Critical periods of maternal weight gain: Effect on twin birth weight

doi:10.1016/S0002-9378(97)70014-0

American Journal of Obstetrics and Gynecology

Volume 177, Issue 5, November 1997, Pages 1055-1062

Presented at the Seventeenth Annual Meeting of the Society of Perinatal Obstetricians, Anaheim, California, January 20-25, 1997.

https://doi.org/10.1016/S0002-9378(97)70014-0 Get rights and content

Abstract

Objective: Our purpose was to evaluate the association between maternal weight gain and twin birth weight. Study Design: This historic cohort study was based on 646 live-born twin births of ≥28 weeks from Baltimore, Maryland, Miami, Florida, and Ann Arbor, Michigan. The sum of twin-pair birth weight was modeled as a function of either net maternal weight at delivery or rates of maternal weight gain with use of multiple regression. Results: Birth weight was significantly associated with weight gain before 20 weeks in underweight women, before 20 weeks and after 28 weeks in overweight women, and during all three gestational periods in normal-weight women. Weight gain before 20 weeks had the largest effect on infants of underweight women, less of an effect on infants of normal-weight women, and half as much effect on infants of overweight women. Weight gain after 28 weeks significantly affected the infant birth weights of normal-weight and overweight women, but the effect was half as great among infants of the latter group. Conclusions: These findings suggest that weight gain during critical periods of gestation significantly influences twin birth weight; these critical periods vary by maternal pregravid weight status.

Section snippets

Study population

The study population included all twin pregnancies delivered at the Johns Hopkins Hospital, Baltimore, between Jan. 1, 1979, and Dec. 31, 1995; at Jackson Memorial Hospital, Miami, between July 1, 1993, and Oct. 31, 1996; and at the University of Michigan Hospital, Ann Arbor, between Jan. 1, 1995, and Oct. 31, 1996. The study sample was limited to pregnancies meeting the following inclusion criteria: (1) both twins born alive, (2) ≥28 weeks' gestation by last menstrual period, first-trimester

Results

A total of 646 twin pregnancies ≥28 weeks' gestation were included in the study sample. A description of the study sample by study site, placental chorion, and infertility treatment is given in Table I. The three study sites differed significantly by maternal age, racial composition, percent of women treated for infertility, percent of women who smoked during pregnancy, and placental chorion diagnosis. Among pregnancies with confirmed placental chorion diagnosis, significant differences were

Comment

These findings confirm the association between pregravid weight, rates of maternal weight gain, and twin birth weight and highlight the importance of weight gain during the first half of pregnancy, particularly for underweight women. Maternal weight at delivery exerts the greatest effect on twin birth weight in underweight women and the least effect in overweight women, confirming previous studies with singleton pregnancies.5, 6, 7, 8, 9, 10, 11, 12, 13, 14 This study, based on 646 twin

