330: Weight gain and pregnancy outcomes in overweight or obese women with twin gestations

Abstract

To estimate the association between adherence to weight gain recommendations and pregnancy outcomes in overweight and obese women with twin pregnancies. This is a retrospective cohort study of women with overweight (BMI 25.0 – 29.9 kg/m2) and obese pre- pregnancy BMI (> 30.0 kg/m2) and twin pregnancies delivered > 24 weeks by a single MFM practice between 2005- 2017. Baseline characteristics, weight gain patterns and pregnancy outcomes were compared between women who did and did not meet or exceed gestational weight gain requirements, as recommended by the Institute of Medicine in 2009. Since total weight gain is also dependent on gestational age at delivery, we used weight gain per week to define adequate weight gain for women with overweight (0.85 lb/week) and obese (0.68 lb/week) pre- pregnancy BMI. A total of 252 overweight and obese women with twin pregnancies met inclusion criteria, 171 (67.9%) of whom met or exceeded weight gain requirements and 81 (32.1%) of whom did not. There were no differences in baseline clinical and demographic characteristics between the two groups. Women with inadequate weight gain had significantly less weight gain in each trimester, as well as less total weight gain for the whole pregnancy. Women with inadequate average gestational weight gain had significantly lower birthweights of the larger twin (2440g vs. 2675g, p=0.001) and the smaller twin (2212g vs. 2398g, p=0.005), higher incidence of spontaneous preterm birth <37 weeks (33.3% vs. 21.1%, p=0.03), higher incidence of premature rupture of membranes (24.7% vs. 11.7%, p=0.008), and greater likelihood of any twin birthweight <10th percentile for gestational age (51.9% vs. 35.5%, p=0.01). There were no differences in the likelihood of cesarean delivery, preeclampsia, or gestational diabetes between the two groups. For overweight and obese women with twin gestations, meeting the IOM recommendations for weight gain in pregnancy is associated with improved pregnancy outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)