twin pairs, suggesting that pubertal maturation,
gonadotropins and sexual steroids might be genetically
determined. However, a different result was found for
adrenal hormones: at around ten years of age, we found
significant intra-twin differences for DHEAS and –
although not significant – for androstenedione. The former
smaller twins had higher DHEAS-levels than their co-twins.
At 14.6 years, a pronounced difference was still notable
in those twins with a marked birthweight difference. We
postulate that the observed adrenal androgen
hypersecretion of the smaller twin during late childhood
may have an effect on pubertal maturation and the rate of
growth. This might then further decrease final height and
increase the risk for the PCOS and insulin resistance.

MedicalResearch: What should clinicians and patients take away from your

Response: Children born with a low birthweight should be monitored
closely regarding their pubertal and auxologic development
and signs of hyperandrogenism. A premature adrenarche
might be followed by an early gonadarche and a rapid
progression through pubertal maturation, leaving less time
to reach predicted adult height. If a low-birthweight
child is already at risk of a decreased adult height, a
paediatric endocrinologist should be involved as soon as

MedicalResearch: What recommendations do you have for future research as a
result of this study?

Response: Future research should try to acquire more knowledge about
the long-term endocrinologic and metabolic consequences.
Furthermore, a better understanding of bone-maturation in
low-birthweight-infants could be useful.

MedicalResearch: Is there anything else you would like to add?

Response: We would like to thank all of our TTTS-families, who have
been participating constantly through all these years.


Birthweight Differences in Monozygotic Twins Influence Pubertal Maturation and Near Final Height Schulte, Sandra et al.
The Journal of Pediatrics , Volume 0 , Issue 0 DOI: http://dx.doi.org/10.1016/j.jpeds.2015.12.020
Published Online:January 12, 2016

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Sandra Schulte (2016). Low Birth Weight Linked To Early Puberty and Shortened Stature