Fetal inflammatory responses of twin pairs with birth weight discordance

Abstract

OBJECTIVE: Fetal growth restriction (FGR) is a risk factor for hypertension and cardiovascular disease in adult life. Recent studies reported that FGR is associated with fetal systemic inflammatory response in singleton neonates. The aim of this study was to evaluate whether the fetal inflammatory responses determined by umbilical cord plasma CRP concentrations are different between smaller twins and their larger co-twins. STUDY DESIGN: Out of 935 twin pairs delivered in our hospital from Jan 1999 to Jun 2009, we recruited 39 consecutive dichorionic twin pairs who met the following criteria: (1) delivered by cesarean section, (2) birth weight discordance 20%, (3) absence of labor and/or rupture of membranes, (4) absence of congenital anomaly. Six cases were excluded because of lack of remaing cord blood. High sensitivity CRP of umbilical cord plasma was measured with ELISA kit (Immunodiagnostik AG, Bensheim, Germany) to compare the intensity of fetal inflammatory responses in a twin pair. Paired nonparametirc method was used for analysis. RESULTS: 1) Umbilical cord plasma CRP concentration of smaller twin was higher than that of larger co-twin in 76% (25/33) (P .01); 2) Smaller twins had a significantly higher cord blood CRP concentration than did their larger co-twins (mean SD; 73.1 147.4 ng/mL vs. 35.8 60.8 ng/mL; P .05); 3) There was no significant difference in the umbilical cord plasma CRP level between presenting twin and non-presenting co-twins. CONCLUSION: These observations support that growth restriction is associated with fetal inflammatory response even in a discordant twin pair who shares genetic, maternal and intrauterine environment factors.