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A new care pathway to optimize gestational weight gain in twin pregnancies
2023, American Journal of Obstetrics and Gynecology MFM
Maternal gestational weight gain is an important determinant of pregnancy outcomes and may have an even greater role in twin pregnancies because of their higher rate of pregnancy complications and greater nutritional demands. However, data on the optimal week-specific gestational weight gain in twin pregnancies and on interventions that should be applied in cases of inadequate gestational weight gain are limited.
This study aimed to determine whether a new care pathway that involves monitoring gestational weight gain using a week-specific chart, along with a standardized protocol for managing cases with inadequate gestational weight gain, can optimize maternal gestational weight gain in twin pregnancies.
In this study, patients with twin pregnancies followed in a single tertiary center between February 2021 and May 2022 were exposed to the new care pathway (postintervention group). Gestational weight gain and clinical outcomes were compared with those of a previously described cohort of patients with twins followed in our clinic before the implementation of the new care pathway (preintervention group). The new care pathway targeted patients and care providers and included educational material, a newly developed body mass index group–specific gestational weight gain chart, and a stepwise management algorithm in cases of inadequate gestational weight gain. The body mass index group–specific gestational weight gain charts were divided into 3 zones: (1) green zone (optimal gestational weight gain at 25th–75th centiles); (2) yellow zone (suboptimal gestational weight gain at 5th–24th or 76th–95th centiles); and (3) gray zone (abnormal gestational weight gain, at <5th or >95th centile). The primary outcome was the overall proportion of patients achieving optimal gestational weight gain at birth.
A total of 123 patients were exposed to the new care pathway and were compared with 1079 patients from the preintervention period. Patients in the postintervention group were more likely to achieve optimal gestational weight gain at birth (60.2% vs 47.7%; adjusted odds ratio, 1.91; 95% confidence interval, 1.28–2.86) and were less likely to achieve low-suboptimal gestational weight gain (7.3% vs 14.7%; adjusted odds ratio, 0.41; 95% confidence interval, 0.20–0.85) or any suboptimal gestational weight gain (26.8% vs 34.8%; adjusted odds ratio, 0.60; 95% confidence interval, 0.39–0.93) at birth. In addition, patients in the postintervention group were less likely to have low-abnormal gestational weight gain anytime during gestation (18.9% vs 29.1%; P=.017) and were more likely to have normal gestational weight gain throughout pregnancy (21.3% vs 14.0%; P=.031) or high-abnormal gestational weight gain anytime during gestation (18.0% vs 11.1%; P=.025), suggesting that in comparison with standard care, the new care pathway is more effective in preventing patients from moving into the low-abnormal zone than the high-abnormal zone. Furthermore, the new care pathway was more effective than standard care in correcting high-suboptimal gestational weight gain and high-abnormal gestational weight gain.
Our findings suggest that the new care pathway may be effective in optimizing maternal gestational weight gain in twin gestations, which may in turn contribute to better clinical outcomes. This is a simple, low-cost intervention that can be easily disseminated among providers caring for patients with twin pregnancies.
Maternal weight gain and associations with longitudinal fetal growth in dichorionic twin pregnancies: A prospective cohort study
2017, American Journal of Clinical Nutrition
Maternal metabolic demands are much greater with twin gestations; however, there are no accepted recommendations for maternal weight gain in twin pregnancies.
We assessed the association of maternal weight gain and fetal growth in dichorionic twins throughout pregnancy.
This was a prospective US cohort study (n = 143, 2012–2013) of dichorionic twin pregnancies with known birth outcomes followed from enrollment (11–13 wk) and for ≤6 research visits throughout gestation. Maternal prepregnancy weight was self-reported, and current weight was measured at each research visit and abstracted from prenatal records. Fetal biometry was assessed by ultrasound at each research visit. Maternal weight and twin-pair fetal size trajectories across gestation were modeled. The adjusted associations between maternal weight gain from 0 to 13, 14 to 20, 21 to 27, and 28 to 34 wk and fetal growth at the subsequent week (i.e., 14, 21, 28, and 35 wk, respectively) were estimated with the use of linear regression.
The mean ± SD maternal weight gain from 0 to 13, 14 to 20, 21 to 27, and 28 to 34 wk was 2.8 ± 3.0 kg, 3.9 ± 1.2 kg, 3.8 ± 1.4 kg, and 4.4 ± 2.2 kg, respectively, with a total gain of 17.7 ± 7.4 kg. Maternal weight gain from 0 to 13 wk (first trimester) was not associated with fetal size at 14 wk. Maternal weight gain from 14 to 20 and 21 to 27 wk (second trimester) was significantly associated with increased fetal weight at 21 wk [increase of 10.5 g/kg maternal weight gain (95% CI: 1.2, 19.8 g)] and 28 wk [increase of 21.3 g/kg maternal weight gain (95% CI: 0.6, 42.0 g)]. Maternal weight gain from 14 to 20 wk was associated with increased twin abdominal circumference (AC) and biparietal diameter at 21 wk. Maternal weight gain from 21 to 27 wk was associated with increased femur and humerus lengths at 28 wk.
Maternal weight gain was associated with dichorionic twin fetal growth in the second trimester only, driven by an association with AC earlier in second trimester and long bones later in the second trimester.
Nutrition Recommendations in Pregnancy and Lactation
2016, Medical Clinics of North America
