PDF(Pubmed)
Abstract：
BACKGROUND: Weight gain during pregnancy has an important impact on maternal and neonatal health. Unlike the Institute of Medicine (IOM) recommendations for weight gain in singleton pregnancies, those for twin gestations are termed \"provisional\", as they are based on limited data. The objectives of this study were to determine the neonatal and maternal outcomes associated with gaining weight below, within and above the IOM provisional guidelines on gestational weight gain in twin pregnancies, and additionally, to explore ranges of gestational weight gain among women who delivered twins at the recommended gestational age and birth weight, and those who did not.
METHODS: A retrospective cohort study of women who gave birth to twins at ≥20 weeks gestation, with a birth weight ≥ 500 g was conducted in Nova Scotia, Canada (2003-2014). Our primary outcome of interest was small for gestational age (<10th percentile). In order to account for gestational age at delivery, weekly rates of 2nd and 3rd trimester weight gain were used to categorize women as gaining below, within, or above guidelines. We performed traditional regression analyses for maternal outcomes, and to account for the correlated nature of the neonatal outcomes in twins, we used generalized estimating equations (GEE).
RESULTS: A total of 1482 twins and 741 mothers were included, of whom 27%, 43%, and 30% gained below, within, and above guidelines, respectively. The incidence of small for gestational age in these three groups was 30%, 21%, and 20%, respectively, and relative to gaining within guidelines, the adjusted odds ratios were 1.44 (95% CI 1.01-2.06) for gaining below and 0.92 (95% CI 0.62-1.36) for gaining above. The gestational weight gain in women who delivered twins at 37-42 weeks with average birth weight ≥ 2500 g and those who delivered twins outside of the recommend ranges were comparable to each other and the IOM recommendations.
CONCLUSIONS: While gestational weight gain below guidelines for twins was associated with some adverse neonatal outcomes, additional research exploring alternate ranges of gestational weight gain in twin pregnancies is warranted, in order to optimize neonatal and maternal outcomes.
METHODS: A retrospective cohort study of women who gave birth to twins at ≥20 weeks gestation, with a birth weight ≥ 500 g was conducted in Nova Scotia, Canada (2003-2014). Our primary outcome of interest was small for gestational age (<10th percentile). In order to account for gestational age at delivery, weekly rates of 2nd and 3rd trimester weight gain were used to categorize women as gaining below, within, or above guidelines. We performed traditional regression analyses for maternal outcomes, and to account for the correlated nature of the neonatal outcomes in twins, we used generalized estimating equations (GEE).
RESULTS: A total of 1482 twins and 741 mothers were included, of whom 27%, 43%, and 30% gained below, within, and above guidelines, respectively. The incidence of small for gestational age in these three groups was 30%, 21%, and 20%, respectively, and relative to gaining within guidelines, the adjusted odds ratios were 1.44 (95% CI 1.01-2.06) for gaining below and 0.92 (95% CI 0.62-1.36) for gaining above. The gestational weight gain in women who delivered twins at 37-42 weeks with average birth weight ≥ 2500 g and those who delivered twins outside of the recommend ranges were comparable to each other and the IOM recommendations.
CONCLUSIONS: While gestational weight gain below guidelines for twins was associated with some adverse neonatal outcomes, additional research exploring alternate ranges of gestational weight gain in twin pregnancies is warranted, in order to optimize neonatal and maternal outcomes.
摘要：
背景：孕期体重增加对母婴健康有重要影响。与医学研究所（IOM）关于单胎妊娠体重增加的建议不同，那些用于双胞胎妊娠的被称为“临时”，因为它们基于有限的数据。这项研究的目的是确定与以下体重增加相关的新生儿和产妇结局，在IOM关于双胎妊娠妊娠体重增加的临时指南之内和之上，此外，探讨以推荐的胎龄和出生体重分娩双胞胎的妇女的妊娠期体重增加范围，和那些没有的人。
方法：一项对妊娠≥20周生双胞胎的妇女进行的回顾性队列研究，出生体重≥500g在新斯科舍省进行，加拿大(2003-2014年)。我们感兴趣的主要结果是小于胎龄（<10百分位数）。为了说明分娩时的胎龄，第2个月和第3个月的每周体重增加率用于将女性分类为以下，内,或以上准则。我们对产妇结局进行了传统的回归分析，并解释了双胞胎新生儿结局的相关性，我们使用广义估计方程(GEE)。
结果：共纳入1482对双胞胎和741对母亲，27%的人,43%,30%以下，内,以及上述准则，分别。三组小于胎龄的发生率为30%,21%,20%,分别,相对于在准则内获得，以下为1.44(95%CI1.01-2.06),以上为0.92(95%CI0.62-1.36).在37-42周时分娩双胞胎，平均出生体重≥2500g的妇女和分娩双胞胎超出推荐范围的妇女的妊娠体重增加与IOM的建议具有可比性。
结论：虽然低于双胞胎指南的妊娠期体重增加与一些不良新生儿结局有关，有必要进行其他研究，探索双胎妊娠中妊娠体重增加的替代范围，以优化新生儿和产妇的结局。
方法：一项对妊娠≥20周生双胞胎的妇女进行的回顾性队列研究，出生体重≥500g在新斯科舍省进行，加拿大(2003-2014年)。我们感兴趣的主要结果是小于胎龄（<10百分位数）。为了说明分娩时的胎龄，第2个月和第3个月的每周体重增加率用于将女性分类为以下，内,或以上准则。我们对产妇结局进行了传统的回归分析，并解释了双胞胎新生儿结局的相关性，我们使用广义估计方程(GEE)。
结果：共纳入1482对双胞胎和741对母亲，27%的人,43%,30%以下，内,以及上述准则，分别。三组小于胎龄的发生率为30%,21%,20%,分别,相对于在准则内获得，以下为1.44(95%CI1.01-2.06),以上为0.92(95%CI0.62-1.36).在37-42周时分娩双胞胎，平均出生体重≥2500g的妇女和分娩双胞胎超出推荐范围的妇女的妊娠体重增加与IOM的建议具有可比性。
结论：虽然低于双胞胎指南的妊娠期体重增加与一些不良新生儿结局有关，有必要进行其他研究，探索双胎妊娠中妊娠体重增加的替代范围，以优化新生儿和产妇的结局。
