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

2020 ◽  
Author(s):  
Lilly Y. Liu ◽  
Kelly B. Zafman ◽  
Nathan S. Fox
Keyword(s):  
Weight Gain ◽  
Preterm Birth ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Maternal Weight Gain ◽  
Maternal Weight ◽  
Gestational Weight ◽  
Entire Pregnancy ◽  
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.

scholarly journals Gestational Weight Gain During the Second and Third Trimesters and Adverse Pregnancy Outcomes, Results From a Prospective Pregnancy Cohort in Urban Tanzania

2021 ◽  
Author(s):  
Jiaxi Yang ◽  
Molin Wang ◽  
Deirdre K. Tobias ◽  
Janet W. Rich-Edwards ◽  
Anne Marie Darling ◽  
...  
Keyword(s):  
Weight Gain ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Gestational Weight Gain ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Gestational Weight ◽  
Pregnancy Cohort ◽  
Adverse Pregnancy

Abstract Background Appropriate gestational weight gain (GWG) is important for optimal pregnancy outcomes. This study prospectively evaluated the associations between GWG during the second and third trimesters of pregnancy and adverse pregnancy outcomes in an urban Tanzanian pregnancy cohort. Methods We used data from a randomized clinical trial conducted among pregnant women recruited by 27 weeks of gestation in Dar es Salaam, Tanzania (N = 1,230). Women’s gestational weight was measured at baseline and at monthly antenatal visits. Weekly GWG rate during the second and third trimesters was calculated and characterized as inadequate, adequate, or excessive, in conjunction with measured or imputed early-pregnancy BMI status according to the 2009 Institute of Medicine (IOM) GWG guidelines. We used multivariable Poisson regression with a sandwich variance estimator to calculate risk ratios (RR) for associations of GWG with low birth weight, preterm birth, small for gestational age (SGA), and large for gestational age (LGA). Degree of appropriate GWG defined using additional metrics (i.e., percentage of adequacy, z-score) and potential effect modification by maternal BMI were additionally evaluated. Results According to the IOM guidelines, 517 (42.0%), 270 (22.0%), and 443 (36.0%) women were characterized as having inadequate, adequate, and excessive GWG, respectively. Overall, compared to women with adequate GWG, women with inadequate GWG had a lower risk of LGA births (RR=0.54, 95% CI: 0.36 - 0.80) and a higher risk of SGA births (RR=1.32, 95% CI: 0.95 - 1.81). ­­Women with inadequate GWG as defined by percentage of GWG adequacy had a higher risk of LBW (OR=1.93, 95% CI: 1.03 - 3.63). In stratified analyses by early-pregnancy BMI, excessive GWG among women with normal BMI was associated with a higher risk of preterm birth (RR=1.59, 95% CI: 1.03 - 2.44). Conclusions A comparatively high percentage of excessive GWG was observed among healthy pregnant women in Tanzania. Both inadequate and excessive GWGs were associated with elevated risks of poor pregnancy outcomes. Future studies among diverse SSA populations are warranted to confirm our findings, and clinical recommendations on optimal GWG should be developed to promote healthy GWG in SSA settings. Trial registration This trial was registered as “Prenatal Iron Supplements: Safety and Efficacy in Tanzania” (NCT01119612; http://clinicaltrials.gov/show/NCT01119612).

scholarly journals Gestational Weight Gain and Pregnancy Outcomes among Nulliparous Women

2019 ◽  
Author(s):  
Annie M. Dude ◽  
William Grobman ◽  
David Haas ◽  
Brian M. Mercer ◽  
Samuel Parry ◽  
...  
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pregnancy Outcomes ◽  
Large For Gestational Age ◽  
Gestational Weight ◽  
Excessive Gestational Weight Gain ◽  
Hypertensive Disorders

