Abstract
Background: The incidence of twin pregnancies has risen recently. Such pregnancies are associated with an increased risk for poor maternal and infant outcomes. Gestational weight gain, particularly in singleton pregnancies, has been well-linked with maternal and infant outcomes. The aim of the current meta-analysis was to evaluate the effects of gestational weight gain on maternal and fetal outcomes in women with twin pregnancies.Methods: A systematic search was conducted using the PubMed, Scopus, and Google Scholar databases. Studies, either retrospective or prospective in design, evaluating the effects of gestational weight gain (defined using Institute of Medicine (IOM) guidelines) maternal and/or fetal/neonatal outcomes in women with twin pregnancies were included. Statistical analysis was performed using STATA software.Results: Eleven studies were included in the meta-analysis. Mothers with inadequate weight gain had increased risk for gestational diabetes mellitus (OR 1.19; 95% CI: 1.01, 1.40) and decreased risk for gestational hypertension (OR 0.58; 95% CI: 0.49, 0.68) and cesarean section (OR 0.94; 95% CI: 0.93, 0.96). Neonates born to mothers with inadequate weight gain were susceptible to increased risk for preterm delivery (OR 1.17; 95% CI: 1.03, 1.34), very preterm delivery (gestational age <32 weeks) (OR 1.84; 95% CI: 1.36, 2.48), small for gestational age status (OR 1.41; 95% CI: 1.15, 1.72), low birth weight status (<2,500 g) (OR 1.27; 95% CI: 1.17, 1.38), and neonatal intensive care unit (NICU) admission (OR 1.16; 95% CI: 1.08, 1.24). The pooled findings indicate an increased risk for gestational hypertension (OR 1.82; 95% CI: 1.60, 2.06) and cesarean section (OR 1.07; 95% CI: 1.05, 1.08) among mothers with excessive weight gain. Neonates born to mothers with excessive weight gain were susceptible to increased risk for preterm delivery and very preterm delivery, but were associated with a decreased risk for low birth weight status and small for gestational age status.Conclusions: Gestational weight gain in twin pregnancy, either lower or higher than IOM recommended guidelines, is associated with poor maternal and neonatal outcomes. Our findings call for incorporating counseling on optimal weight gain during pregnancy as part of routine antenatal visits.
Highlights
The incidence of twin pregnancies has increased over the last 2–3 decades [1, 2], and given that twin pregnancies have been linked with increased risk of poor maternal and infant outcomes [3,4,5,6], this could potentially emerge as a substantial clinical and public health problem
The review noted a 34% lower risk of small for gestational age (SGA) and 23% lower risk of preterm birth in mothers with excessive gestational weight gain [13], this was countered by an increased risk of cesarean delivery
Neonatal Outcomes Children born to mothers with inadequate weight gain presented an increased risk of preterm delivery, very preterm delivery, small for gestational age status, low birth weight, and neonatal intensive care unit (NICU) admission compared to those born to mothers with adequate weight gain (Figure 3)
Summary
The incidence of twin pregnancies has increased over the last 2–3 decades [1, 2], and given that twin pregnancies have been linked with increased risk of poor maternal and infant outcomes [3,4,5,6], this could potentially emerge as a substantial clinical and public health problem. A recently published meta-analysis using 23 studies documented an increased risk of small for gestational age (SGA) status and preterm birth in mothers with inadequate gestational weight gain [13]. The review noted a 34% lower risk of SGA and 23% lower risk of preterm birth in mothers with excessive gestational weight gain [13], this was countered by an increased risk of cesarean delivery. The incidence of twin pregnancies has risen recently Such pregnancies are associated with an increased risk for poor maternal and infant outcomes. Gestational weight gain, in singleton pregnancies, has been well-linked with maternal and infant outcomes. The aim of the current meta-analysis was to evaluate the effects of gestational weight gain on maternal and fetal outcomes in women with twin pregnancies
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