title: Preliminary report of altered insulin secretion pattern in monochorionic twin pregnancies complicated with selective intrauterine growth restriction.
abstract: OBJECTIVE
  Fetuses with intrauterine growth restriction (IUGR) have adaptive hormonal changes including changes in insulin, which may increase their future risks for developing diabetes mellitus. This study compared cord blood insulin concentrations in IUGR and appropriate for gestational age (AGA) fetuses in a monochorionic (MC) twin model.
  
  
  METHODS
  Ten pairs were classified as selective IUGR (sIUGR) based on having one twin weight below the 10th percentile and with an intertwin birth weight discordance>20%. Fourteen pairs without IUGR were included as a comparison group. Pregnancies with twin-twin transfusion syndrome, congenital structural malformations, and genetic abnormalities were excluded. Insulin and glucose concentrations were measured in cord venous blood at the time of delivery.
  
  
  RESULTS
  Cord blood insulin concentrations of sIUGR fetuses were significantly lower than those of AGA counterpart fetuses in MC twins affected by sIUGR (5.1±4.1 mU/L, range: 0.7-9.9 mU/L for sIUGR fetuses and 12.2±7.6 mU/L, range: 3.5-23.7 mU/L for AGA fetuses, p=0.019). No significant difference in insulin concentrations between larger and smaller fetuses in MC twins without IUGR was observed. Insulin concentration was inversely correlated with gestational age of delivery in all fetuses except in those with sIUGR. We did not find any difference in cord blood glucose concentrations between the two fetuses in both groups.
  
  
  CONCLUSIONS
  Our data show reduced insulin secretion and loss of the physiological decline in concentration over time as gestational age increases in fetuses with sIUGR compared to AGA counterparts.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Tao-Yuan, Taiwan. Electronic address: j12054@cgmh.org.tw.
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
authors.forename: Tzu-Hao
authors.initials: TH
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, Mutah University Al-Karak, Jordan.
authors.forename: Seham M
authors.initials: SM
authors.lastname: Abufraijeh
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
authors.forename: Shuenn-Dyh
authors.initials: SD
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
authors.forename: An-Shine
authors.initials: AS
authors.lastname: Chao
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
authors.forename: Peter C C
authors.initials: PCC
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D001724:Birth Weight; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D005317:Fetal Growth Retardation / Q000097:blood*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007328:Insulin / Q000097:blood* / Q000378:metabolism; D000078790:Insulin Secretion; D011247:Pregnancy; D059285:Pregnancy, Twin; D014430:Twins, Monozygotic; D016216:Ultrasonography, Prenatal
chemical_list: D007328:Insulin
keywords: growth restriction; insulin; monochorionic twins