The Association between Gestational Weight Gain in Each Trimester and Pregnancy Outcomes in Twin Pregnancies

Abstract

Objective Adequate maternal weight gain in twin pregnancies is associated with improved outcomes such as increased fetal growth and decreased incidence of preterm birth. However, it remains unclear when gestational weight gain has the greatest influence on pregnancy outcomes. Our objective was to identify at which time in a twin pregnancy does inadequate maternal weight gain have the greatest association with adverse pregnancy outcomes. Study Design This is a retrospective cohort study of women with twin pregnancies and normal prepregnancy body mass index (BMI, 18.5–24.9 kg/m2) who delivered at ≥24 weeks' gestation by a single maternal–fetal medicine practice between 2005 and 2017. Baseline characteristics and pregnancy outcomes were compared between women with and without adequate average gestational weight gain (weight gain per week based on the 2009 Institute of Medicine recommendations). This analysis was performed for weight gain over the entire pregnancy, as well as from 0 to 16, 16 to 24, and 24 weeks to delivery. Multivariable regression analysis was performed to control for potential confounding variables. Results A total of 609 women with twin pregnancies and normal prepregnancy BMI were included, of whom 386 (63.4%) had adequate average gestational weight gain over the entire pregnancy and 223 (36.6%) did not. Inadequate average gestational weight gain between 0 and 16 weeks' gestation was associated with a higher incidence of birthweight less than the 10th percentile for gestational age (adjusted odds ratio [aOR]: 1.67; 95% confidence interval [CI]: 1.11–2.51) and less than the 5th percentile for gestational age (aOR: 2.10; 95% CI: 1.29–3.40). Inadequate gestational weight gain between 16 and 24 weeks was associated with lower birthweight of the larger twin (β: –0.09; p = 0.04). Inadequate weight gain from 24 weeks to delivery was associated with spontaneous preterm birth <37 weeks' gestation (aOR: 1.67; 95% CI: 1.13–2.47), <34 weeks' gestation (aOR: 4.32; 95% CI: 2.45–7.63), <32 weeks' gestation (aOR: 9.07; 95% CI: 3.66–22.48), and a lower incidence of preeclampsia (aOR: 0.31; 95% CI: 0.16–0.63). Conclusion In twin pregnancies, gestational weight gain between 0 and 16 weeks as well as between 16 and 24 weeks is most associated with fetal growth, whereas gestational weight gain after 24 weeks is most associated with preterm birth. This may help elucidate the mechanism of action of the impact of gestational weight gain in twin pregnancies.

Correlation Between Maternal Weight Gain in Each Trimester and Fetal Growth According to Pre-pregnancy Maternal Body Mass Index in Twin Pregnancies

“…Wen et al reported that in dichorionic twins, weight gain in early pregnancy was found to be associated with birth weight (28). Lilly et al reported that weight gain in the second and rst trimesters of pregnancy is associated with fetal growth, whereas weight gain after 24 weeks is associated with preterm labor (20). However, the above studies are different from our research in that these were studies on normal weight twin pregnancies.…”

“…Furthermore, the rate of preterm labor and short cervical length during pregnancy was high in the underweight group; thus, the possibility of emergency delivery was higher. According to Lilly et al, if weight gain by underweight mothers during pregnancy reached the recommended value for normal BMI mothers, the frequency of preterm labor and pregnancyrelated complications did not increase (20). We found that underweight women had relatively smaller weight gains, which is a study of Asians who are relatively small compared to Westerners who have been mainly studied so far, so it is thought that there is a difference in these results.…”

Gestational weight gain in twin gestations and pregnancy outcomes: a systematic review and meta‐analysis

“…10 Eight studies accounted for BMI group through stratification, 10,20,[22][23][24][29][30][31] six through adjustment 12,21,25,28,33,34 and one used both stratification and adjustment. Three studies accounted for BMI group by restriction to the normal weight category 27,32,35 and one study by restriction to the overweight and obese categories. 26 Thirteen studies used mean weekly GWG to account for the impact of duration of pregnancy on GWG, 12,20,22,[24][25][26][27][28][29][30][31]34,35 two studies achieved this by restricting to term births, 21,33 one by using GWG z-score for gestational week at birth, 10 one used a gestational-age specific cutoff of Luke et al, 36 and two did not account for this variable and were therefore excluded from the meta-analysis.…”

“…Three studies accounted for BMI group by restriction to the normal weight category 27,32,35 and one study by restriction to the overweight and obese categories. 26 Thirteen studies used mean weekly GWG to account for the impact of duration of pregnancy on GWG, 12,20,22,[24][25][26][27][28][29][30][31]34,35 two studies achieved this by restricting to term births, 21,33 one by using GWG z-score for gestational week at birth, 10 one used a gestational-age specific cutoff of Luke et al, 36 and two did not account for this variable and were therefore excluded from the meta-analysis. 19,32 Six studies adjusted for chorionicity 21,25,29,31,34,35 and three adjusted for artificial reproductive therapies.…”

Monochorionic Pseudomonoamniotic Twin Pregnancy Revealing Fetal Demise. A Unique Case

“…Twin pregnancy consists presence of fetal co-existence inside the uterine cavity. Usually, represents fertilization of two eggs from two sperms (dizygotic twins), or fertilization of one egg, separation of the gamete and formation of two embryos (Monozygotic Twins) [1]. All conducted studies from current bibliography estimate incidence of twin pregnancy about 2% of all other pregnancies [2].…”