The Institute of Medicine (IOM) has provisional gestational weight gain (GWG) guidelines for women pregnant with twins due to limited data in this population. To better inform guidelines, the objective of this systematic review was to build on prior work and examine recent data on the associations of GWG with maternal and child health in twin pregnancies.
Materials and Methods:
In February 2021, Ovid MEDLINE, Embase, CINAHL, and Cochrane Library were searched. Observational studies were eligible if published from January 1, 2013 through February 23, 2021, and examined associations of GWG with maternal or child health outcomes after accounting for gestational age at delivery and pre-pregnancy body mass index. Heterogeneity across studies precluded the use of meta-analytic methods.
Results:
A total of 29 studies were included. For maternal outcomes, excessive GWG was associated with an increased risk of hypertensive disorders of pregnancy; whereas studies examining gestational diabetes and delivery method reported mixed findings. For child outcomes, inadequate GWG was associated with lower birthweight, small for gestational age, and preterm birth. Adequate or excessive GWG was associated with later gestational age at delivery.
Conclusions:
This study advances an earlier review by including a more diverse array of maternal and child outcomes. Many of the limitations noted in the original review persist; for example, no studies examined the associations of GWG and outcomes beyond birth. Although it appears that GWG within the IOM guidelines is associated with more optimal outcomes, additional methodologically rigorous studies are needed to better inform evidence-based guidelines.
Get full access to this article
View all access options for this article.
References
1.
MartinJA, HamiltonBE, OstermanMJ. Three decades of twin births in the United States, 1980–2009. NCHS Data Brief, 2012:1–8.
KrotzS, FajardoJ, GhandiS, PatelA, KeithLG. Hypertensive disease in twin pregnancies: A review. Twin Res, 2002; 5:8–14.
4.
Centers for Disease Control and Prevention (CDC). QuickStats: Percentage of live births by cesarean delivery, by plurality—United States, 1996, 2000, and 2006. Morb Mortal Wkly Rep, 2009; 58:542.
5.
NorwitzER, EdusaV, ParkJS. Maternal physiology and complications of multiple pregnancy. Semin Perinatol, 2005; 29:338–348.
6.
SantanaDS, CecattiJG, SuritaFG, et al.Twin pregnancy and severe maternal outcomes: The World Health Organization multicountry survey on maternal and newborn health. Obstet Gynecol, 2016; 127:631–641.
7.
HamiltonBE, MartinJA, OstermanMJ, CurtinSC, MatthewsTJ. Births: Final data for 2014. Natl Vital Stat Rep, 2015; 64:1–64.
8.
MacdormanMF, KirmeyerS. The challenge of fetal mortality. NCHS Data Brief, 2009:1–8.
9.
RaoA, SairamS, ShehataH. Obstetric complications of twin pregnancies. Best Pract Res Clin Obstet Gynaecol, 2004; 18:557–576.
10.
Institute of Medicine and National Research Council. Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: National Academies Press (US), 2009.
11.
BodnarLM, PughSJ, AbramsB, HimesKP, HutcheonJA. Gestational weight gain in twin pregnancies and maternal and child health: A systematic review. J Perinatol, 2014; 34:252–263.
12.
MoherD, ShamseerL, ClarkeM, et al.Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev, 2015; 4:1.
13.
ShamseerL, MoherD, ClarkeM, et al.Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ, 2015; 350:g7647.
14.
BramerWM, GiustiniD, de JongeGB, HollandL, BekhuisT. De-duplication of database search results for systematic reviews in EndNote. J Med Libr Assoc, 2016; 104:240–243.
15.
WhitakerKM, BeckerC, HealyH, WilcoxS, LiuJ. Women's report of health care provider advice and gestational weight gain: A systematic review. J Womens Health (Larchmt), 2021; 30:73–89.
16.
