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

Abstract

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.

A study to assess correlation between maternal weight gain and fetal outcome among primigravidae registered in antenatal clinics

“…Flick et al [12] found a significant relation between neonatal intensive care unit admission and maternal obesity similar to our study. Similar to our study, in a study by Lin et al [13], the maternal weight gain was associated with neonatal intensive care unit admission and neonatal birth weight. In a study by Abide et al [14] also, the maternal weight gain was associated with neonatal intensive care unit admission and neonatal birth weight which were similar to the findings of our study.…”

Perinatal Outcomes and Risk Factors for Preterm Birth in Twin Pregnancies in a Chinese Population: A Multi-center Retrospective Study

“…The IOM lacks recommendations for underweight women (54). In addition, sample sizes of Chinese studies were relatively small and the impact of GWG on preterm birth was inconsistent (16,58). Lin et al found that the risk for patients with GWG below the IOM recommendations was 3.55 times risk for preterm birth before 37 weeks and 2.63 times risk for preterm birth before 35 weeks in Chinese twin pregnancies (16), but this study excluded underweight women.…”

“…GWG has been considered as a predictor in pregnancy outcomes in both singletons and multiple gestations in previous studies (15,16,56,57). Women with GWG below the recommendations of the IOM were at higher risk of small for gestation age and preterm birth, while GWG above the recommendations was associated with decreased risk for preterm birth (15,16,56). However, the impact of GWG and pregnancy outcomes were mainly based on patients from western countries and the results were inconsistent in twin pregnancies (50).…”

“…Methods for predicting preterm birth and risk factors for preterm birth in twin pregnancy have long been studied. A history of preterm birth (12), maternal clinical characteristics, such as age and height (13,14), gestational weight gain (GWG) (15,16), maternal complications, such as preeclampsia (17), biophysical and biochemical tests, (18) are all proposed to aid in identifying and optimizing management of preterm birth in twin gestation.…”

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

“…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].…”