Maternal and neonatal outcomes according to gestational weight gain in twin pregnancies: Are the Institute of Medicine guidelines associated with better outcomes?

Pécheux, Océane; Garabédian, Charles; Drumez, Élodie; Mizrahi, Sarah; Cordiez, Sophie; Deltombe, Sophie; Deruelle, Philippe

doi:10.1016/j.ejogrb.2019.01.010

Cited by 29 publications

(63 citation statements)

References 36 publications

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“…As demonstrated in previous studies, 16,25 we found a positive association between high weight gain and increased risk of preeclampsia. However, whether there is a causal association and the direction of causation are still under debate.…”

Section: Discussionsupporting

confidence: 89%

Is Adherence to the Provisional Institute of Medicine Guidelines of Weight Gain Associated With Better Perinatal Outcomes? A Retrospective Cohort Study of Twin Pregnancies in Southwest China

Yan

Tang

2021

Asia Pac J Public Health

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The applicability of the Institute of Medicine (IOM) recommendations of gestational weight gain (GWG) for Chinese twin gestations is uncertain. In this article, we aimed to investigate the associations between GWG among twin gestations, as categorized according to the 2009 IOM guidelines and perinatal outcomes in Chengdu, China. A retrospective cohort study of pregnant women delivering live twins ≥28 weeks at a tertiary maternal and child hospital was conducted. The incidences of perinatal outcomes were compared across 3 groups—that is, women with low, adequate, and excessive GWG. Logistic regression analyses were next performed to confirm the associations while taking into account potential confounders. Results showed that low GWG was associated with a higher risk of preterm birth, low and very low birthweight, neonatal intensive care unit admission, and gestational diabetes, whereas preeclampsia was more frequent among excessive GWG women. In conclusion, adherence to the 2009 IOM guidelines for twin pregnancies are associated with improved perinatal outcomes. This has the potential to improve short- and long-term public health outcomes.

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Section: Discussionsupporting

confidence: 89%

Is Adherence to the Provisional Institute of Medicine Guidelines of Weight Gain Associated With Better Perinatal Outcomes? A Retrospective Cohort Study of Twin Pregnancies in Southwest China

Yan

Tang

2021

Asia Pac J Public Health

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“…With respect to the birthweight of twins our results suggest that the rate of twins with a BW < 1500 g increased in parallel with increasing pre-pregnancy BMI and EGWG, which is in contrast to other results [8,36,47]. Pre-pregnancy maternal underweight and low maternal GWG are reported to be associated with higher rates of preterm birth, low BW or SGA and NICU admissions [37,[48][49][50][51][52]. In our cohort, the rate of underweight women did not change with time and thus can hardly explain the increasing rates of low BW and prematurity in twins.…”

Section: Meaning Of the Findingscontrasting

confidence: 87%

“…Therefore, the here given quartiles could be of tremendous help for clinicians to avoid accelerated or decreasing weight gain in mothers of twins even within weekly controls. Although several studies have shown that EGWG and a high pre-pregnancy BMI lead to higher rates of HDP and preeclampsia [7,8,37,38], this could not be demonstrated in our cohort which might have partly be caused by the indirect determination of HDP.…”

