Distinct birth size and postnatal growth patterns in preterm twins and singletons: an etiology-based analysis from the INTERPRACTICE-21st study
Abstract Objective Compare birth size and postnatal growth between preterm twins and singletons across gestational age categories and etiologic subgroups. Study design Preterm twins and singletons ( n = 3245) were classified into nine subgroups based on predefined preterm birth etiologies. Postnatal growth (weight, length and head circumference) trajectories were evaluated using multilevel linear regression models accounting for repeated measurements, expressed as z-score changes from birth to hospital discharge based on INTERGROWTH-21 st Standards. Results Twins were significantly smaller at birth than singletons, particularly in late preterm category, but not in the very preterm category. Twin postnatal growth was slower (unadjusted models); most differences attenuated or reversed after adjusting for birth size and key covariates. Twins in the ‘pre-eclampsia’ subgroup showed greater adjusted postnatal weight, whereas weight gain was persistently lower in the ‘perinatal sepsis’ subgroup. Conclusion Preterm twins and singletons have distinct intrauterine and postnatal growth patterns, varying by preterm birth etiology and gestational age categories.
Authors
- Irina Ryumina
- Constanza P. Soto Conti (ORCID: https://orcid.org/0000-0002-5542-704X)
- Gabriela Tavcioska
- Shabina Ariff (ORCID: https://orcid.org/0000-0002-9627-2662)
- Montserrat Izquierdo Renau (ORCID: https://orcid.org/0000-0003-4415-8099)
- Francesca Giuliani (ORCID: https://orcid.org/0000-0002-4265-207X)
- Sonia Deantoni (ORCID: https://orcid.org/0000-0002-8072-2593)
- Paola Roggero (ORCID: https://orcid.org/0000-0003-2667-4620)
- Funda Tüzün (ORCID: https://orcid.org/0000-0001-5348-1168)
- Brenda Eskenazi (ORCID: https://orcid.org/0000-0001-7609-6852)
- Aris T. Papageorghiou (ORCID: https://orcid.org/0000-0001-8143-2232)
- Camilla Menis
- Jacqueline Gyapomaa Asibey
- Robert B. Gunier (ORCID: https://orcid.org/0000-0001-5485-9919)
- Alexandre Lapillonne (ORCID: https://orcid.org/0000-0002-1872-4176)
- Stephen A. Rauch (ORCID: https://orcid.org/0000-0002-6721-4287)
- Leila Cheikh Ismail (ORCID: https://orcid.org/0000-0003-3048-7481)
- Adele Winsey (ORCID: https://orcid.org/0009-0002-5020-3984)
- Ricardo Nieto
- Roseline Ochieng (ORCID: https://orcid.org/0000-0002-3818-7486)
- Chandrakala Bada Shekharappa (ORCID: https://orcid.org/0009-0005-8102-4120)
- Stephen Kennedy
- Zulfiqar Bhutta
- Monica Fumagalli
- Jose Villar
- Irma Alejandra Coronado Zarco
- Fabio Mosca
- Marina Markelova
- Maria Albertina S. Rego
- Brenda Frias Madrid
- Josephine N. A. Agyeman-Duah
Institutions
- Universidade Federal de Minas Gerais (BR)
- Aga Khan University (PK)
- Hôpital Necker-Enfants Malades (FR)
- Hospital Sant Joan de Déu Barcelona (ES)
- Dokuz Eylül University (TR)
- Aga Khan University Hospital Nairobi (KE)
- Hospital for Sick Children (CA)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- University of Sharjah (AE)
- University of Oxford (GB)
- Instituto Nacional de Perinatología (MX)
- Assistance Publique – Hôpitaux de Paris (FR)
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of the Ministry of Healthcare of the Russian Federation (RU)
- Ospedale Regina Margherita (IT)
- St.John's Medical College Hospital (IN)
- University of Turin (IT)
- University of California, Berkeley (US)
Publication Details
- Journal
- Journal of Perinatology
- Published
- 2026-10-14
- DOI
- https://doi.org/10.1038/s41372-026-02912-6
- Primary Topic
- Assisted Reproductive Technology and Twin Pregnancy
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Family Larsson‐Rosenquist Foundation
- National Institute for Health and Care Research
- University of Oxford