The Guinea-Bissau Twin Registry Update: A Platform for Studying Twin Mortality and Metabolic Disease

Abstract

Sub-Saharan Africa has the highest natural twinning rate in the world. Unfortunately, due to lack of adequate care during pregnancy, labor and postnatally, twin mortality in Sub-Saharan Africa also remains very high. Thus, it has been estimated that one in five twins dies during the childhood years. In spite of this, surprisingly few twin studies have been conducted in the region, making additional epidemiological data much needed. In 2009, we established one of the first twin registries in Sub-Saharan Africa at the Bandim Health Project in Guinea-Bissau. The registry had two main objectives. First, we wanted to describe the twinning rate and mortality patterns among newborn twins, including mortality risk factors and hospitalization patterns. Such studies can help the local clinicians improve twin health by identifying the most vulnerable children. Second, and in light of the rapidly increasing diabetes rates in Africa, we wanted to use the registry to particularly focus on metabolic disorders. Twins are often born with low birth weight, which according to the ‘thrifty phenotype hypothesis’ could predispose them to metabolic disorders later in life. Yet, no such ‘fetal programming’ data have previously been available from African twins despite the fact that nutritional patterns and influences from other factors (e.g., infections) could be markedly different here compared to high-income settings. In this article, we summarize the findings and current status of the Guinea-Bissau twin registry.

Twins in Guinea-Bissau have a ‘thin-fat’ body composition compared to singletons

“…This secondary analysis from the Guinea-Bissau twin registry, using previously collected data 17 , was prompted by the description of 'thin-fat' body composition of the Indian compared to the European newborns. The Indian phenotype persists in later life and is thought to result from maternal-fetal undernutrition of macro-and micronutrients 4,7,9 .…”

“…This is a secondary analysis of previously collected (2009-2012) data from one of Africa's first twin registries set up by the Bandim Health Project (BHP) in Guinea-Bissau 19 . The BHP is a health and demographic surveillance site (HDSS), conducting epidemiological and health related research in the capital Bissau over the past 40 years.…”

“…The copyright holder for this preprint this version posted July 8, 2021. ; https://doi.org/10.1101/2021.07.07.21260161 doi: medRxiv preprint In Africa, there is a high natural twining rate, including in Guinea-Bissau, a low-income country 16 . A twin registry was set up by the Bandim Health Project (BHP, www.bandim.org) in the capital city of Bissau 17 . Follow up of twins in this registry showed that young twins had higher plasma glucose concentrations both in fasting and in the post-prandial state compared to age-matched singletons 18,19 .…”

Twins in Guinea-Bissau have a ‘thin-fat’ body composition compared to singletons

“…17,18 A twin registry was set up by the Bandim Health Project (BHP, www.bandim.org) in the capital city of Bissau. 19 Follow-up of twins in this registry showed that young twins had higher plasma glucose concentrations both in fasting and in the post-glucose state compared to age-matched singletons. 20,21 This study measured skinfolds in addition to the routine anthropometry and provided an opportunity to compare adiposity of twins with that of singletons.…”

“…This is a secondary analysis of previously collected (2009-2012) data from one of Africa's first twin registries set up by the Bandim Health Project (BHP) in Guinea-Bissau. 19 The BHP is a health and demographic surveillance site (HDSS), conducting epidemiological and health related research in the capital Bissau over the past 40 years. The results of the two main metabolic twin studies have previously been reported.…”