Weight gain during twin pregnancy with favorable pregnancy outcomes in Japan: A retrospective investigation for new criteria based on perinatal registry data

Abstract

In 2009, the United States Institute of Medicine (IOM) reported the optimal gestational weight gain (GWG) during twin pregnancy based on the pre-pregnancy body mass index (BMI). However, there are ethnic variations in the relationship between GWG and pregnancy outcomes. We aimed to establish the criteria for optimal GWG during twin pregnancy in Japan. The study included cases of dichorionic diamniotic twin pregnancy registered in the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System between 2013 and 2017. We analyzed data for cases wherein both babies were appropriate for gestational age and delivered at term. Cases were classified into four groups based on the pre-pregnancy BMI: underweight (BMI <18.5 kg/m2), normal weight (18.5 kg/m2 ≤BMI< 25.0 kg/m2), overweight (25.0 kg/m2 ≤BMI< 30.0 kg/m2), and obese (BMI ≥30.0 kg/m2) and we calculated the 25th–75th percentile range for GWG for the cases. The 3,936 cases were included. The GWG ranges were 11.5–16.5 kg, 10.3–16.0 kg, 6.9–14.7 kg, and 2.2–11.7 kg in the underweight, normal weight, overweight, and obese groups, respectively. Thus, in the current study, the optimal GWG during twin pregnancy was lower than that specified by the IOM criteria. Factoring this in maternal management may improve the outcomes of twin pregnancies in Japan.

Gestational weight gain adequacy among twin pregnancies in France

“…found results more similar to ours (multi-centre Japanese cohort,2013Obata et al, 2021]; population-based Chinese cohort usingChinese BMI standards, 2011Chen et al, 2018]), finding lower 25th percentiles of GWG, though the 75th percentiles in the Chinese study varied in relation to the IOM guidelines.…”

Review of Dietary Recommendations for Twin Pregnancy: Does Nutrition Science Keep Up with the Growing Incidence of Multiple Gestations?

“…[ 43 , 44 , 45 ]. For example, too low a body weight gain increases the risk of pre-term birth, while an excessive body weight gain—the risk of gestational diabetes and hypertension [ 46 , 47 ]. Both in a singleton and twin pregnancy, the maternal body weight gain also correlates with the newborns’ birth weight.…”

“…Both in a singleton and twin pregnancy, the maternal body weight gain also correlates with the newborns’ birth weight. Mothers with a low body weight gain more frequently give birth to small-for-gestational-age infants, while among the newborns of mothers who gained too much weight, macrosomia is more common [ 14 , 46 , 48 , 49 ]. For twin pregnancies, it is suggested that the body weight gain in the individual trimesters of pregnancy can be more important than the total weight gain [ 50 ].…”

“…According to the guidelines, the body weight gain of women pregnant with twins depends on their pre-pregnancy BMI, just like for a singleton pregnancy. Based on the course of pregnancy in women who gave birth after the end of the 36th week of pregnancy to twins weighing ≥ 2500 g, it was determined that it is optimal for women with a normal body weight to put on 17 to 25 kg, overweight women—14–23 kg, while obese women—11–19 kg [ 21 , 46 , 53 ]. It needs to be emphasized that such a body weight gain in women pregnant with twins who had a normal pre-pregnancy body weight is 47–56% higher compared to women expecting one child, while in obese women—even 111–120% higher.…”

“…Asian countries might be an exception due to the lower height of women. As Obata et al, indicate, the body weight gain in Japanese women pregnant with twins that led to a normal birth weight of both infants was considerably lower than the American guidelines in more than 70% women and amounted to 11.5–16.5 kg in preconceptionally underweight women, 10.3–16.0 kg in women with a normal body weight, 6.9–14.7 kg in overweight women and 2.2–11.7 kg in obese women [ 46 ].…”