Download PDF
Am J Perinatol 2023; 40(10): 1040-1046
DOI: 10.1055/s-0043-1764345
SMFM Fellowship Series Article

Early Gestational Weight Gain and the Risk of Preeclampsia in Dichorionic Twin Pregnancies

Tiffany E. Deihl
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Lisa M. Bodnar
2   Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
3   Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Sara M. Parisi
3   Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Katherine P. Himes
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
2   Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
› Author Affiliations Funding This work was supported by NIH Grant (R01 NR014245) to L.M.B. (PI) and K.P.H. (Co-I). The funding source had no role in the design of this study or manuscript preparation.
› Further Information
    Permissions and Reprints

Abstract

Objective The purpose of our study was to evaluate the body mass index (BMI)-specific association between early gestational weight gain (GWG) in dichorionic twin pregnancies and the risk of preeclampsia.

Study Design We conducted a retrospective cohort study of all dichorionic twin pregnancies from 1998 to 2013. Data were obtained from a perinatal database and chart abstraction. Prepregnancy BMI was categorized as normal (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), and obese (≥30 kg/m2). Early GWG was defined as the last measured weight from 160/7 to 196/7weeks' gestation minus prepregnancy weight. GWG was standardized for gestational duration using BMI-specific z-score charts for dichorionic pregnancies. Preeclampsia was diagnosed using American College of Obstetricians and Gynecologists criteria and identified with International Classification of Diseases-9 coding. Early GWG z-score was modeled as a three-level categorical variable (≤ − 1 standard deviation [SD], 0, 3 +1 SD), where −1 to +1 was the referent group. We estimated risk differences and 95% confidence intervals (CIs) via marginal standardization.

Results We included 1,693 dichorionic twin pregnancies in the cohort. In adjusted analysis, the incidence of preeclampsia increased with increasing early GWG among women with normal BMI. Women with normal BMI and a GWG z-score < − 1 (equivalent to 2.6 kg by 20 weeks) had 2.5 fewer cases of preeclampsia per 100 births (95% CI: −4.7 to − 0.3) compared with the referent; those with GWG z-score > +1 (equivalent to gaining 9.8 kg by 20 weeks) had 2.8 more cases of preeclampsia per 100 (95 % CI: 0.1–5.5) compared with the referent. In adjusted analyses, early GWG had minimal impact on the risk of preeclampsia in women with overweight or obesity.

Conclusion GWG of 2.6 kg or less by 20 weeks was associated with a decreased risk of preeclampsia among women pregnant with dichorionic twins and normal prepregnancy BMI. Current GWG guidelines focus on optimizing fetal weight and gestational length. Our findings demonstrate the importance of considering other outcomes when making GWG recommendations for twin pregnancy.

Key Points

  • Early GWG decreased with increasing BMI category.

  • Among women with normal weight, as early GWG increased so did the risk of preeclampsia.

  • There was no association between early GWG and preeclampsia among women with overweight or obesity.