Abstract Objective To determine the association between total gestational weight gain and perinatal outcomes. Study Design Data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (NuMoM2b) study were used. Total gestational weight gain was categorized as inadequate, adequate, or excessive based on the 2009 Institute of Medicine guidelines. Outcomes examined included hypertensive disorders of pregnancy, mode of delivery, shoulder dystocia, large for gestational age or small for-gestational age birth weight, and neonatal intensive care unit admission. Results Among 8,628 women, 1,666 (19.3%) had inadequate, 2,945 (34.1%) had adequate, and 4,017 (46.6%) had excessive gestational weight gain. Excessive gestational weight gain was associated with higher odds of hypertensive disorders (adjusted odds ratio [aOR] = 2.05, 95% confidence interval [CI]: 1.78–2.36) Cesarean delivery (aOR = 1.24, 95% CI: 1.09–1.41), and large for gestational age birth weight (aOR = 1.49, 95% CI: 1.23–1.80), but lower odds of small for gestational age birth weight (aOR = 0.59, 95% CI: 0.50–0.71). Conversely, inadequate gestational weight gain was associated with lower odds of hypertensive disorders (aOR = 0.75, 95% CI: 0.62–0.92), Cesarean delivery (aOR = 0.77, 95% CI: 0.65–0.92), and a large for gestational age birth weight (aOR = 0.72, 95% CI: 0.55–0.94), but higher odds of having a small for gestational age birth weight (aOR = 1.64, 95% CI: 1.37–1.96). Conclusion Both excessive and inadequate gestational weight gain are associated with adverse maternal and neonatal outcomes.

scholarly journals Insufficient maternal gestational weight gain and infant neurodevelopment at 12 months of age: the Japan Environment and Children’s Study

2021 ◽  
Author(s):  
Noriko Motoki ◽  
Yuji Inaba ◽  
Takumi Shibazaki ◽  
Yuka Misawa ◽  
Satoshi Ohira ◽  
...  
Keyword(s):  
Cohort Study ◽  
Weight Gain ◽  
Problem Solving ◽  
Developmental Delay ◽  
Gestational Weight Gain ◽  
Fine Motor ◽  
Maternal Weight Gain ◽  
Maternal Weight ◽  
Gestational Weight ◽  
Infant Neurodevelopment

AbstractAbnormal maternal gestational weight gain (GWG) increases the risk of obstetric-related complications. This investigation examined the impact of GWG on infant neurodevelopmental abnormalities at 12 months of age using the data of a nationwide Japanese cohort study. Questionnaire data were obtained from the ongoing Japan Environment and Children’s Study cohort study. Maternal GWG was subdivided as below, within, or above the reference values of the Institution of Medicine pregnancy weight guidelines. The Ages and Stages Questionnaire, third edition (ASQ-3) is a parent-reported developmental screening instrument for children across five domains: communication, gross motor, fine motor, problem-solving, and personal–social. Multiple logistic regression analysis was employed to identify correlations between GWG and developmental delay defined as ASQ-3 scores of less than two standard deviations below the mean. A total of 30,694 mothers with singleton live births and partners who completed the questionnaire were analyzed. The prevalence of mothers below, within, and above the GWG guidelines was 60.4% (18,527), 32.1% (9850), and 7.5% (2317), respectively. We recorded 10,943 infants (35.7%) who were outliers in at least one ASQ-3 domain. After controlling for covariates, GWG below established guidelines was associated with a significantly higher risk of developmental delay for the communication (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.09–1.34), gross motor (OR 1.14, 95% CI 1.05–1.24), fine motor (OR 1.13, 95% CI 1.04–1.24), problem-solving (OR 1.09, 95% CI 1.01–1.18), and personal–social (OR 1.15, 95% CI 1.07–1.24) domains.Conclusion: This large survey revealed a possible deleterious effect of insufficient maternal GWG on infant neurodevelopment.Trial registration: The Japan Environment and Children’s Study (JECS) was registered in the UMIN Clinical Trials Registry on January 15, 2018 (number UMIN000030786). What is Known:• Inappropriate maternal gestational weight gain may cause obstetric complications and adverse birth outcomes.• Excess maternal weight gain may result in gestational diabetes, hypertension, eclampsia, caesarean delivery, and macrosomia, while insufficient maternal weight gain has been associated with pre-term birth and small for gestational age. What is New:• This study provides important information on a possible adverse effect of insufficient maternal gestational weight gain on offspring neurodevelopment at 12 months of age.• Our findings indicate a need to reconsider the optimal body mass index and gestational weight gain for women desiring pregnancy.

