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Normal and abnormal growth of multiples.

Isaac Blickstein1

  • 1Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel. blick@netvision.net.il

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|September 18, 2002
PubMed
Summary

Multiple fetuses adapt to uterine conditions, often appearing smaller than singletons but not necessarily growth-restricted. Significant size differences can arise from unequal nutrient supply within the uterus.

Area of Science:

  • Perinatology
  • Maternal-Fetal Medicine
  • Neonatology

Background:

  • Singleton growth curves do not accurately represent fetal development in multiple gestations (twins and triplets).
  • While individual fetuses in multiples may be smaller than singletons, most are not small for gestational age (SGA) by singleton standards.
  • Multiple gestations exhibit 'growth promotion' in total fetal mass compared to singletons, with individual size differences representing adaptation.

Purpose of the Study:

  • To analyze growth patterns and discordance in twin and triplet pregnancies.
  • To differentiate between growth adaptation and growth restriction in multiples.
  • To investigate the impact of the uterine environment on fetal growth and size equality in multiple births.

Main Methods:

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  • Analysis of growth curves from large twin and triplet series.
  • Comparison of fetal size and birth weight discordance in relation to gestational age.
  • Evaluation of the uterine environment's role in fetal development and nutrient distribution.

    • Main Results:

    • Individual fetal size in multiples is better described as growth adaptation rather than restriction.
    • Significant birth weight discordance often stems from unequal nurturing by the uterine environment.
    • Mild size discordance may appear after mid-gestation as a compensatory mechanism for maturity.
    • A competent uterine environment supports increased total birth weight and decreased discordance.

    Conclusions:

    • Fetal growth in multiples is a complex adaptation to uterine capacity and resource allocation.
    • Birth weight discordance in multiples is a marker of the uterine environment's ability to support equitable fetal growth.
    • Failed adaptation to the uterine environment can lead to significant growth restriction and discordance in multiple gestations.