Keywords

gestations - preeclampsia - early gestational weight gain - dichorionic twins


Publication History

Received: 01 February 2023

Accepted: 01 February 2023

Article published online:
14 March 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Martin JA, Hamilton BE, Osterman MJK. Three Decades of Twin Births in the United States, 1980–2009. NCHS Data Brief, No 80. Hyattsville, MD: National Center for Health Statistics; 2012
    Google Scholar
  • 2 Martin JA, Osterman MJK. Is Twin Childbearing on the Decline? Twin Births in the United States, 2014–2018. NCHS Data Brief, no 351. Hyattsville, MD: National Center for Health Statistics; 2019
    Google Scholar
  • 3 MacDorman MF, Gregory EC. Fetal and perinatal mortality: United States, 2013. Natl Vital Stat Rep 2015; 64 (08) 1-24
    PubMedGoogle Scholar
  • 4 Matthews TJ, MacDorman MF, Thoma ME. Infant mortality statistics from the 2013 period linked birth/infant death data set. Natl Vital Stat Rep 2015; 64 (09) 1-30
    PubMedGoogle Scholar
  • 5 Luke B, Brown MB. Contemporary risks of maternal morbidity and adverse outcomes with increasing maternal age and plurality. Fertil Steril 2007; 88 (02) 283-293
    CrossrefPubMedGoogle Scholar
  • 6 CDC. QuickStats: percentage of live births by cesarean delivery, by plurality–United States, 1996, 2000, 2006. MMWR 2009; 58 (19) 542
    PubMedGoogle Scholar
  • 7 Viswanathan M, Siega-Riz AM, Moos MK. et al. Outcomes of maternal weight gain. Evid Rep Technol Assess (Full Rep) 2008; (168) 1-223
    PubMedGoogle Scholar
  • 8 Institute of Medicine. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: National Academies Press; 2009
    Google Scholar
  • 9 Markham KB, Funai FF. Pregnancy-related hypertension. In: Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR, Greene MF. eds. Creasy and Resnik's Maternal-Fetal Medicine.
    Google Scholar
  • 10 Liu LY, Zafman KB, Fox NS. The association between gestational weight gain in each trimester and pregnancy outcomes in twin pregnancies. Am J Perinatol 2021; 38 (06) 567-574
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Hutcheon JA, Bodnar LM. Good practices for observational studies of maternal weight and weight gain in pregnancy. Paediatr Perinat Epidemiol 2018; 32 (02) 152-160
    CrossrefPubMedGoogle Scholar
  • 12 Freese KE, Bodnar LM, Brooks MM, McTIGUE K, Himes KP. Population-attributable fraction of risk factors for severe maternal morbidity. Am J Obstet Gynecol MFM 2020; 2 (01) 100066
    CrossrefPubMedGoogle Scholar
  • 13 Howe CJ, Cole SR, Lau B, Napravnik S, Eron Jr JJ. Selection bias due to loss to follow up in cohort studies. Epidemiology 2016; 27 (01) 91-97
    CrossrefPubMedGoogle Scholar
  • 14 Committee Opinion No. 700: methods for estimating the due date. Obstet Gynecol 2017; 129 (05) e150-e154
    CrossrefPubMedGoogle Scholar
  • 15 Hutcheon JA, Platt RW, Abrams B. et al. Pregnancy weight gain by gestational age in women with uncomplicated dichorionic twin pregnancies. Paediatr Perinat Epidemiol 2018; 32 (02) 172-180
    CrossrefPubMedGoogle Scholar
  • 16 Gestational hypertension and preeclampsia. ACOG Practice Bulletin Number 222. Obstet Gynecol 2020; 135 (06) e237-e260
    CrossrefPubMedGoogle Scholar
  • 17 Shrier I, Platt RW. Reducing bias through directed acyclic graphs. BMC Med Res Methodol 2008; 8: 70
    CrossrefPubMedGoogle Scholar
  • 18 Bodnar LM, Himes KP, Abrams B, Parisi SM, Hutcheon JA. Early-pregnancy weight gain and the risk of preeclampsia: a case-cohort study. Pregnancy Hypertens 2018; 14: 205-212
    CrossrefPubMedGoogle Scholar
  • 19 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
    CrossrefPubMedGoogle Scholar
  • 20 Lipworth H, Barrett J, Murphy KE, Redelmeier D, Melamed N. Gestational weight gain in twin gestations and pregnancy outcomes: a systematic review and meta-analysis. BJOG 2022; 129 (06) 868-879
    CrossrefPubMedGoogle Scholar