Citation Excerpt :
Of note, these guidelines are considered provisional because the evidence to support them is not as strong as it is for singletons. Interestingly, a weight gain of 24 pounds by 24 weeks has been associated with higher rates of birth weights greater than 2500 g.31,32 Evidence for nutritional management of higher order multiples (eg, triplets, quadruplets) is lacking, but they can be managed similarly to twin gestations. The World Health Organization and the National Institutes of Health define normal weight as a BMI of 18.5 to 24.9 kg/m2, overweight as a BMI of 25 to 29.9 kg/m2, and obesity as a BMI of 30 kg/m2 or greater.
Implementation of the new institute of medicine gestational weight gain guidelines
2010, Journal of Midwifery and Women's Health
In May 2009, the Institute of Medicine (IOM) introduced revised gestational weight gain guidelines that were based on balancing the benefits and risks of weight gain for both the mother and child's health. This article provides an overview of these new recommendations, explaining the key changes made from the previous 1990 IOM recommendations. The important role of health care providers of pregnant women in the implementation of the new recommendations is detailed, and specific guidance for troubleshooting issues that may be encountered when helping women achieve appropriate gestational weight gains is provided.
Maternal morbidity and infant death in twin vs triplet and quadruplet pregnancies
2008, American Journal of Obstetrics and Gynecology
Citation Excerpt :
In its 1990 report, the Institute of Medicine also suggested a range of maternal weight gain of 35-45 lb (16-20 kilogram) for term twin pregnancies.49 The general consensus among researchers who have evaluated these guidelines for twins is that total weight gain should be at least 40-45 lb (18-20 kg), with an emphasis on adequate weight gain before 24 weeks of gestation.57-67 The pattern of maternal weight gain has been shown to be as important as total weight gain in its effect on birthweight in both singleton and twin pregnancies.
The purpose of this study was to calculate nationally representative, population-based estimates of maternal and neonatal risks in triplet and quadruplet pregnancies compared with twin pregnancies.
The study population included 316,696 twin, 12,193 triplet, and 778 quadruplet pregnancies from the 1995-2000 Matched Multiple Birth Data Set. Adjusted odds ratios (AORs) and 95% CIs estimated the risk of complications and were controlled for maternal age, race, parity, and smoking status.
Compared with mothers of twins, mothers of triplets and quadruplets were more likely to be diagnosed with preterm premature rupture of membranes (AORs, 1.53, 1.74, respectively), pregnancy-associated hypertension (AORs, 1.22, 1.27), and excessive bleeding (AORs, 1.50, 2.22), to require tocolysis (AORs, 2.85, 5.03), and to be delivered by cesarean (AORs, 6.55, 7.38) at <29 weeks of gestation (AORs, 3.76, 7.96), and to have ≥1 infants die (AORs, 3.02, 4.07).
Triplet and quadruplet pregnancies have significantly higher risks than twin pregnancies for most maternal and neonatal complications. Maternal anthropometric, nutritional, and previous reproductive factors may be particularly important in the reduction of these excess risks and improvement of outcomes in multiple births.
Twin weight discordance and maternal weight gain in twin pregnancies
2007, International Journal of Gynecology and Obstetrics
Citation Excerpt :
These two groups did not show significant differences for any other factors. The patterns of the mean maternal weight change in twin pregnancies agreed with previous reports, although the actual gestational intervals were slightly different from this study [13,14,18]. The present study has found that the weight discordance of twins at an early stage remained unchanged as long as maternal weight constantly increased throughout pregnancy.
To evaluate the association between twin weight discordance and maternal weight change during the gestational period.
One hundred forty-seven twin pregnancies (Group A: < 25%, Group B: ≥ 25% birth weight discordance) were analyzed using Student's t-test, χ²-test, and two-way ANOVA at three gestational intervals: before 18 weeks, 18 to 28 weeks, and 28 weeks to birth.
There was no statistically significant difference between the two groups involving maternal age, parity, duration of pregnancy, height, pregravid weight, and conception method. Group A showed a pattern of constantly increasing maternal weight without a significant change in the twin weight discordance throughout gestation. However, Group B showed a fluctuation in maternal BMI with remarkably elevated twin weight discordance at 28 weeks to birth.
The results suggest that in twin pregnancies constant maternal weight gain throughout gestation is important for maintaining a twin weight discordance of less than 25%.

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^☆: From the Department of Obstetrics and Gynecology, University of Michigan Medical School,^a and the Center for Statistical Consultation and Research,^b University of Michigan, the Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine,^c and the Department of Obstetrics and Gynecology, the University of Miami School of Medicine.^d

^☆☆: Reprint requests: Barbara Luke, ScD, Department of Obstetrics and Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr., F4866 Mott, Ann Arbor, MI 48109-0264.

^★: 0002-9378/97 $5.00 + 0 6/6/84561

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Critical periods of maternal weight gain: Effect on twin birth weight☆,☆☆,★

Abstract

Section snippets

Study population

Results

Comment

Obstet Gynecol

Am J Obstet Gynecol

Obstet Gynecol

Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol

J Am Dietet Assoc

J Am Dietet Assoc

Am J Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol