Gestational Weight Gain and Adverse Birth Outcomes in Twin Pregnancies

Bodnar, Lisa M.; Himes, Katherine P.; Abrams, Barbara; Lash, Timothy L.; Parisi, Sara M.; Eckhardt, Cara L.; Braxter, Betty; Minion, Sarah; Hutcheon, Jennifer A.

doi:10.1097/aog.0000000000003504

Cited by 38 publications

(74 citation statements)

References 47 publications

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“…In addition, our study provided reliable results through multivariate analysis of factors such as maternal outcomes through binary logistic regression and neonatal outcomes by the GEE. Although the gestational age at birth, chorionicity, and fetal sex are important variables that can lead to adverse outcomes, many previous studies did not correct for them [34,[36][37][38][39]. In addition, GEE analysis, which is a method used to adjust for the correlation between twins, was not performed in previous studies despite its necessity [22,34,36,39].…”

Section: Discussionmentioning

confidence: 99%

Gestational weight gain in twin pregnancies in Korea: application of the 2009 Institute of Medicine recommendations

Choi¹,

Hong²,

Jeon³

et al. 2020

Obstet Gynecol Sci

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Objective To investigate the effect of gestational weight gain (GWG) on maternal and neonatal outcomes based on the Institute of Medicine (IOM) guidelines for twin pregnancies. Methods This study included women with twin pregnancies who delivered at Seoul National University Bundang Hospital. Based on the weight gain per gestational week according to the 2009 IOM guidelines, the subjects were divided into the following 3 groups: inadequate, adequate, and excessive GWG. We compared the maternal and neonatal outcomes of each group. Results A total of 1,738 twin pregnancies were included in our study. Of these cases, 881, 694, and 163 (50.7%, 39.9%, and 9.4%, respectively) twin pregnancies were categorized into the inadequate, adequate, and excessive GWG groups, respectively. In the inadequate GWG group, the risks of preterm birth <34 weeks (aOR, 2.33, 95% confidence interval [CI], 1.63-3.34) and delivering neonates who were small for gestational age (aOR, 1.92, 95% CI, 1.42-2.60) were increased, and the risk of preeclampsia (aOR, 0.49, 95% CI, 0.32-0.76) was decreased. The excessive GWG group had an increased risk of the neonates being large for gestational age (aOR, 1.79, 95% CI, 1.15-2.81). Conclusion The 2009 IOM recommendations for GWG can be applied to Korean women with twin pregnancies to help achieve optimal maternal and neonatal outcomes. However, more than half of the women were categorized as having inadequate weight gain according to the guidelines. Further studies should be performed to obtain Korean national references for GWG in twin pregnancies.

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Section: Discussionmentioning

confidence: 99%

Gestational weight gain in twin pregnancies in Korea: application of the 2009 Institute of Medicine recommendations

Choi¹,

Hong²,

Jeon³

et al. 2020

Obstet Gynecol Sci

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“…Bodnar et al 51 found the association between self-reported pre-pregnancy BMI and pregnancy outcomes was overestimated without considering misclassification. However, Momoli et al 50 and Bodnar et al 52 reported that the observed relationship did not change markedly after applying PBAM compared to conventional methods.…”

Section: Discussionmentioning

confidence: 95%

“…Some studies applied this method in other contexts. [50][51][52][53][54][55] For example, De Silva et al 53 found a stronger association between the risk of maternal transfusion and inter-pregnancy interval after adjusting for misclassification of severe maternal morbidity. Bodnar et al 51 found the association between self-reported pre-pregnancy BMI and pregnancy outcomes was overestimated without considering misclassification.…”

Section: Discussionmentioning

confidence: 99%

<p>Effect of Smoking on Breast Cancer by Adjusting for Smoking Misclassification Bias and Confounders Using a Probabilistic Bias Analysis Method</p>

