Challenges for better care based on the course of maternal body mass index, weight gain and multiple outcome in twin pregnancies: a population-based retrospective cohort study in Hessen/Germany within 15 years

Schubert, J; Timmesfeld, Nina; Noever, K; Arabin, Birgit

doi:10.1007/s00404-020-05440-6

Cited by 4 publications

(9 citation statements)

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“…Several studies described that excessive gestational weight gain is associated with obstetrical adverse outcomes. Women who did not meet the guidelines for gestational weight gain had a high rate of fetal growth disbalance, premature rupture of membranes, C-section, and prematurity [ 3 , 15 ]. Adherence to a healthy diet during pregnancy, such as a Mediterranean diet, prevented excessive gestational weight gain and postpartum weight retention [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…The Spanish Institute of Statistics reflects that the percentage of obesity (BMI ≥ 30 kg/m 2 ) in women aged 18–44 years is approximately 10.5%, considering overweight women (BMI = 25–29.9 kg/m 2 ) the prevalence increases to 20.4% [ 2 ]. Maternal obesity has been shown to increase short- and long-term maternal, obstetric, and neonatal complications [ 3 ]. These women are at increased risk of developing gestational diabetes, pregnancy-induced hypertension, preeclampsia, prolonged labor, shoulder dystocia, prematurity, and C-section, as well as fetal malformations, fetal growing disbalance, and increased perinatal mortality [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Maternal Obesity in Twin Pregnancy: The Role of Nutrition to Reduce Maternal and Fetal Complications

et al. 2022

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There are more and more obese mothers with twin gestations. For a long time before, the responses of lymphocytes and platelets in obese women can cause a low-grade inflammation. In addition, a proper control of gestational weight gain would improve the outcomes in mothers with high pre-gestational body mass index (BMI). In women with high pre-gestational BMI and twin pregnancy, our aims were to explore the biochemical and hematological parameters and to study the rate of obstetric adverse outcomes. This was an observational and retrospective study conducted in the Hospital Universitario La Paz (Madrid, Spain). We included 20 twin pregnancies as the lean group (BMI = 18.5–24.9 kg/m2), homogeneous in the maternal age and ethnicity, and having parity with other 20 twin pregnancies as the obese group (BMI ≥ 30 kg/m2). The maternal data and maternal, fetal, obstetric, and neonatal complications were collected from the medical records. In the first and third trimester of pregnancy, the biochemical and hematological parameters of the blood were assayed. In this cohort, gestational weight gain was significantly lower in the obese than lean group. In the first trimester, the hemoglobin levels in obese women (12.1 ± 0.8 g/dL) were lower than lean women (12.6 ± 0.7 g/dL; p-Value = 0.048). In addition, the tendency of glucose levels, TSH levels and platelets was to increase in obese compared to lean women. In the third trimester, the TSH levels were higher in obese (3.30 ± 1.60 mUI/L) than lean women (1.70 ± 1.00 mUI/L; p-Value = 0.009). Furthermore, there was a tendency for levels of platelets and lymphocytes to increase in obese compared to lean women. No significant differences were detected in the rate of maternal, fetal, obstetrical, and neonatal complications between the groups. The hemoglobin, platelets, lymphocytes and TSH levels need further investigation to understand potential subclinical inflammation in obese women. Furthermore, obese women with twin pregnancies should follow-up with a specialist nutritionist, to help them control their gestational weight gain with appropriate dietary measures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Maternal Obesity in Twin Pregnancy: The Role of Nutrition to Reduce Maternal and Fetal Complications

et al. 2022

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“…In absence of international or national guidelines for maternal GWG in twin pregnancies, we had classified the maternal GWG per week in quartiles (Q), with the medium quartiles (Q2 and Q3) representing normal GWG. This resulted in cut-offs of GWG < 419.4 g/week for low GWG (Q1), 419.4 – 692.3 g/week for normal GWG (Q2 and Q3) and > 692.3 g/week for high GWG (Q4) 8 .…”

Section: Methodsmentioning

confidence: 99%

“…Twin births had increased since the 1980s in most Western countries, mainly due to artificial reproductive techniques 7 . Accordingly, in Germany (Hessen), twin births increased between 2000 and 2015 from 1.5% to 1.9% 8 . Nevertheless, the rates of obesity in the whole population, among pregnant women with singletons and with twin pregnancies continue to increase 8 , 9 .…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Maternal Body Mass Index and Gestational Weight Gain in Twin Pregnancies

