Download PDF
Am J Perinatol 2017; 34(13): 1293-1301
DOI: 10.1055/s-0037-1603318
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Achievement of Body Mass Index Specific Weight Gain Recommendations: Impact on Preterm Birth in Twin Pregnancies

Candice W. Greenan
1   Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
,
Roger B. Newman
1   Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
,
Barbara Wojciechowski
2   Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
,
Colleen J. Christensen
3   Furman University, Greenville, South Carolina
› Author Affiliations
Further Information

Publication History

23 March 2017

28 March 2017

Publication Date:
15 May 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Objective To determine whether achievement of body mass index specific weight gain recommendations is associated with reduced preterm birth or neonatal morbidity among twin gestations.

Study Design This was a retrospective cohort study of twin gestations delivered at the Medical University of South Carolina from 2000 to 2010. In total, 588 women in all prepregnancy body mass index categories who delivered ≥24 weeks' gestation were included. Women were grouped as achieved or underachieved based on total weight gain and gestational age at delivery. Maternal and neonatal outcomes were compared between the groups.

Results Body mass index specific weight gain goals were achieved by 59.9% of women. The achieved group had a 1.5-fold reduction in the rate of preterm birth <32 weeks (18.8 vs. 30.5%; p = 0.001). Achievers had larger mean birthweights (2,146 ± 584 g vs. 1,859 ± 593 g; p < 0.001) and were significantly less likely to deliver either twin with a birthweight less than the 10th percentile for gestational age (larger twin 0.6 vs. 4.7%, p = 0.001; smaller twin 12.2 vs. 21.6%, p = 0.002). Composite neonatal morbidity, days on the respirator, length of hospital stay, and rate of neonatal intensive care unit admission were significantly decreased in the achieved group.

Conclusion Achievement of body mass index specific weight gain goals improves preterm birth rates, neonatal birthweights, and composite neonatal outcomes in women carrying twins.

Keywords

gestational weight gain - maternal weight gain - neonatal morbidity - preterm birth - twin pregnancy

Note

The study was presented as posters #422 and #282 at the 36th annual meeting of the Society for Maternal-Fetal Medicine, Atlanta, GA, February 2–6, 2016. This article represents the views of the author and not those of Veterans Health Administration.


 

