4.2 | Strengths and limitations
The main strengths of the study are, first, to reveal altered neonatal hair metabolome in response to early intrauterine environment dysbiosis of DCDA twins with growth discordance. Secondly,
we evidenced that hair metabolic variations in utero may be associated with poor neurocognitive development of growth discordance in DCDA twins.
Our findings are subject to the following limitations. Only 14 DCDA-D twin pairs were included in this study because BW discrepancy increases the risk of neonatal complications and infant mortality, making it challenging to follow up both co-twins at 2~3 years old. A longer follow-up study of larger sample size should be performed to evaluate the metabolic effects of the intrauterine environment reflected by using multiple various biospecimens on the later neurobehavioral development.