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Turk Arch Pediatr
Turk Arch Pediatr
Turkish Archives of Pediatrics
2757-6256
Turkish Pediatrics Association

10.5152/TurkArchPediatr.2024.24123
tap-59-5-513
Letter to the Editor
Intrauterine Growth References for Turkish Infants
Al-Mendalawi Mahmood Dhahir http://orcid.org/0000-0003-2872-453X

Department of Paediatrics, University of Baghdad Al-Kindy College of Medicine, Baghdad, Iraq
Corresponding author:Mahmood Dhahir Al-Mendalawi ક mdalmendalawi@yahoo.com
Cite this article as: Al-Mendalawi MD. Intrauterine growth references for Turkish infants. Turk Arch Pediatr. 2024;59(5):513-514 .

9 2024
01 9 2024
59 5 513514
27 5 2024
12 6 2024
2024 authors
2024
authors
https://creativecommons.org/licenses/by-nc/4.0/ Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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pmcIn the May 2024 issue of your prestigious journal, Atıcı et al1 formulated intrauterine growth charts (IGC) based on various anthropometric measurements for Turkish infants. The following limitation guards the clinical applicability of the formulated IGC. The evaluation of twin pregnancy utilizing singleton growth charts (SGC) is a matter of concern. Indeed, SGC could categorize approximately one-third of twins, both postnatally and prenatally, as small-for-gestational age (SGA). Importantly, infants categorized as SGA based on the twin-specific growth chart (TSGC), but not those categorized as SGA based on the SGC, have a substantially accelerated likelihood of poor neonatal outcomes in comparison with infants categorized as appropriate-for-gestational age.2 The utilization of TSGC could decrease the rate of twin fetuses with suspicious intrauterine growth restriction (IGR) by approximately 8-fold and could result in IGR diagnosis which is correlated more faithfully with poor perinatal consequences than IGR diagnosis relied upon SGC, without insulting the finding out of twin fetuses at susceptibility for poor outcomes induced by utero-placental inadequacy. Moreover, SGA twins have less susceptibility to exhibit worse perinatal outcomes or to have utero-placental insufficiency evidence than SGA singletons.3 As a result, using TSGC is considered reasonable and preferred over SGC to gauge the growth of twin fetuses and predict neonatal morbidity and mortality.3 In Türkiye, the accessible data showed that the reported mean multiple pregnancies and mean twin birth rates were 1.9% and 1.7%, respectively. Most multiple pregnancies (80%-97.3%) were found to be twin pregnancies. There were high neonatal and perinatal mortality rates (40-98/1000 and 58-156/1000, respectively).4 Therefore, the use of IGC constructed by Atıcı et al1 in clinical settings and research to assess twin pregnancies would be misleading. The formulation of twin-specific IGC for Turkish infants, similar to those designed for certain populations5-6 is solicited as it is considered a guide for neonatologists to identify high-risk fetuses and neonates who might demand specialized health care.

Peer-review: Externally peer-reviewed.

Declaration of Interests: The author has no conflicts of interest to declare.
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References

1. Atıcı A Kanık A Çelik Y Helvacı İ , Turkish Neonatology Society Study Group. Intrauterine growth references for Turkish infants. Turk Arch Pediatr. 2024;59 (3 ):270 27 6.39140875
2. Briffa C Di Fabrizio C Kalafat E , et al. Adverse neonatal outcome in twin pregnancy complicated by small-for-gestational age: twin vs singleton reference charts. Ultrasound Obstet Gynecol. 2022;59 (3 ):377 3 84. (10.1002/uog.23764)34405924
3. Hiersch L Barrett J Fox NS Rebarber A Kingdom J Melamed N . Should twin-specific growth charts be used to assess fetal growth in twin pregnancies? Am J Obstet Gynecol. 2022;227 (1 ):10 28. (10.1016/j.ajog.2022.01.027)35114185
4. Sezer SD Küçük M Yüksel H , et al. Perinatal and neonatal outcomes of twin pregnancies in Turkey. Twin Res Hum Genet. 2011;14 (2 ):201 2 12. (10.1375/twin.14.2.201)21425905
5. Leroy B Lefort F Neveu P Risse RJ Trévise P Jeny R . Intrauterine growth charts for twin fetuses. Acta Genet Med Gemellol (Roma). 1982;31 (3-4 ):199 206. (10.1017/s0001566000008291)7170920
6. Xia YQ Lyu SP Zhang J , et al. Development of fetal growth charts in twins stratified by chorionicity and mode of conception: a retrospective cohort study in China. Chin Med J (Engl). 2021;134 (15 ):1819 18 27. (10.1097/CM9.0000000000001616)34238852