Section: Meaning Of the Findingscontrasting

confidence: 77%

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

Timmesfeld

Noever³

et al. 2020

Arch Gynecol Obstet

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Introduction Studies on maternal weight, gestational weight gain and associated outcomes in twin pregnancies are scarce. Therefore, we analyzed these items in a large cohort. Methods Data from 10,603/13,725 total twin pregnancies from the perinatal database in Hessen, Germany between 2000 and 2015 were used after exclusion of incomplete or non-plausible data sets. The course of maternal and perinatal outcomes was evaluated by linear and logistic regression models. Results The rate of twin pregnancies increased from 1.5 to 1.9% (p < 0.00001). Mean maternal age and pre-pregnancy weight rose from 31.4 to 32.9 years and from 68.2 to 71.2 kg, respectively (p < 0.001). The rates of women with a body mass index ≥ 30 kg/m2 increased from 11.9 to 16.9% with a mean of 24.4–25.4 kg/m2 (p < 0.001). The overall increase of maternal weight/week was 568 g, the 25th quartile was 419, the 75th quartile 692 g/week. The total and secondary caesareans increased from 68.6 to 73.3% and from 20.6 to 39.8%, respectively (p < 0.001). Rates of birthweight < 1500 g and of preterm birth < 28 and from 28 to 33 + 6 weeks all increased (p < 0.01). No significant changes were observed in the rates of stillbirth, perinatal mortality and NICU admissions. Conclusion The global trend of the obesity epidemic is equally observed in German twin pregnancies. The increase of mean maternal weight and the calculated quartiles specific for twin pregnancies help to identify inadequate weight gain in twin gestations. Policy makers should be aware of future health risks specified for singleton and twin gestations.

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“…In addition, an increased risk of gestational anemia was observed among women with inadequate weight gain. Recently Pécheux et al [26] speculated that strengthening uterine contractions may occur by a surge of stress hormones, induced by placenta dysfunction in the anemia status. Based on our results, we stressed the necessity of sufficient weight gain among women with twin gestations.…”

Section: Discussionmentioning

confidence: 99%

The effect of gestational weight gain on perinatal outcomes among Chinese twin gestations based on Institute of Medicine guidelines

Lin

Fan

et al. 2019

BMC Pregnancy Childbirth

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Background Gestational weight gain (GWG) has implications for perinatal outcomes, the guidelines for maternal weight gain, however, remain understudied among twin pregnancies. This study aimed to assess the associations between perinatal outcomes and GWG among twin pregnancies, based on the US institute of Medicine (IOM) 2009 guidelines. Methods A retrospective cohort study of pregnant women with viable twins ≥26 weeks of gestation, was conducted in Foshan, China, during July 2015 and June 2018. Maternal BMI was categorized based on Chinese standard and GWG was categorized as below, within and above the IOM 2009 recommendations. Underweight women were excluded for analysis. Perinatal outcomes were compared among these groups. To assess the independent impact of GWG on the perinatal outcomes, conventional multivariable regression and general estimated equation (GEE) were utilized for maternal outcomes and neonatal outcomes, respectively. Results A total of 645 mothers with twin pregnancies were included, of whom 15.0, 41.4 and 43.6% gained weight below, within and above guidelines, respectively. Compared to weight gain within guidelines, inadequate weight gain was associated with increased risks in spontaneous preterm birth < 37 weeks (aOR:3.55; 95% CI: 1.73–7.28) and < 35 weeks (aOR:2.63; 95% CI: 1.16–5.97). Women who gained weight above guidelines were more likely to have gestational hypertension disorder (aOR: 2.36; 95% CI: 1.32–4.21), pre-eclampsia (aOR: 2.59; 95% CI: 1.29–5.21) and have fetuses weighted >90th percentile and less likely to have fetuses weighted < 2500 g and < 1500 g. Conclusions Maintenance of gestational weight gain within the normal range could decrease the risk of adverse perinatal outcomes. However, the causality between pre-eclampsia and gestational weight gain requires further investigations.

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Maternal and neonatal outcomes according to gestational weight gain in twin pregnancies: Are the Institute of Medicine guidelines associated with better outcomes?

Cited by 29 publications

References 36 publications

Is Adherence to the Provisional Institute of Medicine Guidelines of Weight Gain Associated With Better Perinatal Outcomes? A Retrospective Cohort Study of Twin Pregnancies in Southwest China

Is Adherence to the Provisional Institute of Medicine Guidelines of Weight Gain Associated With Better Perinatal Outcomes? A Retrospective Cohort Study of Twin Pregnancies in Southwest China

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

The effect of gestational weight gain on perinatal outcomes among Chinese twin gestations based on Institute of Medicine guidelines

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