Pakzad¹,

Yaseri²,

Salehiniya³

et al. 2020

CLEP

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The aim of this study was to determine the association between smoking and breast cancer after adjusting for smoking misclassification bias and confounders. Methods: In this case-control study, 1000 women with breast cancer and 1000 healthy controls were selected. Using a probabilistic bias analysis method, the association between smoking and breast cancer was adjusted for the bias resulting from misclassification of smoking secondary to self-reporting as well as a minimally sufficient adjustment set of confounders derived from a causal directed acyclic graph (cDAG). Population attributable fraction (PAF) for smoking was calculated using Miettinen's formula. Results: While the odds ratio (OR) from the conventional logistic regression model between smoking and breast cancer was 0.64 (95% CI: 0.36-1.13), the adjusted ORs from the probabilistic bias analysis were in the ranges of 2.63-2.69 and 1.73-2.83 for non-differential and differential misclassification, respectively. PAF ranges obtained were 1.36-1.72% and 0.62-2.01% using the non-differential bias analysis and differential bias analysis, respectively. Conclusion: After misclassification correction for smoking, the non-significant negativeadjusted association between smoking and breast cancer changed to a significant positiveadjusted association.

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“…In this tertiary care center, many studies have investigated the effects of single maternal risk factors such as diabetes mellitus, antenatal coverage, small for gestational age, cesarean delivery, malpresentation, and body mass index on pregnancy outcomes [ 9 - 11 ]. However, the antenatal risk score, which is multifactorial, is not only an educational tool but also a comprehensive assessment of potential pregnancy complications.…”

Section: Discussionmentioning

confidence: 99%

Association of Antenatal Risk Score With Maternal and Neonatal Mortality and Morbidity

Al-Hindi¹,

Sayari²,

Solami³

et al. 2020

Cureus

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Introduction/Objectives Women with high-risk pregnancies require careful follow-up, management, and efficient allocation of resources to achieve optimal pregnancy outcomes. This study investigated the association between an updated, validated antenatal risk index score and neonatal mortality and morbidity in a tertiary care center in Saudi Arabia. Methods This retrospective cohort study included pregnant women delivered at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between June 2016 and December 2018. Pregnant women who delivered before arrival, delivered in another hospital, or without an antenatal risk score because of missing data were excluded. The study cohort was recruited by simple random selection. Data of mothers and neonates were extracted from electronic health records. The pregnancy risk was assigned using a validated antenatal risk score index, creating low, moderate, and high-risk pregnancy categories. The association between antenatal risk scores, maternal and neonatal outcomes was investigated. Results A total of 533 pregnant women were included in the analysis, of whom 298 (55.9%) had low antenatal risk scores, 185 (34.7%) had moderate-risk scores, and 50 (9.4%) had high-risk scores. Maternal characteristics showed that high-risk mothers had higher age, gravidity, parity, and abortions than those with low or moderate-risk pregnancies. Newborns of high-risk mothers belonged more often to the male gender and had lower gestational ages, birth weights, and Apgar scores. For maternal outcomes, there was no maternal mortality. High-risk mothers had more cesarean sections and longer lengths of stay as compared to the low and moderate risk group. There was a trend toward increased stillbirths. Neonatal mortality, neonatal intensive care unit (NICU) admission, congenital anomalies, and length of stay were significantly increased in neonates of high-risk mothers. Conclusions An antenatal risk score is a feasible tool in identifying low, moderate, and high-risk pregnancies in a tertiary center outside a North American system. The higher scores were associated with maternal complications as well as neonatal mortality and morbidity. This is the first study to report maternal demographics, mortality, stillbirths, male gender, and congenital anomalies and their associations with categories of pregnancy level of risk. The clinical and economic benefits of antenatal risk screening in Saudi Arabia warrant further large population-based study that includes multi-domain socioeconomic determinants of health specific to our region.

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Gestational Weight Gain and Adverse Birth Outcomes in Twin Pregnancies

Cited by 38 publications

References 47 publications

Gestational weight gain in twin pregnancies in Korea: application of the 2009 Institute of Medicine recommendations

Gestational weight gain in twin pregnancies in Korea: application of the 2009 Institute of Medicine recommendations

<p>Effect of Smoking on Breast Cancer by Adjusting for Smoking Misclassification Bias and Confounders Using a Probabilistic Bias Analysis Method</p>

Association of Antenatal Risk Score With Maternal and Neonatal Mortality and Morbidity

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