Objective To determine whether achievement of body mass index specific weight gain recommendations is associated with reduced preterm birth or neonatal morbidity among twin gestations. Study Design This was a retrospective cohort study of twin gestations delivered at the Medical University of South Carolina from 2000 to 2010. In total, 588 women in all prepregnancy body mass index categories who delivered ≥24 weeks' gestation were included. Women were grouped as achieved or underachieved based on total weight gain and gestational age at delivery. Maternal and neonatal outcomes were compared between the groups. Results Body mass index specific weight gain goals were achieved by 59.9% of women. The achieved group had a 1.5-fold reduction in the rate of preterm birth <32 weeks (18.8 vs. 30.5%; p = 0.001). Achievers had larger mean birthweights (2,146 ± 584 g vs. 1,859 ± 593 g; p < 0.001) and were significantly less likely to deliver either twin with a birthweight less than the 10th percentile for gestational age (larger twin 0.6 vs. 4.7%, p = 0.001; smaller twin 12.2 vs. 21.6%, p = 0.002). Composite neonatal morbidity, days on the respirator, length of hospital stay, and rate of neonatal intensive care unit admission were significantly decreased in the achieved group. Conclusion Achievement of body mass index specific weight gain goals improves preterm birth rates, neonatal birthweights, and composite neonatal outcomes in women carrying twins.

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INTRODUCTION: Elective induction of labor has increased over time resulting in higher cesarean delivery rates. Maternal and neonatal outcomes of pregnancies undergoing pre-induction cervical ripening at 39 weeks were compared with those induced at later gestational ages. METHODS: Retrospective cohort study of singleton pregnancies induced without a medical indication and a Bishop score less than 8 or simplified Bishop score less than 5 at 39 0/7-6/7, 40 0/7-6/7, and 41 0/7-6/7 weeks between 2006 and 2015. Specific individual maternal and neonatal outcomes were compared. Chi-square, One-way ANOVA, and Fisher exact test were used for statistical analysis. RESULTS: Of the 718 identified pregnancies, 143 (19.9%) were induced at 39 weeks, 240 (33.4%) at 40 weeks, and 335 (46.6%) at 41 weeks. Nulliparity was significantly higher in the 41-week group than in the 40-, and the 39-week groups (78.8%, 64.5%, and 37.7%, respectively; P < .00001). Among nulliparous women, cesarean delivery was significantly lower at 39 weeks (27.7%) than at 40 weeks (34.4%), and at 41 weeks (47.7%) (P=.0003). Conversely, cesarean delivery rate was low and not significantly different among multiparous women at each of the gestational age groups. Postpartum hemorrhage and chorioamnionitis rates were significantly higher at 41 weeks compared with the other groups (all P < .0001). NICU admission, 5-minute Apgar scores less than 7, respiratory distress syndrome, and neonatal death rates did not differ significantly among the groups. CONCLUSION: Elective induction of labor at 39 weeks with unfavorable cervix was associated with favorable maternal outcomes and low cesarean delivery rate.

OBJECTIVE: To determine whether achievement of body mass index (BMI)-specific weight gain recommendations is associated with a reduced risk of preterm birth (PTB) and improved neonatal outcomes among twin gestations. STUDY DESIGN: A retrospective cohort study of twin gestations delivered at the Medical University of South Carolina from 2000-2010. 588 women who delivered 24 weeks gestation in all prepregnancy BMI categories were included. Women with major fetal anomalies, fetal aneuploidy, twin-twin transfusion syndrome, cotwin fetal demise, and incomplete prenatal weight records were excluded. BMI-specific weight gain recommendations derived from Luke et al, J Reprod Med, 2003 were applied to each woman based on pre-pregnancy BMI. Women were assigned the designation of achieved or underachieved based on total weight gain and gestational age at delivery. Maternal and neonatal outcomes were compared between the groups. Our sample provides 80% power to detect a 50% difference in the rate of PTB < 32 weeks (p<0.05). RESULTS: BMI-specific weight gain goals were achieved by 49.3 % of women. The achieved group had a 2.5 fold reduction in the rate of preterm birth < 32 weeks (13 vs 34%). African Americans, women with an underweight pre-pregnancy BMI and women with a lower number of prenatal visits were significantly less likely to achieve recommended weight gain goals (Table 1). Women who achieved weight gain recommendations were significantly less likely to deliver any twin with a birth weight less than the tenth percentile for gestational age (larger twin, 0.3 vs 4.0 %, smaller twin 10.3 vs 21.5%). Composite neonatal morbidity, days on the respirator, length of hospital stay and rate of neonatal intensive care unit admission were significantly decreased in the achieved group. CONCLUSION: Achievement of BMI specific weight gain recommendations can decrease the incidence of preterm birth < 32 weeks and improve neonatal outcomes in twin gestations.

OBJECTIVE: Primary objective was to evaluate differences in twin birth weights (BW) between black and white parturients. Secondary objective was to determine the correlates of any observed disparity. STUDY DESIGN: We performed a retrospective cohort study of all dichorionic/diamniotic (DC) and monochorionic/diamniotic (MC) twin gestations delivered at a single academic center between 2000-2010 to black or white parturients greater than 23 weeks' gestation. We excluded fetal anomalies, aneuploidy, IUFD, or twin-to-twin transfusion syndrome. Average twin pair BW was compared and individual twins were assigned a BW percentile using published chorionicity-specific twin references. Average BW, percentile frequencies, maternal and obstetric variables were analyzed by univariate and regression analysis to determine clinical correlates of observed growth disparities. RESULTS: 530 twin sets were identified (267 white DC, 160 black DC, 65 white MC, and 38 black MC). The average BW of white DC twins was 2137g vs. 1956g for black DC twins (95% CI 265.2 to 94.8, p<0.001). The average BW of white MC twins was 2042g vs. 1758g for black MC twins (95% CI 478.7 to 89.7, p¼0.004). The distribution of BW percentiles was shifted significantly to the left (Figure) for black twins, including a greater frequency of BW <10th percentile (p¼0.002). No significant differences were identified in gestational age at delivery. Black parturients were significantly more likely to be younger, Medicaid recipients, single, and achieved less than the recommended weight gain; while white parturients were significantly more likely to have used assisted reproduction, smoke, and be diagnosed as pre-eclamptic. Regression analysis demonstrated that maternal race (p¼0.001) and pre-eclampsia (p¼0.04) were significantly associated with birth weight disparity (Table). CONCLUSION: Maternal race is an independent determinant of BW in both DC and MC twins. The shifted distribution of BW percentiles between black and white DC and MC twins suggests the need for race/ethnicity-specific growth standards for twins, as have been recently developed for singletons.