title: The association of gestational weight gain per institute of medicine guidelines and prepregnancy body mass index on outcomes of twin pregnancies.
abstract: OBJECTIVE
  To determine if current recommendations for weight gain in twin pregnancies according to maternal prepregnancy body mass index (PPBMI) influence perinatal outcomes.
  
  
  METHODS
  We identified women with twins enrolled in a maternity risk screening and education program with initial screening and prenatal care initiated at <20 weeks and delivery at >23.9 weeks. Women with normal, overweight, or obese PPBMI were included (n = 5129). Pregnancy outcomes were compared between those women with weight gain meeting or exceeding 2009 Institute of Medicine recommendations and patients who did not meet weight gain guidelines.
  
  
  RESULTS
  Rates of spontaneous preterm delivery at <35 weeks were higher in all PPBMI groups for those with weight gain below guidelines. In all PPBMI groups, numbers of pregnancies with both infants weighing >2500 g or >1500 g were significantly higher for women gaining weight at or above guidelines. Logistic regression analysis was utilized to assess multivariate impact on outcome of spontaneous preterm delivery at <35 weeks showing that regardless of PPBMI level, women who gain below recommended guidelines are 50% more likely to deliver spontaneously at <35 weeks.
  
  
  CONCLUSIONS
  In twin pregnancies, weight gain below recommended guidelines determined by maternal PPBMI is associated with higher rates of spontaneous preterm delivery at <35 weeks.
authors.affiliation: Associates in Advanced Maternal Fetal Medicine, Miami, FL, USA.
authors.forename: Victor H
authors.initials: VH
authors.lastname: González-Quintero
authors.forename: Anupama S Q
authors.initials: AS
authors.lastname: Kathiresan
authors.forename: Felipe José
authors.initials: FJ
authors.lastname: Tudela
authors.forename: Debbie
authors.initials: D
authors.lastname: Rhea
authors.forename: Cheryl
authors.initials: C
authors.lastname: Desch
authors.forename: Niki
authors.initials: N
authors.lastname: Istwan
mesh_terms: D000328:Adult; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017408:Guidelines as Topic; D006801:Humans; D007231:Infant, Newborn; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin / Q000502:physiology*; D047928:Premature Birth / Q000209:etiology*; D012189:Retrospective Studies; D014481:United States; D015430:Weight Gain / Q000502:physiology*