The ideal twin pregnancy: Patterns of weight gain, discordancy, and length of gestation

Luke, Barbara; Minogue, John P.; Witter, Frank R.; Keith, Louis; Johnson, Timothy R.B.

doi:10.1016/0002-9378(93)90628-v

Cited by 116 publications

(81 citation statements)

References 11 publications

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“…Neonatal mortality rates are more strongly correlated with twinspecific centiles than with singleton centiles. As reported before (Alexander et al, 1998;Kleinman et al, 1991;Loos et al, 2005;Luke et al, 1991Luke et al, , 1993, up to 32 weeks of gestation, twins and singletons did not differ according to birthweight and to the frequency of SGA, LBW and VLBW. However, after 33 weeks the weight of twins trailed that of singletons and the curves deviated, implicating that IUGR occurs more frequently in twins after 33 weeks of gestation.…”

Section: Discussionsupporting

confidence: 78%

Twin-Specific Intrauterine ‘Growth’ Charts Based on Cross-Sectional Birthweight Data

et al. 2008

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The assessment of fetal growth is an essential component of good antenatal care, especially for twins. The aims of this study are to develop twin-specific intrauterine 'growth' charts, based on cross-sectional birthweight data, for monochorionic and dichorionic twins according to sex and parity, and to detect twins at risk for neonatal death by comparing the use of twin-specific and singleton charts. The study sample consisted of 76,471 singletons and 8454 twins (4227 pairs) born in East Flanders (Belgium). Birthweights were analyzed using a nonlinear Gaussian regression. After 33 weeks of gestation, the birthweights of twins started to deviate from singletons (difference of 900 grams at 42 weeks). Birthweights of dichorionic twins continued to increase, whereas those of monochorionic twins decreased after week 40 (difference of more than 300 g at 42 weeks). After 31 weeks of gestation, neonatal mortality increased as centile decreased, and was especially high if birthweight was below the twin-specific third centile: .032 (below) versus .007 (above). Using singleton centiles, this was less obvious. In conclusion, twin-specific growth charts, taking chorionicity into account, are more accurate to detect twins at risk for neonatal death. Therefore the presented charts, based on cross-sectional birthweight data, enable an improved assessment of twin growth.

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Section: Discussionsupporting

confidence: 78%

Twin-Specific Intrauterine ‘Growth’ Charts Based on Cross-Sectional Birthweight Data

et al. 2008

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“…In both retrospective and prospective cohorts, Luke and her colleagues observed a significant increase in birthweight and gestational age in twins whose mother gained enough weight during early (up to 24 weeks) pregnancy. (Luke et al, 1991;Luke et al, 1993;Luke & Leurgans, 1996;Luke et al, 1997;Luke, 1998;Luke et al, 1998;Luke, Hediger, et al, 2003). The general consensus among researchers who have evaluated these twin guidelines is that to qualify as 'enough', total weight gain should be at least 40-45 pounds (18-20 kg), with an emphasis on adequate weight gain before 24 weeks' gestation (Luke, Brown et al, 1998) In a recent prospective intervention study, Luke, Brown et al (2003) observed that pregnancies in women who participated in a specialized program, which included twice-monthly visits, dietary prescription of 3000 to 4000 kcal per day, multimineral supplementation, and patient education, were associated with improved pregnancy outcomes, and lower neonatal morbidity, and consequently reduced cost per twin compared to nonparticipants.…”

mentioning

confidence: 99%

Perinatal Outcome and Change in Body Mass Index in Mothers of Dichorionic Twins: A Longitudinal Cohort Study

Simões¹,

Cordeiro²,

Júlio³

et al. 2008

Twin Res Hum Genet

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We used a prospective cohort to analyze the effect of change in BMI rather than change in weight, in mothers carrying dichorionic twins from a population that did not receive any dietary intervention. A total of 269 mothers (150 nulliparas and 119 multiparas) were evaluated. The average change (%) from the pre-gravid BMI was 7.2 ± 6.1, 17.4 ± 8.2, and 28.7 ± 10.8, at 12–14, 22–25, and 30–34 weeks, respectively, without difference between nulliparas and multiparas. The comparison between maternities below or above the average change from the pregravid BMI failed to demonstrate an advantage (in terms of total twin birthweight and gestational age) of an above average change from the pregravid BMI, even when the lower versus upper quartiles were compared. Our observations reached different conclusions regarding the recommended universal dietary intervention in twin gestations. A cautious approach is advocated towards seemingly harmless excess weight gain, as normal weight women may turn overweight, or even obese, by the end of pregnancy, and be exposed to the untoward effects of obesity on future health and body image.

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“…Luke et al [1] have reported that nearly 70% of ideal twin pregnancies are deliveries between 35 and 38 weeks' gestation using length-of-stay and growth retardation criteria. In addition, Minakami and Sato [2] have reported that the estimated date of delivery at 37-38 weeks' gestation may be appropriate in multifetal pregnancies.…”

Section: Introductionmentioning

confidence: 99%

Clinical Trial of Induction of Labor versus Expectant Management in Twin Pregnancy

Suzuki

Otsubo

Sawa

et al. 2000

Gynecol Obstet Invest

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Objective: The appropriate date of delivery in twin pregnancies is supposed to be earlier than that in singleton pregnancy. The aim of this study was to compare two strategies for managing twin pregnancies (i.e., immediate induction and expectant management). Methods: Seventeen patients underwent immediately induced labor by administration of oral prostaglandin E₂ at 37 weeks, while 19 patients underwent expectant management. Results: The average gestational age at delivery in the induction group was 37.5 ± 0.4 weeks, significantly earlier than that in the expectant management group (39.0 ± 1.1 weeks). However, there were no significant differences in the average birth weight between the two groups (2,700 ± 330 g in the induction group vs. 2,672 ± 392 g in the expectant management group). The cesarean delivery rate in the induction group was 18%, not significantly different from that in the expectant management group (32%). The most common indication for cesarean section in the expectant management group was maternal infection, while there was no maternal infection in the induction group (p = 0.08). Conclusion: It may be acceptable do intervene in twin pregnancies earlier than in singleton pregnancies during term.

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The ideal twin pregnancy: Patterns of weight gain, discordancy, and length of gestation

Cited by 116 publications

References 11 publications

Twin-Specific Intrauterine ‘Growth’ Charts Based on Cross-Sectional Birthweight Data

Twin-Specific Intrauterine ‘Growth’ Charts Based on Cross-Sectional Birthweight Data

Perinatal Outcome and Change in Body Mass Index in Mothers of Dichorionic Twins: A Longitudinal Cohort Study

Clinical Trial of Induction of Labor versus Expectant Management in Twin Pregnancy

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