  • 21 Algeri P, Pelizzoni F, Bernasconi DP. et al. Influence of weight gain, according to Institute of Medicine 2009 recommendation, on spontaneous preterm delivery in twin pregnancies. BMC Pregnancy Childbirth 2018; 18 (01) 6
    CrossrefPubMedGoogle Scholar
  • 22 Fox NS, Saltzman DH, Kurtz H, Rebarber A. Excessive weight gain in term twin pregnancies: examining the 2009 Institute of Medicine definitions. Obstet Gynecol 2011; 118 (05) 1000-1004
    CrossrefPubMedGoogle Scholar
  • 23 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
    CrossrefPubMedGoogle Scholar
  • 24 Pécheux O, Garabedian C, Drumez E. et al. Maternal and neonatal outcomes according to gestational weight gain in twin pregnancies: are the Institute of Medicine guidelines associated with better outcomes?. Eur J Obstet Gynecol Reprod Biol 2019; 234: 190-194
    CrossrefPubMedGoogle Scholar
  • 25 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
    CrossrefPubMedGoogle Scholar
  • 26 Pettit KE, Lacoursiere DY, Schrimmer DB, Alblewi H, Moore TR, Ramos GA. Maternal and neonatal outcomes in women with twin pregnancies with excessive gestational weight gain. J Matern Fetal Neonatal Med 2016; 29 (13) 2182-2185
    CrossrefPubMedGoogle Scholar
  • 27 Shamshirsaz AA, Haeri S, Ravangard SF. et al. Perinatal outcomes based on the institute of medicine guidelines for weight gain in twin pregnancies. J Matern Fetal Neonatal Med 2014; 27 (06) 552-556
    CrossrefPubMedGoogle Scholar
  • 28 Gavard JA, Artal R. Gestational weight gain and maternal and neonatal outcomes in term twin pregnancies in obese women. Twin Res Hum Genet 2014; 17 (02) 127-133
    CrossrefPubMedGoogle Scholar
  • 29 Kosinska-Kaczynska K, Szymusik I, Kaczynski B, Wielgos M. Observational study of associations between gestational weight gain and perinatal outcomes in dichorionic twin pregnancies. Int J Gynaecol Obstet 2017; 138 (01) 94-99
    CrossrefPubMedGoogle Scholar
  • 30 Bodnar LM, Hutcheon JA, Parisi SM, Pugh SJ, Abrams B. Comparison of gestational weight gain z-scores and traditional weight gain measures in relation to perinatal outcomes. Paediatr Perinat Epidemiol 2015; 29 (01) 11-21
    CrossrefPubMedGoogle Scholar
  • 31 Luke B, Keith L, Johnson TR, Keith D. Pregravid weight, gestational weight gain and current weight of women delivered of twins. J Perinat Med 1991; 19 (05) 333-340
    CrossrefPubMedGoogle Scholar
  • 32 Luke B, Minogue J, Abbey H. et al. The association between maternal weight gain and the birthweight of twins. J Matern Fetal Med 1992; 1: 267-276
    CrossrefPubMedGoogle Scholar
  • 33 Luke B, Minogue J, Witter FR, Keith LG, Johnson TR. The ideal twin pregnancy: patterns of weight gain, discordancy, and length of gestation. Am J Obstet Gynecol 1993; 169 (03) 588-597
    CrossrefPubMedGoogle Scholar
  • 34 Luke B, Leurgans S. Maternal weight gains in ideal twin outcomes. J Am Diet Assoc 1996; 96 (02) 178-181
    CrossrefPubMedGoogle Scholar
  • 35 Luke B, Gillespie B, Min S-J, 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
    CrossrefPubMedGoogle Scholar
  • 36 Luke B, Min S-J, Gillespie B. et al. The importance of early weight gain in the intrauterine growth and birth weight of twins. Am J Obstet Gynecol 1998; 179 (05) 1155-1161
    CrossrefPubMedGoogle Scholar
  • 37 Luke B. What is the influence of maternal weight gain on the fetal growth of twins?. Clin Obstet Gynecol 1998; 41 (01) 56-64
    CrossrefPubMedGoogle Scholar
  • 38 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
    PubMedGoogle Scholar
  • 39 Landon MB, Galan HL, Jauniaux ERM. et al. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th revised ed.. Philadelphia, PA: Elsevier, Inc; 2021: 1280
    Google Scholar
  • 40 Campbell DM, Templeton A. Maternal complications of twin pregnancy. Int J Gynaecol Obstet 2004; 84 (01) 71-73
    CrossrefPubMedGoogle Scholar
  • 41 Hinkle SN, Hediger ML, Kim S. et al. Maternal weight gain and associations with longitudinal fetal growth in dichorionic twin pregnancies: a prospective cohort study. Am J Clin Nutr 2017; 106 (06) 1449-1455
    CrossrefPubMedGoogle Scholar