Schubert¹,

Timmesfeld

Noever³

et al. 2022

Geburtshilfe Frauenheilkd

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Objective This retrospective cohort study analyzes risk factors for abnormal pre-pregnancy body mass index and abnormal gestational weight gain in twin pregnancies. Methods Data from 10 603/13 682 twin pregnancies were analyzed using uni- and multivariable logistic regression models to determine risk factors for abnormal body mass index and weight gain in pregnancy. Results Multiparity was associated with pre-existing obesity in twin pregnancies (aOR: 3.78, 95% CI: 2.71 – 5.27). Working in academic or leadership positions (aOR: 0.57, 95% CI: 0.45 – 0.72) and advanced maternal age (aOR: 0.96, 95% CI: 0.95 – 0.98) were negatively associated with maternal obesity. Advanced maternal age was associated with a lower risk for maternal underweight (aOR: 0.95, 95% CI: 0.92 – 0.99). Unexpectedly, advanced maternal age (aOR: 0.98, 95% CI: 0.96 – 0.99) and multiparity (aOR: 0.6, 95% CI: 0.41 – 0.88) were also associated with lower risks for high gestational weight gain. Pre-existing maternal underweight (aOR: 1.55, 95% CI: 1.07 – 2.24), overweight (aOR: 1.61, 95% CI: 1.39 – 1.86), obesity (aOR: 3.09, 95% CI: 2.62 – 3.65) and multiparity (aOR: 1.64, 95% CI: 1.23 – 2.18) were all associated with low weight gain. Women working as employees (aOR: 0.85, 95% CI: 0.73 – 0.98) or in academic or leadership positions were less likely to have a low gestational weight gain (aOR: 0.77, 95% CI: 0.64 – 0.93). Conclusion Risk factors for abnormal body mass index and gestational weight gain specified for twin pregnancies are relevant to identify pregnancies with increased risks for poor maternal or neonatal outcome and to improve their counselling. Only then, targeted interventional studies in twin pregnancies which are desperately needed can be performed.

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Lifestyle Interventions to Improve Pregnancy Outcomes: a Systematic Review and Specified Meta-Analyses

Behnam

Timmesfeld

Arabin

2022

Geburtshilfe Frauenheilkd

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To compare the impact of lifestyle interventions for overweight and obese pregnant women a systematic review and meta-analysis was conducted using pre-registration and audit of the interventions as selection criteria. PubMed, Web of Science and CENTRAL were searched for randomized controlled trials examining diet, exercise, combined interventions or associated behavioral therapy. Trials were selected if they reported one of the primary outcomes (gestational diabetes, hypertensive disorders, perinatal mortality, admission to neonatal intensive care unit). Results were established from the total group and separately from pre-registered or clinically audited studies. Out of 1304 titles, 28 randomized controlled trials were included. Among the primary outcomes only hypertensive disorders were significantly reduced by exercise in the total group: odds ratio 0.52 (95% confidence interval 0.28 to 0.96, four trials, 1324 participants). When behavioral therapy supported combined interventions, maternal weight gain, (Standardized Mean Difference −0.16 kilogram; 95% confidence interval −0.28 to −0.04, four trials, 2132 participants) and neonatal birthweight, (Standardized Mean Difference −0.4 gram; 95% confidence interval −0.62 to −0.18, five trials, 1058 participants), were significantly reduced within the total group and both specified meta-analyses. Higher frequencies of physical activity improved the results. Risk of bias, assessed with the Cochrane Tool, was low to moderate. Elements of behavioral therapy might better prevent adverse effects of maternal obesity when combined with lifestyle interventions. Unfortunately, high heterogeneity due to different intervention and population characteristics was a limiting factor. Future studies should also focus on increased intensities of physical activity.

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Challenges for better care based on the course of maternal body mass index, weight gain and multiple outcome in twin pregnancies: a population-based retrospective cohort study in Hessen/Germany within 15 years

Cited by 4 publications

References 50 publications

Maternal Obesity in Twin Pregnancy: The Role of Nutrition to Reduce Maternal and Fetal Complications

Maternal Obesity in Twin Pregnancy: The Role of Nutrition to Reduce Maternal and Fetal Complications

Risk Factors for Maternal Body Mass Index and Gestational Weight Gain in Twin Pregnancies

Lifestyle Interventions to Improve Pregnancy Outcomes: a Systematic Review and Specified Meta-Analyses

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