Table 4.
Summary of findings on gestational weight gain in twin pregnancies and maternal outcomes among studies that controlled for prepregnancy BMI and gestational age at delivery
| Study | GWG measure | Outcome defined | Control variables | Results |
|---|---|---|---|---|
| Gestational diabetes | ||||
| Fox et al. 2010 (A) (26) and 2011 (B) (27) | Adequacy of GWGa | GDM (definition not specified) | A: None B: Race, pregravid BMI, age, IVF, GA, chorionicity, fetal reduction |
A: No difference in GDM prevalence comparing low GWG vs. normal GWG in NL (6.2% vs. 4.1%, p=0.5), OV (11.8% vs. 8.8%, p=0.7) or OB (0% vs. 30%, p=0.08). B: No difference in GDM prevalence comparing low, normal, and excessive GWG overall (7.3%, 7.9%, 2.6%, p=0.15) or among NL (7.0%, 2.0%, 0%, p=0.9). |
| Gónzalez-Quintero et al. 2012 (28) | Rate of total GWG compared with the 2009 IOM recs (<IOM vs. ≥IOM) a | GDM (definition not specified) | None | Higher prevalence of GDM in those gaining below IOM guidelines vs. at or above guidelines overall (12.7% vs. 8.7%, p<0.0001) and in NL (11.6% vs. 7.2%, p<0.0001), but not in OV (11.6% vs. 8.7%, p=0.1) or OB (17.3% vs. 13.2%, p=0.09). |
| Hypertensive disorders of pregnancy | ||||
| Fox et al. 2010 (A) (26) and 2011 (B) (27) | Adequacy of GWGa | Gestational hypertension; preeclampsia (both defined using 2002 ACOG criteria) | A: None B: Race, pregravid BMI, age, IVF, GA, chorionicity, fetal reduction |
A: No difference in gestational hypertension prevalence comparing low GWG vs. normal GWG in NL (13.9% vs. 19.8%, p=0.2), OV (11.8% vs. 21.2%, p=0.4) or OB (25.0% vs. 20.0%, p=0.7). B: No difference in gestational hypertension prevalence comparing low, normal, and excessive GWG overall (12.7%, 9.2%, 13.2%, p=0.9) or among NL (7.0%, 8.2%, 12.0%, p=0.6). No difference in preeclampsia prevalence comparing low, normal, and excessive GWG overall (7.3%, 7.9%, 10.5%, p=0.8) or among NL (7.0%, 8.2%, 12.0%, p=0.8). |
| Gónzalez-Quintero et al. 2012 (28) | Rate of total GWG compared with the 2009 IOM recs (<IOM vs. ≥IOM) a | Pregnancy-related hypertension (definition not specified) | None | Lower prevalence of pregnancy-related hypertension in those gaining below IOM guidelines vs. at or above guidelines overall (16.3% vs. 22.5%, p<0.0001), in NL (12.2% vs. 17.4%, p<0.0001), and in OV (17.7% vs. 27.2%, p=0.001), but not OB (26.3% vs. 30.9, p=0.1) |
| Luke et al. 1993b (35) | Total GWG and rate of GWG at ≤24 wk and >24 wks | Preeclampsia (defined using the 1986 ACOG criteria) | None | Compared with controls, preeclamptic pregnancies had higher total GWG (21.1 kg vs. 17.2 kg, p<0.0001), higher rate of total GWG (0.61 kg/wk vs. 0.54 kg/wk, p<0.0001), and higher rate of GWG at >24 weeks (0.97 kg/wk vs. 0.66 kg/wk, p<0.0001), but there was no difference in rate of GWG ≤24 wk (0.47 kg/wk vs. 0.44 kg/wk, p=ns). |
ACOG, American Congress of Obstetricians and Gynecologists; ART, assisted reproductive technologies; BMI, body mass index; GA, gestational age; GDM, gestational diabetes; GWG, gestational weight gain; IOM, Institute of Medicine; IVF, in vitro fertilization; NL, normal weight before pregnancy; OB, obese before pregnancy; OV, overweight before pregnancy;
a
Rate of total GWG compared with the 2009 IOM recommendations divided by 37 weeks.