Obstet Gynecol Sci.  2020 Nov;63(6):690-699. 10.5468/ogs.20133.

Gestational weight gain in twin pregnancies in Korea: application of the 2009 Institute of Medicine recommendations

• Choi BY
• Hong S
• Jeon M
• Park JY
• Oh KJ
• Hong JS

• KMID: 2511209
• DOI: http://doi.org/10.5468/ogs.20133

Abstract

Objective
To investigate the effect of gestational weight gain (GWG) on maternal and neonatal outcomes based on the Institute of Medicine (IOM) guidelines for twin pregnancies.
Methods
This study included women with twin pregnancies who delivered at Seoul National University Bundang Hospital. Based on the weight gain per gestational week according to the 2009 IOM guidelines, the subjects were divided into the following 3 groups: inadequate, adequate, and excessive GWG. We compared the maternal and neonatal outcomes of each group.
Results
A total of 1,738 twin pregnancies were included in our study. Of these cases, 881, 694, and 163 (50.7%, 39.9%, and 9.4%, respectively) twin pregnancies were categorized into the inadequate, adequate, and excessive GWG groups, respectively. In the inadequate GWG group, the risks of preterm birth <34 weeks (aOR, 2.33, 95% confidence interval [CI], 1.63–3.34) and delivering neonates who were small for gestational age (aOR, 1.92, 95% CI, 1.42–2.60) were increased, and the risk of preeclampsia (aOR, 0.49, 95% CI, 0.32–0.76) was decreased. The excessive GWG group had an increased risk of the neonates being large for gestational age (aOR, 1.79, 95% CI, 1.15–2.81).
Conclusion
The 2009 IOM recommendations for GWG can be applied to Korean women with twin pregnancies to help achieve optimal maternal and neonatal outcomes. However, more than half of the women were categorized as having inadequate weight gain according to the guidelines. Further studies should be performed to obtain Korean national references for GWG in twin pregnancies.

Keyword

Gestational weight gain; Twin pregnancy; Institute of Medicine; Pregnancy outcome

Figure

• 

  Fig. 1. Study flow chart and population. GA, gestational age; BMI, body mass index; GWG, gestational weight gain; MCMA, monochorionic monoamniotic twin; TTTS, twin-to-twin transfusion syndrome.

Reference

References

1. American College of Obstetricians and Gynecologists. ACOG Committee opinion No. 548: weight gain during pregnancy. Obstet Gynecol. 2013; 121:210–2.

2. Nohr EA, Vaeth M, Baker JL, Sørensen TI, Olsen J, Rasmussen KM. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr. 2008; 87:1750–9.

3. LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group, Voerman E, Santos S, Inskip H, Amiano P, Barros H, et al. Association of gestational weight gain with adverse maternal and infant outcomes. JAMA. 2019; 321:1702–15.

4. Diemert A, Lezius S, Pagenkemper M, Hansen G, Drozdowska A, Hecher K, et al. Maternal nutrition, inadequate gestational weight gain and birth weight: results from a prospective birth cohort. BMC Pregnancy Childbirth. 2016; 16:224.

5. Viswanathan M, Siega-Riz AM, Moos MK, Deierlein A, Mumford S, Knaack J, et al. Outcomes of maternal weight gain. Evid Rep Technol Assess (Full Rep). 2008; 1–223.

6. Institute of Medicine. Nutrition during pregnancy: part I: weight gain, part II: nutrient supplements. Washington, D.C: The National Academies Press;1990.

7. Rogozińska E, Zamora J, Marlin N, Betrán AP, Astrup A, Bogaerts A, et al. Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials. BMC Pregnancy Childbirth. 2019; 19:322.

8. Luke B, Hediger ML, Nugent C, Newman RB, Mauldin JG, Witter FR, et al. Body mass index--specific weight gains associated with optimal birth weights in twin pregnancies. J Reprod Med. 2003; 48:217–24.

9. Arora P, Tamber Aeri B. Gestational weight gain among healthy pregnant women from Asia in comparison with Institute of Medicine (IOM) guidelines-2009: a systematic review. J Pregnancy. 2019; 2019:3849596.

10. Goldstein RF, Abell SK, Ranasinha S, Misso ML, Boyle JA, Harrison CL, et al. Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women. BMC Med. 2018; 16:153.

11. Denize KM, Acharya N, Prince SA, da Silva DF, Harvey AL, Ferraro ZM, et al. Addressing cultural, racial and ethnic discrepancies in guideline discordant gestational weight gain: a systematic review and meta-analysis. PeerJ. 2018; 6:e5407.

12. Wie JH, Park IY, Namkung J, Seo HW, Jeong MJ, Kwon JY. Is it appropriate for Korean women to adopt the 2009 Institute of Medicine recommendations for gestational weight gain? PLoS One. 2017; 12:e0181164.

