Maternal Education is a Major Factor in Growth Regulation in Twins and Singletons

Abstract

Background: The social, economic, political, and emotional (SEPE) environment plays a crucial role in shaping human development both pre- and post-birth, with direct and independent effects on growth, as research shows. Objectives: This study examines the growth of twins and singletons and their association with maternal education as one of the social-economic (SE) variables. Methods: This cross-sectional study utilized Nutritional Status Monitoring for Children under 5 Years Old in Bandung District in September 2019. A total of 158 healthy children aged < 5 years, involving 35 twins (70 children) and 88 singletons, were included. Data on weight and length at birth and weight and length/height taken at age 8.6 to 60 months were plotted according to WHOCGS 2006. Statistical analyses and visualizations, including SE variables analysis, were conducted using density plots, correlation plots, St. Nicolas House Analysis (SNHA), and ANOVA. Results: At birth, z-scores of the body length, weight, and body mass index (BMI) of twins were lower than those of singletons (P < 0.05). After birth, z-scores of twins' length/height, weight, and BMI adjusted to those of singletons, with maternal education being the strongest among SE variables of early childhood growth adjustment. Conclusions: Twins were shorter, lighter, and had a lower average BMI at birth than singletons. There was no apparent association between birth measurements and SE variables. However, after birth, maternal education starts to gain a central position in regulating child growth.