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Mackie FL, Hall MJ, Morris RK, Kilby MD. Early prognostic factors of outcomes in monochorionic twin pregnancy: systematic review and meta-analysis. Am J Obstet Gynecol 2018; 219:436-446. [PMID: 29763608 DOI: 10.1016/j.ajog.2018.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/11/2018] [Accepted: 05/07/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Monochorionic twin pregnancies are high-risk, however at present, no screening test is available to predict which monochorionic twin pregnancy will develop complications. OBJECTIVE We sought to assess ability of first-trimester pregnancy-related factors (ultrasound measurements, maternal characteristics, biomarkers) to predict complications in monochorionic twin pregnancies. DATA SOURCES Data sources were MEDLINE, Embase, ISI Web of Science, CINAHL, the Cochrane Central Registration of Controlled Trials and Research Registers, and Google Scholar, from inception to May 12, 2017. Gray literature and bibliographies of articles were checked. STUDY ELIGIBILITY CRITERIA Studies that reported ultrasound measurements, maternal characteristics, or potential biomarkers, measured in the first trimester in monochorionic-diamniotic twin pregnancies, where the potential prognostic ability between the variable and twin-twin transfusion syndrome, growth restriction, or intrauterine fetal death could be assessed, were included. STUDY APPRAISAL AND SYNTHESIS METHODS Quality assessment was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology checklist by 2 reviewers independently. For meta-analysis, odds ratios using a random effects model, or standardized mean difference were calculated. If a moderate association was found, the prognostic ability was evaluated by calculating the sensitivity and specificity. Risk of heterogeneity was reported as I2 and publication bias was visually assessed by funnel plots and quantitatively by Egger test. RESULTS In all, 48 studies were eligible for inclusion. Twenty meta-analyses could be performed. A moderate association was demonstrated in 3 meta-analyses, between: nuchal translucency >95th centile in one/both fetuses and twin-twin transfusion syndrome (odds ratio, 2.29 [95% confidence interval, 1.05-4.96], I2 = 6.6%, 4 studies, 615 pregnancies); crown-rump length discordance ≥10% and twin-twin transfusion syndrome (odds ratio, 2.43 [95% confidence interval, 1.13-5.21], I2 = 14.1%, 3 studies, 708 pregnancies); and maternal ethnicity and twin-twin transfusion syndrome (odds ratio, 2.12 [95% confidence interval, 1.17-3.83], I2 = 0.0%, 5 studies, 467 pregnancies), but none demonstrated a prognostic ability for any outcome under investigation. CONCLUSION It is not currently possible to predict adverse outcomes in monochorionic twin pregnancies. We have revealed a lack of research investigating first-trimester biomarkers in monochorionic twin pregnancies. Different assessment methods and definitions of each variable and outcome were an issue and this highlights the need for a large cohort study to evaluate these factors.
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Affiliation(s)
- Fiona L Mackie
- Center for Women's and Children Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.
| | - Matthew J Hall
- Medical School, University of Birmingham, Birmingham, United Kingdom
| | - R Katie Morris
- Center for Women's and Children Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; West Midlands Fetal Medicine Centre, Birmingham Women's and Children's National Health Service Foundation Trust, Edgbaston, United Kingdom
| | - Mark D Kilby
- Center for Women's and Children Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; West Midlands Fetal Medicine Centre, Birmingham Women's and Children's National Health Service Foundation Trust, Edgbaston, United Kingdom
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Milenković S, Jankovic B, Mirković L, Jovandaric MZ, Milenković D, Otašević B. Lipids and Adipokines in Cord Blood and at 72 h in Discordant Dichorionic Twins. Fetal Pediatr Pathol 2017; 36:106-122. [PMID: 27841711 DOI: 10.1080/15513815.2016.1242675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) is a risk factor for developing metabolic syndrome later in life. We explored whether adipokine concentrations in cord blood (CB) and on day 3 (D3) were related to impaired fetal growth and lipids in IUGR twins. PATIENTS AND METHODS Thirty-six discordant (birth weight [BW] discordance ≥20% calculated in relation to the heavier co-twins) and 42 concordant (BW discordance ≤ 10%) twin pairs were included. RESULTS In IUGR twins, both adiponectin/BW and triglyceride (TG) levels were significantly higher, while total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol were lower in CB. On D3, both leptin and HDL-C levels were significantly lower and TG levels were significantly higher in IUGR twins. In the discordant group, the alterations in lipids were not related to any adipokine. CONCLUSIONS IUGR is related to lower leptin level and proatherogenic lipid profile (higher TG and lower HDL-C), which are not influenced by adipokine at birth.