13. Schieve LA, Cogswell ME, Scanlon KS. An empiric evaluation of the Institute of Medicine’s pregnancy weight gain guidelines by race. Obstet Gynecol. 1998; 91:878–84.

14. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363:157–63.

15. Fox NS, Rebarber A, Roman AS, Klauser CK, Peress D, Saltzman DH. Weight gain in twin pregnancies and adverse outcomes: examining the 2009 Institute of Medicine guidelines. Obstet Gynecol. 2010; 116:100–6.

16. 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; 118:1000–4.

17. Lee JJ. Birth weight for gestational age patterns by sex, plurality, and parity in Korean population. Korean J Pediatr. 2007; 50:732.

18. Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993; 80:27–38.

19. 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; 35:85–9.

20. Simões T, Cordeiro A, Júlio C, Reis J, Dias E, Blickstein I. Perinatal outcome and change in body mass index in mothers of dichorionic twins: a longitudinal cohort study. Twin Res Hum Genet. 2008; 11:219–23.

21. 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; 138:94–9.

22. Algeri P, Pelizzoni F, Bernasconi DP, Russo F, Incerti M, Cozzolino S, et al. Influence of weight gain, according to Institute of Medicine 2009 recommendation, on spontaneous preterm delivery in twin pregnancies. BMC Pregnancy Childbirth. 2018; 18:6.

23. Fox NS, Stern EM, Saltzman DH, Klauser CK, Gupta S, Rebarber A. The association between maternal weight gain and spontaneous preterm birth in twin pregnancies. J Matern Fetal Neonatal Med. 2014; 27:1652–5.

24. Huang A, Ji Z, Zhao W, Hu H, Yang Q, Chen D. Rate of gestational weight gain and preterm birth in relation to prepregnancy body mass indices and trimester: a follow-up study in China. Reprod Health. 2016; 13:93.

25. Kabiru W, Raynor BD. Obstetric outcomes associated with increase in BMI category during pregnancy. Am J Obstet Gynecol. 2004; 191:928–32.

26. Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol. 2010; 115:597–604.

27. Simmons D. Diabetes and obesity in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2011; 25:25–36.

28. Lee KH, Han YJ, Chung JH, Kim MY, Ryu HM, Kim JH, et al. Treatment of gestational diabetes diagnosed by the IADPSG criteria decreases excessive fetal growth. Obstet Gynecol Sci. 2020; 63:19–26.

29. Viecceli C, Remonti LR, Hirakata VN, Mastella LS, Gnielka V, Oppermann ML, et al. Weight gain adequacy and pregnancy outcomes in gestational diabetes: a metaanalysis. Obes Rev. 2017; 18:567–80.

30. Harper LM, Tita A, Biggio JR. The institute of medicine guidelines for gestational weight gain after a diagnosis of gestational diabetes and pregnancy outcomes. Am J Perinatol. 2015; 32:239–46.

31. Katon J, Reiber G, Williams MA, Yanez D, Miller E. Weight loss after diagnosis with gestational diabetes and birth weight among overweight and obese women. Matern Child Health J. 2013; 17:374–83.

32. Li N, Liu E, Guo J, Pan L, Li B, Wang P, et al. Maternal prepregnancy body mass index and gestational weight gain on pregnancy outcomes. PLoS One. 2013; 8:e82310.

33. Cedergren M. Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Int J Gynaecol Obstet. 2006; 93:269–74.

34. Chen Y, Liu Y, Zhang Y, Hu R, Qian Z, Xian H, et al. Gestational weight gain per pre-pregnancy body mass index and birth weight in twin pregnancies: a cohort study in Wuhan, China. Sci Rep. 2018; 8:12496.

35. Lutsiv O, Hulman A, Woolcott C, Beyene J, Giglia L, Armson BA, et al. Examining the provisional guidelines for weight gain in twin pregnancies: a retrospective cohort study. BMC Pregnancy Childbirth. 2017; 17:330.

36. González-Quintero VH, Kathiresan AS, Tudela FJ, Rhea D, Desch C, Istwan N. The association of gestational weight gain per institute of medicine guidelines and prepregnancy body mass index on outcomes of twin pregnancies. Am J Perinatol. 2012; 29:435–40.

37. Bodnar LM, Himes KP, Abrams B, Lash TL, Parisi SM, Eckhardt CL, et al. Gestational weight gain and adverse birth outcomes in twin pregnancies. Obstet Gynecol. 2019; 134:1075–86.

38. Lin D, Fan D, Wu S, Chen G, Li P, Ma H, et al. The effect of gestational weight gain on perinatal outcomes among Chinese twin gestations based on Institute of Medicine guidelines. BMC Pregnancy Childbirth. 2019; 19:262.

39. Gavard JA, Artal R. Gestational weight gain and maternal and neonatal outcomes in term twin pregnancies in obese women. Twin Res Hum Genet. 2014; 17:127–33.

40. Rasmussen KM, Yaktine AL; Institute of Medicine; National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. Washington, D.C: The National Academies Press;2009.