  • References

  • 1 Martin JA, Hamilton BE, Osterman MJK, Curtin SC, Matthews TJ. Births: final data for 2013. Natl Vital Stat Rep 2015; 64 (01) 1-65
    PubMedSearch in Google Scholar
  • 2 Martin JA, Hamilton BE, Osterman MJ. Three decades of twin births in the United States, 1980-2009. NCHS Data Brief 2012; 80 (80) 1-8
    PubMedSearch in Google Scholar
  • 3 The ESHRE Capri Workshop Group. Multiple gestation pregnancy. Hum Reprod 2000; 15 (08) 1856-1864
    CrossrefPubMedSearch in Google Scholar
  • 4 Grether JK, Nelson KB, Cummins SK. Twinning and cerebral palsy: experience in four northern California counties, births 1983 through 1985. Pediatrics 1993; 92 (06) 854-858
    PubMedSearch in Google Scholar
  • 5 Yokoyama Y, Shimizu T, Hayakawa K. Incidence of handicaps in multiple births and associated factors. Acta Genet Med Gemellol (Roma) 1995; 44 (02) 81-91
    PubMedSearch in Google Scholar
  • 6 Luke B, Minogue J, Witter FR. The role of fetal growth restriction and gestational age on length of hospital stay in twin infants. Obstet Gynecol 1993; 81 (06) 949-953
    PubMedSearch in Google Scholar
  • 7 Kilpatrick SJ, Jackson R, Croughan-Minihane MS. Perinatal mortality in twins and singletons matched for gestational age at delivery at > or = 30 weeks. Am J Obstet Gynecol 1996; 174 (1 Pt 1): 66-71
    CrossrefPubMedSearch in Google Scholar
  • 8 Biggio JR, Anderson S. Spontaneous preterm birth in multiples. Clin Obstet Gynecol 2015; 58 (03) 654-667
    CrossrefPubMedSearch in Google Scholar
  • 9 Institute of Medicine. Nutrition during Pregnancy. Washington, DC: National Academies Press; 1990
    Search in Google Scholar
  • 10 Luke B, Hediger ML, Nugent C. , et al. Body mass index--specific weight gains associated with optimal birth weights in twin pregnancies. J Reprod Med 2003; 48 (04) 217-224
    PubMedSearch in Google Scholar
  • 11 Institute of Medicine and National Research Council. Weight Gain during Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press; 2009
    Search in Google Scholar
  • 12 Artal R, Lockwood CJ, Brown HL. Weight gain recommendations in pregnancy and the obesity epidemic. Obstet Gynecol 2010; 115 (01) 152-155
    CrossrefPubMedSearch in Google Scholar
  • 13 Chu SY, D'Angelo DV. Gestational weight gain among US women who deliver twins, 2001-2006. Am J Obstet Gynecol 2009; 200 (04) 390.e1-390.e6
    CrossrefPubMedSearch in Google Scholar
  • 14 Bodnar LM, Pugh SJ, Abrams B, Himes KP, Hutcheon JA. Gestational weight gain in twin pregnancies and maternal and child health: a systematic review. J Perinatol 2014; 34 (04) 252-263
    CrossrefPubMedSearch in Google Scholar
  • 15 Fox NS, Rebarber A, Roman AS, Klauser CK, Peress D, Saltzman DH. Weight gain in twin pregnancies and adverse outcomes: examining the 2009 Institute of Medicine guidelines. Obstet Gynecol 2010; 116 (01) 100-106
    CrossrefPubMedSearch in Google Scholar
  • 16 González-Quintero VH, Kathiresan AS, Tudela FJ, Rhea D, Desch C, Istwan N. The association of gestational weight gain per institute of medicine guidelines and prepregnancy body mass index on outcomes of twin pregnancies. Am J Perinatol 2012; 29 (06) 435-440
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Pettit KE, Lacoursiere DY, Schrimmer DB, Alblewi H, Moore TR, Ramos GA. The association of inadequate mid-pregnancy weight gain and preterm birth in twin pregnancies. J Perinatol 2015; 35 (02) 85-89
    CrossrefPubMedSearch in Google Scholar
  • 18 Lal AK, Kominiarek MA. Weight gain in twin gestations: are the Institute of Medicine guidelines optimal for neonatal outcomes?. J Perinatol 2015; 35 (06) 405-410
    CrossrefPubMedSearch in Google Scholar
  • 19 Luke B, Brown MB, Misiunas R. , et al. Specialized prenatal care and maternal and infant outcomes in twin pregnancy. Am J Obstet Gynecol 2003; 189 (04) 934-938
    CrossrefPubMedSearch in Google Scholar
  • 20 Goodnight W, Newman R. ; Society of Maternal-Fetal Medicine. Optimal nutrition for improved twin pregnancy outcome. Obstet Gynecol 2009; 114 (05) 1121-1134
    CrossrefPubMedSearch in Google Scholar
  • 21 Min SJ, Luke B, Gillespie B. , et al. Birth weight references for twins. Am J Obstet Gynecol 2000; 182 (05) 1250-1257
    CrossrefPubMedSearch in Google Scholar
  • 22 National Center for Health Statistics. Final Natality Data. Available at www.marchofdimes.org/peristats . Accessed February 4, 2014
    PubMed
  • 23 Morgan TK. Role of the placenta in preterm birth: a review. Am J Perinatol 2016; 33 (03) 258-266
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Hediger ML, Luke B, Gonzalez-Quintero VH. , et al. Fetal growth rates and the very preterm delivery of twins. Am J Obstet Gynecol 2005; 193 (04) 1498-1507
    CrossrefPubMedSearch in Google Scholar
  • 25 Villar J, Cogswell M, Kestler E, Castillo P, Menendez R, Repke JT. Effect of fat and fat-free mass deposition during pregnancy on birth weight. Am J Obstet Gynecol 1992; 167 (05) 1344-1352
    CrossrefPubMedSearch in Google Scholar
  • 26 Hediger ML, Scholl TO, Schall JI, Healey MF, Fischer RL. Changes in maternal upper arm fat stores are predictors of variation in infant birth weight. J Nutr 1994; 124 (01) 24-30
    CrossrefPubMedSearch in Google Scholar
  • 27 Scholl TO, Sowers M, Chen X, Lenders C. Maternal glucose concentration influences fetal growth, gestation, and pregnancy complications. Am J Epidemiol 2001; 154 (06) 514-520
    CrossrefPubMedSearch in Google Scholar
  • 28 Luke B, Brown MB, Misiunas RB. , et al. Elevated maternal glucose concentrations and placental infection in twin pregnancies. J Reprod Med 2005; 50 (04) 241-245
    PubMedSearch in Google Scholar
  • 29 Luke B, Gillespie B, Min SJ, Avni M, Witter FR, O'Sullivan MJ. Critical periods of maternal weight gain: effect on twin birth weight. Am J Obstet Gynecol 1997; 177 (05) 1055-1062
    CrossrefPubMedSearch in Google Scholar