Lem, A.J.

Short Adolescents Born Small for Gestational Age : Gonadal and thyroid function, bone mineral density, quality of life and adult height: The effects of growth hormone and additional postponement of puberty (Doctoral Thesis)

2012-11-09T00:00:00Z

From 1991, our research group and others have been investigating children with short stature who were born small for gestational age (SGA), both before and during treatment with biosynthetic growth hormone (GH). In 2005, GH treatment was licensed for short SGA children in the Netherlands. Many questions though remained unanswered, especially about the efficacy of GH treatment when started at an older age, just before or during puberty. This doctoral thesis describes studies evaluating short adolescents born SGA who were treated with GH, and additionally with postponement of puberty by gonadotropin-releasing hormone analogue (GnRHa).

Anti-Müllerian hormone in short girls born small for gestational age and the effect of growth hormone treatment (Article)

2011-04-01T00:00:00Z

Background Fetal growth restriction is thought to negatively influence reproductive function in later life. Serum anti-Mllerian hormone (AMH) is a marker of the primordial follicle pool. The objectives of this study were to evaluate the effect of being born small for gestational age (SGA) on serum AMH levels and to investigate the effect of growth hormone (GH) treatment on serum AMH levels in short SGA girls.Methods Serum AMH levels were investigated in 246 prepubertal girls aged 310 years: 119 untreated short SGA and 127 healthy controls. Associations between AMH levels and clinical characteristics were analysed using multiple regression analyses. In addition, we investigated the effect of GH treatment on serum AMH levels in short SGA girls.Results Serum AMH levels were similar in short SGA and healthy control girls (P 0.95). In short SGA girls, AMH levels were not significantly influenced by birth weight standard deviation score (SDS), birth length SDS and gestational age, even after adjustment for age, height SDS and body mass index (BMI) SDS at sampling, socio-economic status and maternal smoking during gestation. Serum AMH levels did not change during 4 years of GH treatment in short SGA girls (P 0.43). Conclusions Serum AMH levels in prepubertal short SGA girls are similar to healthy controls, indicating that the follicle pool is not compromised due to SGA birth. GH treatment has no effect on AMH levels in short SGA girls.

Should short children born small for gestational age with a distance to target height <1 standard deviation score be excluded from growth hormone treatment? (Article)

2010-09-01T00:00:00Z

Context The criteria for starting growth hormone (GH), an approved treatment for short children born small for gestational age (SGA), differ between Europe and the USA. One European requirement for starting GH, a distance to target height (DTH) of ≥1 standard deviation score (SDS), is controversial. Objective To investigate the influence of DTH on growth during GH treatment in short SGA children and to ascertain whether it is correct to exclude children with a DTH <1 SDS from GH. Patients A large group of short prepubertal SGA children (baseline n = 446; 4 years GH n = 215). Measurements We analysed the prepubertal growth response during 4 years of GH. We investigated the influence of the continuous variable DTH SDS on growth response and a possible DTH SDS cut-off level below which point the growth response is insufficient. Results Height gain SDS during 4 years of GH showed a wide variation at every DTH SDS level. Multiple regression analyses demonstrated that, after correction for other significant variables, an additional DTH of 1 SDS resulted in 0·13 SDS more height gain during 4 years of GH. We found no significant differences in height gain below and above certain DTH SDS cut-off levels. Conclusions DTH SDS had a weak positive effect on height gain during 4 years of GH, while several other determinants had much larger effects. We found no support for using any DTH cut-off level. Based on our data, excluding children with a DTH <1 SDS from GH treatment is not justified.