GreenanCW, ChristensenC, WojciechowskiB, TaamR, NewmanR. Validation of body mass index (BMI)-specific weight gain recommendations for twin gestations in all maternal BMI categories. Am J Obstet Gynecol, 2016; 214:S163.
17.
GreenanCW, ChristensenC, WojciechowskiB, TaamR, NewmanRB. Gestational weight gain in twin pregnancies: Does achievement of body mass index-specific weight gain recommendations reduce preterm birth and neonatal morbidity?. Am J Obstet Gynecol, 2016; 214:S233.
18.
KoHJ, JunJK, ParkCW, ParkJS, YoonBH. Clinical factors associated with failed trials of labor in late preterm and term twin pregnancies. Am J Obstet Gynecol, 2014; 210:S335–S336.
19.
LiuLY, ZafmanKB, FoxNS. 330: Weight gain and pregnancy outcomes in overweight or obese women with twin gestations. Am J Obstet Gynecol, 2019; 220:S230.
20.
LutsivO, HulmanA, WoolcottC, et al.Is gestational weight gain above the guidelines associated with less SGA in twins?. Am J Obstet Gynecol, 2016; 214:S166.
21.
PettitK, LacoursiereD, SchrimmerD, AlblewiH, MooreT, RamosG. Maternal and neonatal outcomes in women with twin pregnancies with excessive gestational weight gain. Am J Obstet Gynecol, 2015; 212:S361–S362.
22.
PettitKE, LacoursiereDY, SchrimmerDB, AlblewiH, MooreTR, RamosGA. The association of inadequate mid-pregnancy weight gain and preterm birth in twin pregnancies. J Perinatol, 2015; 35:85–89.
23.
PettitKE, SchrimmerD, AlblewiH, MooreTR, LaCoursiereDY, RamosGA. The association between second-trimester weight gain and preterm birth in twin pregnancies. Obstet Gynecol, 2014; 123:2S.
24.
SuzukiS. Optimal weight gain during twin pregnancy in Japanese women with favorable perinatal outcomes. J Matern Fetal Neonatal Med, 2016; 29:1–14.
25.
LiuLY, ZafmanKB, FoxNS. Weight gain in twin pregnancies: At what point in pregnancy does it matter most?. Reprod Sci, 2019; 26:233A.
26.
GandhiM, GandhiR, ShypailoR, et al.Do maternal body composition and physical activity influence birthweight percentiles in twins?. Am J Obstet Gynecol, 2017; 216:S101–S102.
27.
OzcanT, BacakS, Zozzaro-SmithPP, SeligmanN, GlantzC. Second and third trimester weight gain and perinatal outcome among twin pregnancies. Am J Obstet Gynecol, 2014; 210:S286–S287.
28.
PécheuxO, GarabedianC, DrumezE, et al.Maternal and neonatal outcomes according to gestational weight gain in twin pregnancies: Are the American IOM guidelines associated with better issues in Europe?. Eur J Obstet Gynecol Reprod Biol, 2019; 234:e46–e47.
29.
LiuLY, ZafmanKB, FoxNS. Weight gain and pregnancy outcomes in underweight women with twin gestations. J Matern Fetal Neonatal Med, 2018:1–141.
30.
LiuLY, ZafmanKB, FoxNS. The association between gestational weight gain in each trimester and pregnancy outcomes in twin pregnancies. Am J Perinatol, 2020:1–8.
31.
PettitKE, LacoursiereDY, SchrimmerDB, AlblewiH, MooreTR, RamosGA. Maternal and neonatal outcomes in women with twin pregnancies with excessive gestational weight gain. J Matern Fetal Neonatal Med, 2016; 29:2182–2185.
32.
BodnarLM, HimesKP, AbramsB, et al.Gestational weight gain and adverse birth outcomes in twin pregnancies. Obstet Gynecol, 2019; 134:1075–1086.
33.
LalA, KimH, KominiarekM. Gestational weight gain in twins: Are the Institute of Medicine guidelines optimal for pregnancy outcomes?. Am J Obstet Gynecol, 2014; 210:S284–S285.
