medwireNews: Dutch research indicates that health-related quality of life (HRQoL) remains largely stable over the 12 years after completion of growth hormone (GH) therapy for short stature in children who were born small for gestational age (SGA-GH).
HRQoL was mostly similar at around age 30 years in the 176 SGA-GH participants and a comparison group of 99 adults born at an appropriate gestational age (AGA) with normal height, say Demi Dorrepaal, from the Erasmus Medical Center in Rotterdam, and co-workers.
However, the SGA-GH participants had lower scores on the TNO-AZL Adults QoL questionnaire than the AGA participants for measures of cognition, pain, vitality, happiness and anger, as well as more internalising and externalising problem behaviours according to the Adolescent Behavior Checklist.
The researchers say that this outcome was “also true” at around age 30 years for the 50 patients born SGA with short stature and the 77 patients born SGA who had spontaneous catch-up to normal height, “suggesting that lower HRQoL and more internalizing problem behavior are probably more related to the underlying condition of being born SGA than to GH-treatment.”
They add in The Journal of Clinical Endocrinology & Metabolism: “Adult height was negatively associated with externalizing problem behaviour, but the influence was small.”
The SGA-GH participants received GH therapy for an average of 8.5 years until they reached adult height at an average age of 15.9 years. The assessments were completed 6 months after finishing GH therapy and again after 2, 5 and 12 years. By the last assessment, the patients were aged an average of 28.6 years.
Over follow-up, the SGA-GH cohort had no significant changes in HRQoL for the subscales of cognition, social contacts, daily activities, sex, vitality, happiness, depressive mood and anger but did experience negative changes with regard to gross motor function, pain and sleep.
Nevertheless, after 12 years they experienced fewer internalising problems – self-reflecting behaviours, such as anxiety or depression – and fewer externalising problems – such as conflicts with other people and social mores – compared with baseline. Although levels of internalising problems were higher than in the AGA group, levels of externalising problems were lower, Dorrepaal et al observe.
There were significant differences between the SGA-GH, AGA and other SGA groups in terms of educational attainment, income and fat mass, but they were comparable in terms of chronic comorbidity, mental and psychiatric conditions, and lifestyle factors such as smoking, alcohol use and exercise.
The researchers say that SGA-GH adults were significantly more likely to be content with their adult height than the SGA adults with short stature (86 vs 60%) but less likely to be content than the AGA controls (95%) and the SGA adults with catch-up growth (91%).
The investigators also observe that patients in the various SGA groups were more likely to have chronic physical conditions, like asthma, migraine or thyroid disorders, than their AGA group counterparts, and had lower levels of education and income.
“The decrease in HRQoL subscale pain in SGA-GH adults, indicating more pain, is probably not related to cessation of GH-treatment but might be explained by the fact that SGA-GH adults had a lower educational level and probably more often a physical profession compared to AGA adults, which could have increased back pain or pain in joints and muscles,” Dorrepaal et al suggest.
By Lynda Williams
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