Adolescent Gestational Weight Gain and Birth Weight

PEDIATRICS ◽  
1993 ◽  
Vol 92 (6) ◽  
pp. 805-809
Author(s):  
Catherine Stevens-Simon ◽  
Elizabeth R. MCAnarney ◽  
Klaus J. Roghmann
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Gestational Weight Gain ◽  
Low Income ◽  
Black Adolescents ◽  
Maternal Weight Gain ◽  
Maternal Weight ◽  
Gestational Weight ◽  
Prepregnancy Weight ◽  
Older Adolescents

Objective. To examine the relationship among maternal age, prepregnancy weight, gestational weight gain, and birth weight in 141 low-income black adolescents and their infants. Study sample. One hundred forty-one consecutively enrolled, low-income, black adolescents who entered prenatal care prior to their 23rd week of gestation, were free of chronic diseases, took no regular medications, had no known uterine anomalies, and gave birth to one live neonate. Results. After controlling for prepregnancy weight and other potentially confounding variables, we found a significant relationship between gestational weight gain and infant birth weight among younger adolescents (&lt;16 years old at conception), but not among older adolescents (16 through 19 years old at conception); younger adolescents contributed more of their gestational weight gain to their fetuses than did older adolescents. Among younger adolescents the rate of maternal weight gain during the entire gestation was significantly correlated with birth weight (r = .40; P &lt; .01), whereas for older adolescents only maternal weight gain during the second half of gestation was significantly correlated with birth weight (r = .25, P &lt; .05). Conclusions. The data do not support the thesis that younger adolescents compete with their fetuses for nutrients; in fact, younger study adolescents transferred more of their gestational weight gain to their fetuses than did older adolescents.

The association between maternal weight gain and spontaneous preterm birth in twin pregnancies

2014 ◽  
Vol 27 (16) ◽  
pp. 1652-1655 ◽  
Author(s):  
Nathan S. Fox ◽  
Erica M. Stern ◽  
Daniel H. Saltzman ◽  
Chad K. Klauser ◽  
Simi Gupta ◽  
...  
Keyword(s):  
Weight Gain ◽  
Preterm Birth ◽  
Maternal Weight Gain ◽  
Maternal Weight ◽  
Spontaneous Preterm Birth ◽  
Twin Pregnancies

291: Gestational weight gain in twin pregnancies is not associated with discordance in birthweight or small for gestational age

2015 ◽  
Vol 212 (1) ◽  
pp. S157
Author(s):  
Bahram Salmanian ◽  
Kathleen Antony ◽  
Diana Racusin ◽  
Kjersti Aagaard ◽  
Amirhoushang Shamshirsaz ◽  
...  
Keyword(s):  
Weight Gain ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Gestational Weight ◽  
Twin Pregnancies

scholarly journals Effect of maternal weight gain according to the Institute of Medicine recommendations on pregnancy outcomes in a Chinese population

2019 ◽  
Vol 47 (9) ◽  
pp. 4397-4412 ◽  
Author(s):  
Ping Guan ◽  
Fei Tang ◽  
Guoqiang Sun ◽  
Wei Ren
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Large For Gestational Age ◽  
Maternal Weight ◽  
Increased Risk

Objective This study aimed to analyze the effects of maternal weight on adverse pregnancy outcomes. Methods Data were retrospectively collected from a hospital in Wuhan, China. A total of 1593 pregnant women with singletons were included. Adverse outcomes during pregnancy, such as small for gestational age (SGA), large for gestational age (LGA), and hypertensive disorders in pregnancy (HDP) were analyzed. Results The risks of low birth weight, SGA, and preterm birth were significantly higher in the inadequate gestational weight gain (GWG) group compared with the adequate GWG group. GWG over the guidelines was related to a higher risk of macrosomia, LGA, cesarean section, and HDP than GWG within the guidelines. The risks of low birth weight (OR = 5.082), SGA (OR = 3.959), preterm birth (OR = 3.422), and gestational diabetes mellitus (OR = 1.784) were significantly higher in women with a normal pre-pregnancy body mass index (BMI) and inadequate GWG compared with women with a normal pre-pregnancy BMI and adequate GWG. The risks of macrosomia (OR = 3.654) and HDP (OR = 1.992) were increased in women with normal pre-pregnancy BMI and excessive GWG. Conclusion Women with an abnormal BMI and inappropriate GWG have an increased risk of adverse maternal and infant outcomes. Weight management during the perinatal period is required.

