title: Assessing Weight Gain by the 2009 Institute of Medicine Guidelines and Perinatal Outcomes in Twin Pregnancy.
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.
authors.affiliation: The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA. ozcans@email.chop.edu.
authors.forename: Tulin
authors.initials: T
authors.lastname: Ozcan
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bacak
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Zozzaro-Smith
authors.affiliation: Clinical and Translational Science Institute, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
authors.forename: Dongmei
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA.
authors.forename: Seyhan
authors.initials: S
authors.lastname: Sagcan
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Seligman
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Glantz
mesh_terms: D000328:Adult; D001724:Birth Weight / Q000502:physiology; D015992:Body Mass Index; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division / Q000458:organization & administration; D009518:New York / Q000453:epidemiology; D016017:Odds Ratio; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000502:physiology / Q000706:statistics & numerical data; D012307:Risk Factors; D014427:Twins / Q000706:statistics & numerical data*; D014481:United States; D015430:Weight Gain
keywords: 2009 IOM guidelines; Twin pregnancy; Weight gain