Examining the effects of second-and third-trimester gestational weight gain rates on the perinatal outcomes among Chinese twin pregnancies: a retrospective cohort study

Background: This paper investigated how second- and third-trimester gestational weight gain relates to perinatal outcomes among normal weight women with twin pregnancies in Fujian, China. Methods: A retrospective study examining the medical records of 931 normal weight twin-pregnant women was conducted in Fujian Maternity and Child Health Hospital from 2014 to 2018.The 2nd and 3rdtrimester weekly weight gain rates were calculated, and women were categorized as gaining below, within, or above the 2009 Institute of Medicine (IOM) recommended rates. The association between the trimester-specific weight gain rate and perinatal outcome was determined by traditional regression analysis among groups. Results: A total of 25.9%, 19.8% and 54.3% of women had rates of weight gain across the 2nd and 3rd trimesters less than, greater than or within the recommended rates respectively. Multivariate logistic regression analysis showed that weight gain greater than the recommended rate in the 2nd trimester was associated with a decreased risk of preeclampsia (aOR:0.489,95%CI:0.289 similar to 0.974). Weight gain less than the recommended rate of weight gain in the 3(rd) trimester was associated with increased risks of premature delivery(aOR:2.079, 95%CI:1.467 similar to 2.968), gestational diabetes mellitus (aOR: 2.048, 95%CI:1.411 similar to 2.971), intrahepatic cholestasis syndrome (aOR:3.015,95%CI: 1.058 similar to 8.587), pre-labour rupture of membrane (aOR: 1.708,95%CI: 1.169 similar to 2.493), average twin birth weight < 2500 g(aOR:1.532,95%CI: 1.125 similar to 2.084) and neonatal respiratory distress syndrome (aOR:4.934,95%CI:1.626 similar to 15.083) and was associated with decreased risks of caesarean section (aOR:0.589,95%CI:0.386 similar to 0.898) and preeclampsia (aOR:0.471, 95%CI:0.274 similar to 0.808). In addition, weight gain greater than the recommended rate of weight gain in the 3rd trimester was associated with increased risks of premature delivery (aOR:1.589,95%CI:1.428 similar to 2.951) and gestational hypertension (aOR:2.137,95% CI:1.034 similar to 4.415) as well as preeclampsia (aOR:2.246, 95%CI:1.462 similar to 3.452). The stratified analysis of weight gain in the 3(rd) trimester showed that there was no significant difference in the incidence of adverse pregnancy outcomes compared to the 2nd trimester weight gain groups. Conclusions: While this study showed that a gestational weight gain rate above or below the recommendation in the 3rd trimester was associated with some adverse maternal and neonatal outcomes, further prospective and multicentre studies are required to explore alternate ranges of gestational weight gain rates in twin pregnancies.

Automated summary

This study investigated the relationship between gestational weight gain in the second and third trimesters and perinatal outcomes among normal weight women with twin pregnancies in Fujian, China. The results showed that weight gain above the recommended rate in the second trimester was associated with a decreased risk of preeclampsia, while weight gain below the recommended rate in the third trimester was associated with increased risks of premature delivery, gestational diabetes mellitus, and other adverse outcomes. In addition, weight gain above the recommended rate in the third trimester was associated with increased risks of premature delivery and gestational hypertension.