Abstract
Objective The objective is to estimate the impact of maternal weight gain outside the 2009 Institute of Medicine recommendations on perinatal outcomes in twin pregnancies. Study Design Twin pregnancies with two live births between January 1, 2004 and December 31, 2014 delivered after 23 weeks Finger Lakes Region Perinatal Data System (FLRPDS) and Central New York Region Perinatal Data System were included. Women were classified into three groups using pre-pregnancy body mass index (BMI). Perinatal outcomes in women with low or excessive weekly maternal weight gain were assessed using normal weekly weight gain as the referent in each BMI group. Results Low weight gain increased the risk of preterm delivery, birth weight less than the 10th percentile for one or both twins and decreased risk of macrosomia across all BMI groups. There was a decreased risk of hypertensive disorders in women with normal pre-pregnancy weight and an increased risk of gestational diabetes with low weight gain in obese women. Excessive weight gain increased the risk of hypertensive disorders and macrosomia across all BMI groups and decreased the risk of birth weight less than 10th percentile one twin in normal pre-pregnancy BMI group. Conclusion Among twin pregnancies, low weight gain is associated with low birth weight and preterm delivery in all BMI groups and increased risk of gestational diabetes in obese women. Our study did not reveal any benefit from excessive weekly weight gain with potential harm of an increase in risk of hypertensive disorders of pregnancy. Normal weight gain per 2009 IOM guidelines should be encouraged to improve pregnancy outcome in all pre-pregnancy BMI groups.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Armstrong, R. A. (2014). When to use the Bonferroni correction. Ophthalmic and Physiological Optics, 34, 502–5088.
Blondel, B., Kogan, M. D., Alexander, G. R., Dattani, N., Kramer, M. S., Macfarlane, A., et al. (2002). The impact of the increasing number of multiple births on the rates of preterm birth and low Birth weight: An international study. American Journal of Public Health, 92, 1323–1330.
Bogaerts, A., Van den Bergh, B. R., Ameye, L., Witters, I., Martens, E., Timmerman, D., et al. (2013). Interpregnancy weight change and risk for adverse perinatal outcome. Obstetrics and Gynecology, 122, 999–1009.
Carpenter, M. W., & Coustan, D. R. (1982). Criteria for screening tests for gestational diabetes. American Journal of Obstetrics and Gynecology, 144, 768–773.
Dye, T. D., Wojtowycz, M. A., & Aubry, R. H. (1997). A cost evaluation of implementing a quality-oriented, regional perinatal data system. Journal of Public Health Management and Practice, 3, 37–40.
Flegal, K. M., Kit, B. K., Orpana, H., & Graubard, B. I. (2013). Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA, 309, 71–82.
Fox, N. S., Rebarber, A., Roman, A. S., Klauser, C. K., Peress, D., & Saltzman, D. H. (2010). Weight gain in twin pregnancies and adverse outcomes: Examining the 2009 Institute of Medicine guidelines. Obstetrics and Gynecology, 116, 100–106.
Fox, N. S., Saltzman, D. H., Kurtz, H., & Rebarber, A. (2011). Excessive weight gain in term twin pregnancies: Examining the 2009 Institute of Medicine definitions. Obstetrics and Gynecology, 118, 1000–1004.
Gavard, J. A., & Artal, R. (2014). Gestational weight gain and maternal and neonatal outcomes in term twin pregnancies in obese women. Twin Research and Human Genetics, 17, 127–133.
González-Quintero, V. H., Kathiresan, A. S., Tudela, F. J., Rhea, D., Desch, C., & Istwan, N. (2012). The association of gestational weight gain per institute of medicine guidelines and prepregnancy body mass index on outcomes of twin pregnancies. American Journal of Perinatology, 29, 435–440.
Institute of Medicine. (2009). Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: The National Academies Press.
Kajantie, E., & Hovi, P. (2014). Is very preterm birth a risk factor for adult cardiometabolic disease? Seminars in Fetal and Neonatal Medicine, 19, 112–117.
Lal, A. K., & Kominiarek, M. A. (2015). Weight gain in twin gestations: Are the Institute of Medicine guidelines optimal for neonatal outcomes? Journal of Perinatology, 35, 405–410.
Lantz, M. E., Chez, R. A., Rodriguez, A., & Porter, K. B. (1996). Maternal weight gain patterns and birth weight outcome in twin gestation. Obstetrics and Gynecology, 87, 551–556.
Lawn, J. E., Gravett, M. G., Nunes, T. M., Rubens, C. E., Stanton, C., & GAPPS Review Group. (2010). Global report on preterm birth and stillbirth (1 of 7): Definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth, 10 (Suppl 1), S1.
Luke, B., Hediger, M. L., Nugent, C., Newman, R. B., Mauldin, J. G., Witter, F. R., et al. (2003). Body mass index-specific weight gains associated with optimal birth weights in twin pregnancies. The Journal of Reproductive Medicine, 48, 217–224.
Martin, J. A., Hamilton, B. E., & Osterman, M. J. K. (2012). Three decades of twin births in the United States, 1980–2009. NCHS Data Brief no 80.
Martin, J. A., Hamilton, B. E., Sutton, P. D., et al. (2008). Births: Final data for 2006, National vital statistics reports; vol 57, no 7. Hyattsville, MD: National Center for Health Statistics.
Mwaniki, M. K., Atieno, M., Lawn, J. E., & Newton, C. R. (2012). Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: A systematic review. Lancet, 379, 445–452.
National Diabetes Data Group. (1979). Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes, 28, 1039–1057.
National High Blood Pressure Education Program. (2000). Report of the national high blood pressure education program working group on high blood pressure in pregnancy. American Journal of Obstetrics and Gynecology, 183, S1–S22.
Roohan, P. J., Josberger, R. E., Acar, J., Dabir, P., Feder, H. M., & Gagliano, P. J. (2003). Validation of birth certificate data in New York State. Journal of Community Health, 28, 335–346.
Shamshirsaz, A. A., Haeri, S., Ravangard, S. F., Sangi-Haghpeykar, H., Gandhi, M., Ozhand, A., et al. (2014). Perinatal outcomes based on the institute of medicine guidelines for weight gain in twin pregnancies. The Journal of Maternal-Fetal and Neonatal Medicine, 27, 552–556.
Siega-Riz, A. M., Viswanathan, M., Moos, M. K., Deierlein, A., Mumford, S., Knaack, J., et al. (2009). A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: Birthweight, fetal growth, and postpartum weight retention. American Journal of Obstetrics and Gynecology, 201(339), e1–e14.
Soltani, H., & Fraser, R. B. (2000). A longitudinal study of maternal anthropometric changes in normal weight, overweight and obese women during pregnancy and postpartum. British Journal of Nutrition, 84, 95–101.
Viswanathan, M., Siega-Riz, A. M., Moos, M. K., Deierlein, A., Mumford, S., Knaack, J., et al. (2008). Outcomes of maternal weight gain. Evidence Report/Technology Assessment, 168, 1–223.
Zhang, J., & Yu, K. F. (1998). What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA, 18(280), 1690–1691.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ozcan, T., Bacak, S.J., Zozzaro-Smith, P. et al. Assessing Weight Gain by the 2009 Institute of Medicine Guidelines and Perinatal Outcomes in Twin Pregnancy. Matern Child Health J 21, 509–515 (2017). https://doi.org/10.1007/s10995-016-2134-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-016-2134-6