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Affiliation(s)
- Svetlana Milenković
- a Clinic for Gynecology and Obstetrics , Neonatology, Clinical Center of Serbia , Belgrade , Serbia
| | - Borisav Jankovic
- b Institute for Mother and Child Health "Dr Vukan Čupić ," Belgrade , Serbia.,c School of Medicine , University of Belgrade , Belgrade , Serbia
| | - Ljiljana Mirković
- c School of Medicine , University of Belgrade , Belgrade , Serbia.,d Clinic for Gynecology and Obstetrics , Perinatology, School of Medicine, Clinical Center of Serbia , Belgrade , University of Belgrade
| | - Miljana Z Jovandaric
- a Clinic for Gynecology and Obstetrics , Neonatology, Clinical Center of Serbia , Belgrade , Serbia
| | - Dušan Milenković
- e Center for Anesthesia and Resuscitation , Clinical Center of Serbia , Belgrade , Serbia
| | - Biljana Otašević
- a Clinic for Gynecology and Obstetrics , Neonatology, Clinical Center of Serbia , Belgrade , Serbia
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Milenković SJ, Mirković LB, Jovandarić MZ, Milenković DM, Banković VV, Janković BZ. Leptin and adiponectin levels in discordant dichorionic twins at 72 hours of age-associations with anthropometric parameters and insulin resistance. J Pediatr Endocrinol Metab 2017; 30:417-426. [PMID: 28306538 DOI: 10.1515/jpem-2016-0352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/30/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Insulin resistance (IR) in adults has been associated with intrauterine growth restriction (IUGR). Leptin and adiponectin correlations with anthropometric parameters and IR at 72 h in discordant twins were tested. METHODS We included 24 discordant (birth weight discordance ≥20% in relation to the heavier cotwin) and 30 concordant (birth weight discordance ≤10%) twins. RESULTS A correlation between leptin (but not adiponectin) level and birth weight (BW), birth length and head circumference in IUGR twins was recorded (p<0.05). Insulin sensitivity (IS) and homeostatic model assessment (HOMA)-IR in IUGR twins were similar to appropriate-for-gestational-age cotwins and unrelated to adipokines. In IUGR twins, adiponectin and insulin associated positively. In larger concordant twins' leptin level correlated with HOMA-IR and insulin. CONCLUSIONS Leptin, but not adiponectin, levels correlate positively with anthropometric parameters in IUGR twins. IR in IUGR twins is unrelated to adipokines in the first few days of life.
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Affiliation(s)
- Svetlana J Milenković
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia - Neonatology, Višegradska 26, Belgrade 11000
| | | | | | - Dušan M Milenković
- Center for Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade
| | - Violeta V Banković
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade
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Milenković SJ, Mirković LB, Jovandarić MZ, Milenković DM, Banković VV, Janković BZ. Leptin and adiponectin levels in discordant dichorionic twins at 72 hours of age-associations with anthropometric parameters and insulin resistance. J Pediatr Endocrinol Metab 2017; 30. [DOI: doi: 10.1515/jpem-2016-0352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
AbstractBackground:Insulin resistance (IR) in adults has been associated with intrauterine growth restriction (IUGR). Leptin and adiponectin correlations with anthropometric parameters and IR at 72 h in discordant twins were tested.Methods:We included 24 discordant (birth weight discordance ≥20% in relation to the heavier cotwin) and 30 concordant (birth weight discordance ≤10%) twins.Results:A correlation between leptin (but not adiponectin) level and birth weight (BW), birth length and head circumference in IUGR twins was recorded (p<0.05). Insulin sensitivity (IS) and homeostatic model assessment (HOMA)-IR in IUGR twins were similar to appropriate-for-gestational-age cotwins and unrelated to adipokines. In IUGR twins, adiponectin and insulin associated positively. In larger concordant twins’ leptin level correlated with HOMA-IR and insulin.Conclusions:Leptin, but not adiponectin, levels correlate positively with anthropometric parameters in IUGR twins. IR in IUGR twins is unrelated to adipokines in the first few days of life.
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Kim KJ, Kim JY, Park SJ, Yoon H, Yoon CH, Kim WU, Cho CS. Serum leptin levels are associated with the presence of syndesmophytes in male patients with ankylosing spondylitis. Clin Rheumatol 2012; 31:1231-8. [PMID: 22644087 DOI: 10.1007/s10067-012-1999-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 03/31/2012] [Accepted: 05/08/2012] [Indexed: 10/28/2022]
Abstract
The aim of this study is to clarify the association between serum leptin levels and the presence of syndesmophytes in male patients with ankylosing spondylitis (AS). Seventy-two male patients with AS and 20 age-matched healthy male controls were included. Patients were stratified by the presence of syndesmophytes. Serum leptin levels were measured and adjusted for body mass index (BMI). In addition, bone-specific alkaline phosphatase (BALP), osteocalcin, and telopeptide of type I collagen were determined. Patients with syndesmophytes were associated with older age (p < 0.001), longer disease duration (p = 0.003), and higher BMI (p = 0.038). Serum leptin levels and leptin per BMI (leptin/BMI) ratio were not different between AS patients and healthy controls. However, serum leptin/BMI ratio was significantly higher in patients with syndesmophytes compared to those without (p = 0.010). In multivariate analysis, higher serum leptin/BMI ratio remained significantly associated with the presence of syndesmophytes (p = 0.029). Moreover, serum leptin/BMI ratio was positively correlated with serum BALP (γ = 0.279, p = 0.039). However, there was no significant association between serum leptin/BMI ratio and bone mineral density. Serum leptin levels are elevated in male AS patients with syndesmophytes and were found to be correlated with bone formation marker, suggesting a potential role of leptin in new bone formation in AS.
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Affiliation(s)
- Ki-Jo Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Fisher A, Srikusalanukul W, Davis M, Smith P. Interactions between Serum Adipokines and Osteocalcin in Older Patients with Hip Fracture. Int J Endocrinol 2012; 2012:684323. [PMID: 22518129 PMCID: PMC3296446 DOI: 10.1155/2012/684323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 12/17/2011] [Indexed: 12/15/2022] Open
Abstract
Introduction. Experiments on genetically modified animals have discovered a complex cross-regulation between adipokines (leptin, adiponectin) and osteocalcin. The relationships between these molecules in human osteoporosis are still unclear. We evaluated the hypothesis of a bidirectional link between adipokines and osteocalcin. Materials and Methods. In a cross-sectional study of 294 older patients with osteoporotic hip fracture, we estimated serum concentrations of leptin, adiponectin, resistin, osteocalcin, parameters of mineral metabolism, and renal function. Results. After adjustment for multiple potential confounders, serum osteocalcin concentration was inversely associated with resistin and positively with leptin, leptin/resistin ratio, and adiponectin/resistin ratio. In multivariate regression models, osteocalcin was an independent predictor of serum leptin, resistin, leptin/resistin, and adiponectin/resistin ratios. Conclusions. Our data support the bidirectional regulation between osteocalcin and adipokines, but contrary to the genetically modified animal models, in older subjects with osteoporotic hip fracture, serum osteocalcin is positively associated with leptin and inversely with resistin.
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Affiliation(s)
- Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, P.O. Box 11, Woden, ACT 2606, Australia
- Australian National University Medical School Canberra, Canberra, ACT 0200, Australia
- *Alexander Fisher:
| | - Wichat Srikusalanukul
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, P.O. Box 11, Woden, ACT 2606, Australia
- Australian National University Medical School Canberra, Canberra, ACT 0200, Australia
| | - Michael Davis
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, P.O. Box 11, Woden, ACT 2606, Australia
- Australian National University Medical School Canberra, Canberra, ACT 0200, Australia
| | - Paul Smith
- Australian National University Medical School Canberra, Canberra, ACT 0200, Australia
- Department of Orthopaedic Surgery, The Canberra Hospital, P.O. Box 11, Woden, ACT 2606, Australia
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Cheng J, Peng K, Jin E, Zhang Y, Liu Y, Zhang N, Song H, Liu H, Tang Z. Effect of additional boron on tibias of African ostrich chicks. Biol Trace Elem Res 2011; 144:538-49. [PMID: 21461669 DOI: 10.1007/s12011-011-9024-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 03/07/2011] [Indexed: 11/11/2022]
Abstract
The aim of the present study was to find out the effects of boron on ostrich chicks fed with 0 mg/l, 100 mg/l, 200 mg/l, and 400 mg/l of additional boron in water. We measured bone mineral density (BMD), perimeter, length, weight, ash content of ostrich tibias, thickness of cortical bone, and diameter of the marrow cavity. We also analyzed the apoptosis status of paraffin sections using a TUNEL kit and examined serum levels of leptin and estradiol (E(2)). The results were dramatic. Compared with the control group, group C had a very high BMD. The serum levels of leptin in groups C and D were significantly higher than control values, and the levels of E(2) fluctuated. The perimeter, length, weight, and ash content of ostrich tibias all increased significantly with increasing dosage of boron. The cross-section analysis revealed that the bone marrow cavity shifted closer to one side in group D, which was observed on a macro-scale. This shift may be related to the toxicity of excessive boron, as indicated by the apoptosis status. According to the present data, additional boron was helpful for ostrich chick bone development, and 200 mg/l supplement boron in the drinking water appeared to be the most beneficial.
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Affiliation(s)
- Jiayue Cheng
- College of Animal Science and Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China
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Mazaki-Tovi S, Kanety H, Pariente C, Hemi R, Yinon Y, Wiser A, Schiff E, Sivan E. Adiponectin and leptin concentrations in dichorionic twins with discordant and concordant growth. J Clin Endocrinol Metab 2009; 94:892-8. [PMID: 19066299 DOI: 10.1210/jc.2008-2118] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
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.
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Affiliation(s)
- Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel 52621
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Abstract
Body weight impacts both bone turnover and bone density, making it, therefore, an important risk factor for vertebral and hip fractures and ranking it alongside age in importance. The effect of body weight is probably contributed to by both fat mass and lean mass, though in postmenopausal women, fat mass has been more consistently demonstrated to be important. A number of mechanisms for the fat-bone relationship exist and include the effect of soft tissue mass on skeletal loading, the association of fat mass with the secretion of bone active hormones from the pancreatic beta cell (including insulin, amylin, and preptin), and the secretion of bone active hormones (e.g., estrogens and leptin) from the adipocyte. These factors alone probably do not fully explain the observed clinical associations, and study of the actions on bone of novel hormones related to nutrition is an important area of further research. An understanding of this aspect of bone biology may open the way for new treatments of osteoporosis. More immediately, the role of weight maintenance in the prevention of osteoporosis is an important public health message that needs to be more widely appreciated.
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Affiliation(s)
- I R Reid
- University of Auckland, Auckland, New Zealand.
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Current World Literature. Curr Opin Obstet Gynecol 2007; 19:596-605. [DOI: 10.1097/gco.0b013e3282f37e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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