scholarly journals Institute of Medicine Recommendations on the Rate of Gestational Weight Gain and Perinatal Outcomes in Rural Bangladesh

2021 ◽  
Vol 18 (12) ◽  
pp. 6519
Author(s):  
S. M. Tafsir Hasan ◽  
Md Alfazal Khan ◽  
Tahmeed Ahmed
Keyword(s):  
Weight Gain ◽  
Preterm Birth ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Neonatal Outcome ◽  
Perinatal Outcomes ◽  
Institute Of Medicine ◽  
Third Trimester ◽  
Gestational Weight ◽  
Iom Recommendations

Although validated in other parts of the world, the suitability of the U.S. Institute of Medicine (IOM) 2009 recommendations on gestational weight gain (GWG) for Bangladeshi women remains to be examined. We evaluated the association between the weekly rate of weight gain during the second and third trimester of pregnancy, categorized according to IOM recommendations, and adverse perinatal outcomes among 1569 pregnant women with singleton live births in rural Matlab, Bangladesh. Gaining weight at rates below the IOM recommendations was associated with higher odds of preterm birth (adjusted odds ratio (AOR) = 2.0, 95% CI: 1.1–3.6), low birth weight (AOR = 1.4, 95% CI: 1.03–2.0), small-for-gestational-age newborns (AOR = 1.3, 95% CI: 1.04–1.7), and poor neonatal outcome (severe neonatal morbidity or death, AOR = 2.4, 95% CI: 1.03–5.6). A GWG rate above the recommendations was associated with higher odds of cesarean delivery (AOR = 1.7, 95% CI: 1.1–2.6), preterm birth (AOR = 2.2, 95% CI: 1.1–4.4), large-for-gestational-age newborns (AOR = 5.9, 95% CI: 1.5–23.1), and poor neonatal outcome (AOR = 2.7, 95% CI: 1.04–7.0). Our results suggest that the IOM 2009 recommendations on GWG rate during the second and third trimester may be suitable for guiding rural Bangladeshi women in the prenatal period, although the women should aim for rates near the lower bound of the range.

scholarly journals Using Non-inferiority Margins to Define Optimal Gestational Weight Gain Ranges Based on Reducing the Risk of Occurrence of Adverse Neonatal Outcomes

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 728-728
Author(s):  
Thais Carrilho ◽  
Jennifer Hutcheon ◽  
Kathleen Rasmussen ◽  
Dayana Farias ◽  
Michael Reichenheim ◽  
...  
Keyword(s):  
Weight Gain ◽  
Preterm Birth ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
National Research Council ◽  
Neonatal Outcomes ◽  
Composite Outcome ◽  
Gestational Weight ◽  
Adverse Neonatal Outcomes ◽  
Z Scores