34.
LalAK, KominiarekMA. Weight gain in twin gestations: Are the Institute of Medicine guidelines optimal for neonatal outcomes?. J Perinatol, 2015; 35:405–410.
35.
LiuLY, ZafmanKB, FoxNS. Weight gain and pregnancy outcomes in overweight or obese women with twin gestations. J Matern Fetal Neonatal Med, 2021; 34:1774–1779.
36.
OzcanT, BacakSJ, Zozzaro-SmithP, et al.Assessing weight gain by the 2009 Institute of Medicine guidelines and perinatal outcomes in twin pregnancy. Matern Child Health J, 2017; 21:509–515.
37.
GreenanCW, NewmanRB, WojciechowskiB, ChristensenCJ. Achievement of body mass index specific weight gain recommendations: Impact on preterm birth in twin pregnancies. Am J Perinatol, 2017; 34:1293–1301.
38.
BlitzMJ, YukhayevA, PachtmanS, et al.Factors associated with postpartum hemorrhage requiring blood transfusion in twin gestations. Am J Obstet Gynecol, 2018; 218:S150–S151.
39.
HalloranDR, MarshallN, GuildC, CaugheyA. Elevated maternalweight and weight gain on outcomes in twin pregnancies. J Investig Med, 2014; 62:576.
40.
BacakSJ, PressmanEK, RuY, KentTR, O'BrienKO. Impact of prepregnancy body mass index and gestational weight gain on maternal iron status in twin gestations. Reprod Sci, 2016; 23:56A.
41.
SuzukiS. Optimal weight gain during twin pregnancy in Japanese women with favorable perinatal outcomes. J Matern Fetal Neonatal Med, 2018; 31:119–122.
42.
WangL, WenL, ZhengY, et al.Association between gestational weight gain and pregnancy complications or adverse delivery outcomes in Chinese Han dichorionic twin pregnancies: Validation of the Institute of Medicine (IOM) 2009 guidelines. Med Sci Monit, 2018; 24:8342–8347.
43.
XiaoY, ShenM, MaS, TaoX, WenSW, TanH. The association between weight gain during pregnancy and intertwin delivery weight discordance using 2011–2015 birth registration data from the USA. Int J Gynaecol Obstet, 2018; 141:371–377.
44.
ChenY, LiuY, ZhangY, 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.
45.
ShamshirsazAA, HaeriS, RavangardSF, et al.Perinatal outcomes based on the Institute of Medicine guidelines for weight gain in twin pregnancies. J Matern Fetal Neonatal Med, 2014; 27:552–556.
46.
ChoiBY, HongS, JeonM, ParkJY, OhKJ, HongJ-S. Gestational weight gain in twin pregnancies in Korea: Application of the 2009 Institute of Medicine recommendations. Obstet Gynecol Sci, 2020; 63:690–699.
47.
FoxNS, SternEM, SaltzmanDH, KlauserCK, GuptaS, RebarberA. The association between maternal weight gain and spontaneous preterm birth in twin pregnancies. J Matern Fetal Neonatal Med, 2014; 27:1652–1655.
48.
GandhiM, GandhiR, MackLM, et al.Impact of changes in maternal body composition on birth weight and neonatal fat mass in dichorionic twin pregnancies. Am J Clin Nutr, 2018; 108:716–721.
49.
HinkleSN, HedigerML, KimS, et al.Maternal weight gain and associations with longitudinal fetal growth in dichorionic twin pregnancies: A prospective cohort study. Am J Clin Nutr, 2017; 106:1449–1455.
50.
LutsivO, HulmanA, WoolcottC, et al.Examining the provisional guidelines for weight gain in twin pregnancies: A retrospective cohort study. BMC Pregnancy Childbirth, 2017; 17:330.
51.
