Human Reproduction, Vol. 18, No. 8, 1565-1569,
August 2003
© 2003 European Society of Human Reproduction and Embryology
Hypergonadotrophinaemia with reduced uterine and ovarian size in women born small-for-gestational-age
1 Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, 2 Hormonal Laboratory and 3 Department of Radiology, Hospital Materno-Infantil Vall d’Hebron, Autonomous University of Barcelona, 4 Endocrinology Unit, Hospital de Terrassa, Terrassa, Spain and 5 Department of Pediatrics, University of Leuven, Belgium
6 To whom correspondence should be addressed at: Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain. e-mail: libanez{at}hsjdbcn.org
BACKGROUND: Fetal growth restraint has been associated with FSH hypersecretion in early infancy and in early post-menarche, and with reduced uterine and ovarian size in adolescence. It is unknown whether these reproductive anomalies persist, respectively, into late infancy and into the reproductive age range. METHODS: We report follow-up findings in two age groups of girls. A cohort of infants [n = 26; n = 10 born appropriate-for-gestational-age (AGA) and n = 16 born small-for-gestational-age (SGA)], who had been studied at the age of 
4 months, was assessed again at the age of 12 months. A cohort of teenagers (n = 28), who had been studied at the age of 14 years, was assessed again at the age of 18 years; this group was complemented by a transversal cohort of similar age (n = 19) for a total of 47 young women (n = 27 AGA; n = 20 SGA). In infants, only serum FSH was measured; adolescents underwent endocrine-metabolic screening, ultrasound assessment of uterine-ovarian size, and evaluation of body composition by dual X-ray absorptiometry. RESULTS: Serum FSH levels were higher in SGA than AGA infant girls at 4 and 12 months, and higher in SGA than AGA adolescents at 14 and 18 years (all P < 0.01). Longitudinal ultrasound assessments disclosed a late-adolescent increment of uterine size that was less obvious in SGA than AGA girls. In contrast, ovarian volume remained stable in both subgroups. Compilation of longitudinal and transversal results at 18 years of age corroborated the persistent reduction in the uterine size of SGA girls (by 20%; P < 0.005) and in their ovarian volume (by 40%; P < 0.0001); moreover, SGA girls displayed not only a persistent elevation of FSH (by 50%; P < 0.001), but also a rise of LH and fasting insulin, as well as an excess of abdominal fat (all P < 0.01). CONCLUSIONS: The gynaecology of young women born SGA was found to be characterized by hypergonadotrophinaemia and by a reduced uterine and ovarian size.
Key words: FSH/LH/ovary/small-for-gestational-age/uterus
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