Abstract Objectives To identify optimal gestational weight gain (GWG) ranges to prevent adverse neonatal outcomes based on the new Brazilian GWG charts. Methods Data from 9,294 women from the Brazilian Maternal and Child Nutrition Consortium and Birth in Brazil study were used. Women aged ≥18 years, free of hypertensive disorders, diabetes in pregnancy, or diseases affecting GWG, were selected. Total GWG was calculated as last measured prenatal weight minus self-reported pre-pregnancy weight. Total GWG was standardized to gestational age-specific z scores according to the Brazilian GWG charts. A composite outcome was defined as the occurrence of any of small-for-gestational-age birth (SGA, birthweight &lt; 10th percentile), large-for-gestational-age birth (LGA &gt; 90th percentile) according to INTERGROWTH-21st charts, or preterm birth (birth &lt; 37 weeks). We weighted each outcome in a composite index using previously-published weights to account for its relative seriousness. Logistic and Poisson regressions were performed with GWG z scores as exposure and independent outcomes and the composite outcome, respectively. Models were adjusted for maternal age, education, pre-pregnancy BMI, and smoking during pregnancy. GWG ranges associated with the lowest risk of the composite outcome were identified using the non-inferiority margins approach (20%). Results The median total GWG was 12.5 kg (IQR 9–16), and 6.2% of the neonates were SGA, 16.6% LGA, and 10.5% were preterm. Higher GWG z scores were associated with an increase in LGA probabilities and preterm birth compared with neonates born with appropriate weight and ≥37 weeks, respectively. Lower z scores were associated with an increase in SGA probability. The non-inferiority margins analysis showed that to prevent the occurrence of these adverse outcomes, women with underweight, normal-weight, overweight, or obesity should gain between 6.5–14.1 kg, 6.4–13.8 kg, 2.2–12.1 kg, and –2.2–8.9 kg, respectively. Conclusions Total GWG ranges associated with lower risk of adverse neonatal outcomes were identified using non-inferiority margins. The next step must incorporate maternal outcomes in this analysis. Funding Sources Brazilian National Research Council, Brazilian Ministry of Health, Bill and Melinda Gates Foundation.

scholarly journals Gestational Weight Gain and Its Effects on Maternal and Neonatal Outcome in Women With Twin Pregnancies: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Wei Zhong ◽  
Xiaojiao Fan ◽  
Fang Hu ◽  
Meiqin Chen ◽  
Fanshu Zeng
Keyword(s):  
Weight Gain ◽  
Preterm Delivery ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Weight Status ◽  
Gestational Hypertension ◽  
Meta Analysis ◽  
Gestational Weight ◽  
Increased Risk ◽  
Twin Pregnancies

Background: The incidence of twin pregnancies has risen recently. Such pregnancies are associated with an increased risk for poor maternal and infant outcomes. Gestational weight gain, particularly in singleton pregnancies, has been well-linked with maternal and infant outcomes. The aim of the current meta-analysis was to evaluate the effects of gestational weight gain on maternal and fetal outcomes in women with twin pregnancies.Methods: A systematic search was conducted using the PubMed, Scopus, and Google Scholar databases. Studies, either retrospective or prospective in design, evaluating the effects of gestational weight gain (defined using Institute of Medicine (IOM) guidelines) maternal and/or fetal/neonatal outcomes in women with twin pregnancies were included. Statistical analysis was performed using STATA software.Results: Eleven studies were included in the meta-analysis. Mothers with inadequate weight gain had increased risk for gestational diabetes mellitus (OR 1.19; 95% CI: 1.01, 1.40) and decreased risk for gestational hypertension (OR 0.58; 95% CI: 0.49, 0.68) and cesarean section (OR 0.94; 95% CI: 0.93, 0.96). Neonates born to mothers with inadequate weight gain were susceptible to increased risk for preterm delivery (OR 1.17; 95% CI: 1.03, 1.34), very preterm delivery (gestational age &lt;32 weeks) (OR 1.84; 95% CI: 1.36, 2.48), small for gestational age status (OR 1.41; 95% CI: 1.15, 1.72), low birth weight status (&lt;2,500 g) (OR 1.27; 95% CI: 1.17, 1.38), and neonatal intensive care unit (NICU) admission (OR 1.16; 95% CI: 1.08, 1.24). The pooled findings indicate an increased risk for gestational hypertension (OR 1.82; 95% CI: 1.60, 2.06) and cesarean section (OR 1.07; 95% CI: 1.05, 1.08) among mothers with excessive weight gain. Neonates born to mothers with excessive weight gain were susceptible to increased risk for preterm delivery and very preterm delivery, but were associated with a decreased risk for low birth weight status and small for gestational age status.Conclusions: Gestational weight gain in twin pregnancy, either lower or higher than IOM recommended guidelines, is associated with poor maternal and neonatal outcomes. Our findings call for incorporating counseling on optimal weight gain during pregnancy as part of routine antenatal visits.

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