RamM, BergerH, RayJG, et al.Gestational weight gain in twin pregnancies modeled as a function of gestational age and pre-pregnancy body mass index. Am J Obstet Gynecol, 2018; 218:S482.
52.
WenL, LiuX, WangL, et al.Correlation between second trimester weight gain and perinatal outcomes in dichorionic twin pregnancies: The LoTiS cohort study. Eur J Obstet Gynecol Reprod Biol, 2019; 233:64–69.
53.
AlgeriP, PelizzoniF, BernasconiDP, 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.
54.
LinD, FanD, WuS, 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.
55.
PecheuxO, GarabedianC, DrumezE, 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.
56.
SalmanianB, AntonyK, RacusinD, et al.Gestational weight gain in twin pregnancies is not associated with discordance in birth weight or small for gestational age. Am J Obstet Gynecol, 2015; 212:S157.
57.
Kosinska-KaczynskaK, SzymusikI, KaczynskiB, WielgosM. Observational study of associations between gestational weight gain and perinatal outcomes in dichorionic twin pregnancies. Int J Gynaecol Obstet, 2017; 138:94–99.
58.
YeeLM, CaugheyAB, GrobmanWA, ChengYW. Gestational weight gain for women with twins: Are the IOM guidelines appropriate?. Am J Obstet Gynecol, 2017; 216:S437–S438.
59.
ShimuraM, ObataS, MisumiT, MiyagiE, AokiS. Are the Institute of Medicine guidelines for optimal gestational weight gain in twin pregnancies applicable to Japanese women?. J Obstet Gynaecol Res, 2021; 47:337–342.
60.
LucovnikM, BlicksteinI, VerdenikI, SteblovnikL, Trojner BregarA, TulN. Impact of pre-gravid body mass index and body mass index change on preeclampsia and gestational diabetes in singleton and twin pregnancies. J Matern Fetal Neonatal Med, 2014; 27:1901–1904.
61.
WangF, LiangZX, MaoWR, HeSN, ChenDQ. Influence of pre-pregnancy body mass index and gestational weight gain in twin pregnancies on blood glucose, serum lipid and perinatal outcomes. Clin Exp Obstet Gynecol, 2020; 47:376–382.
62.
LikinsB, AlkisM, NewmanR, FinneranMM. 581 Achieving maternal weight gain recommendations and its impact on cervical length shortening in twin gestations. Am J Obstet Gynecol, 2021; 224:S367.
63.
GavardJA, ArtalR. Gestational weight gain and maternal and neonatal outcomes in term twin pregnancies in obese women. Twin Res Hum Genet, 2014; 17:127–133.
64.
GavardJ, ArtalR. The association of gestational weight gain with birth weight in obese pregnant women by obesity class and diabetic status: A population-based historical cohort study. Matern Child Health J, 2014; 18:1038–1047.
65.
HutcheonJA, BodnarLM, JosephKS, AbramsB, SimhanHN, PlattRW. The bias in current measures of gestational weight gain. Paediatr Perinat Epidemiol, 2012; 26:109–116.
66.
HackKE, DerksJB, EliasSG, et al.Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: Clinical implications of a large Dutch cohort study. BJOG, 2008; 115:58–67.
67.
EnsenauerR, ChmitorzA, RiedelC, et al.Effects of suboptimal or excessive gestational weight gain on childhood overweight and abdominal adiposity: Results from a retrospective cohort study. Int J Obes, 2013; 37:505–512.
68.
SridharSB, DarbinianJ, EhrlichSF, et al.Maternal gestational weight gain and offspring risk for childhood overweight or obesity. Am J Obstet Gynecol, 2014; 211:259.e1–259.e8.
69.
KarachaliouM, GeorgiouV, RoumeliotakiT, et al.Association of trimester-specific gestational weight gain with fetal growth, offspring obesity, and cardiometabolic traits in early childhood. Am J Obstet Gynecol, 2015; 212:502.e1–502.e14.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
