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Am J Perinatol 2024; 41(10): 1445-1454
DOI: 10.1055/a-2091-1254
Original Article

Prenatal Weight Change Trajectories and Perinatal Outcomes among Twin Gestations

Amy R. Nichols 
1   Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas
,
Sina Haeri
2   Women's Center of Texas, St. David's Healthcare, Austin, Texas
,
Anthony Rudine
3   Office of Research, St. David's Healthcare, Austin, Texas
,
Natalie Burns
4   Department of Statistics, University of Florida, Gainesville, Florida
,
Paul J. Rathouz
5   Department of Population Health and Biomedical Data Science Hub, The University of Texas at Austin Dell Medical School, Austin, Texas
,
Monique M. Hedderson
6   Division of Research, Kaiser Permanente Northern California, Oakland, California
,
Steven A. Abrams
7   Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas
,
Saralyn F. Foster
1   Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas
,
Rachel Rickman
1   Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas
,
Mollie McDonnold
3   Office of Research, St. David's Healthcare, Austin, Texas
,
Elizabeth M. Widen 
1   Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas
› Author Affiliations Funding This work was supported by the Academy of Nutrition and Dietetics Foundation Jean Hankin Nutritional Epidemiology Research Grant awarded to Amy R. Nichols, PhD, MS, RD, and American Society for Nutrition Predoctoral Fellowship awarded to Amy R. Nichols, PhD, MS, RD, and also supported with grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to the University of Texas at Austin (identifier: NIH R00HD086304; available at: https://brand.utexas.edu/). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Abstract

Objective Despite an increase in twin pregnancies in recent decades, the Institute of Medicine twin weight gain recommendations remain provisional and provide no guidance for the pattern or timing of weight change. We sought to characterize gestational weight change trajectory patterns and examine associations with birth outcomes in a cohort of twin pregnancies.

Study Design Prenatal and delivery records were examined for 320 twin pregnancies from a maternal–fetal medicine practice in Austin, TX 2011-2019. Prenatal weights for those with >1 measured weight in the first trimester and ≥3 prenatal weights were included in analyses. Trajectories were estimated to 32 weeks (mean delivery: 33.7 ± 3.3 weeks) using flexible latent class mixed models with low-rank thin-plate splines. Associations between trajectory classes and infant outcomes were analyzed using multivariable Poisson or linear regression.

Results Weight change from prepregnancy to delivery was 15.4 ± 6.3 kg for people with an underweight body mass index, 15.4 ± 5.8 kg for healthy weight, 14.7 ± 6.9 kg for overweight, and 12.5 ± 6.4 kg for obesity. Three trajectory classes were identified: low (Class 1), moderate (Class 2), or high gain (Class 3). Class 1 (24.7%) maintained weight for 15 weeks and then gained an estimated 6.6 kg at 32 weeks. Class 2 (60.9%) exhibited steady gain with 13.5 kg predicted total gain, and Class 3 (14.4%) showed rapid gain across pregnancy with 21.3 kg predicted gain. Compared to Class 1, Class 3 was associated with higher birth weight z-score (β = 0.63, 95% confidence interval [CI]: 0.31,0.96), increased risk for large for gestational age (IRR = 5.60, 95% CI: 1.59, 19.67), and birth <32 weeks (IRR = 2.44, 95% CI: 1.10, 5.4) that was attenuated in sensitivity analyses. Class 2 was associated with moderately elevated birth weight z-score (β = 0.24, 95% CI: 0.00, 0.48, p = 0.050).

Conclusion Gestational weight change followed a low, moderate, or high trajectory; both moderate and high gain patterns were associated with increased infant size outcomes. Optimal patterns of weight change that balance risk during the prenatal, perinatal, and neonatal periods require further investigation, particularly in high-risk twin pregnancies.

Key Points

  • A majority gained weight below IOM twin recommendations.

  • Three patterns of GWC across pregnancy were identified.

  • Moderate or high GWC was associated with infant size.

Keywords

pregnancy - gestational weight gain - prepregnancy body mass index - twins - adverse pregnancy and infant outcomes - latent class mixed models

Note

Funding sources had no involvement in study design; collection, analysis, and interpretation of data; writing of the report; or in the decision to submit the article for publication.


Supplementary Material



Publication History

Received: 07 March 2023

Accepted: 04 May 2023

Accepted Manuscript online:
10 May 2023

Article published online:
11 July 2023

© 2023. Thieme. All rights reserved.

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