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Kim, Na, Lee, Cha, Shin, and Lee: PREGNANCY PROGNOSIS ACCORDING TO PREPREGNANCY BODY MASS INDEX AND GESTATIONAL WEIGHT GAIN IN TWIN PREGNANCIES
Original Article

Korean J Obstet Gynecol 2012;55(5):300-308.

Published online: 20 January 2012

DOI: https://doi.org/10.5468/KJOG.2012.55.5.300

PREGNANCY PROGNOSIS ACCORDING TO PREPREGNANCY BODY MASS INDEX AND GESTATIONAL WEIGHT GAIN IN TWIN PREGNANCIES

Myung Joo Kim, MD1, Eun Duc Na, MD1, Kyoung Jin Lee, MD, PhD1, Dong Hyun Cha, MD, PhD1, Joong Sik Shin, MD, PhD1, Hwa Young Lee, MD, PhD2

1Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea

2Departments of Internal Medicine, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea

Corresponding author: Kyoung Jin Lee, MD, PhD Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, 566 Nonhyeon-ro, Gangnam-gu, Seoul 135-913, Korea Tel: +82-2-3468-3131 Fax: +82-2-3468-2638 E-mail: jlee3575@chamc.co.kr

Received 27 December 2011       Revised 28 February 2012       Accepted 21 March 2012

Copyright © 2012 Korean Society of Obstetrics and Gynecology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To analyze the pregnancy outcome and prognosis related to prepregnancy body mass index (BMI) and gestational weight gain in twin pregnancies according to the 2009 Institute of Medicine recommendation (IOM).

Methods

The study subjects were 500 twin pregnant women and their 1,000 babies delivered from January 2008 to December 2010. The women divided in 4 groups according to prepregnancy BMI; underweight (BMI<18.5 kg/m2), normal weight (18.5≤BMI<23 kg/m2), overweight (23.0≤BMI<25 kg/m2), and obese (BMI≥25 kg/m2) and also categorized 3 groups according to gestational weight gain; “poor” if it was below the IOM range for the prepregnancy BMI, “normal” if it was within the range, and “excessive” if it was above the range.

Results

Among total 500 twin pregnant women, underweight were 76 (15.2%), normal weight 330 (66.0%), overweight 55 (11.0%) and obese 39 (7.8%); “poor” 237 (47.4%), “normal” 220 (44%) and “excessive” 43 (8.6%). The mean total weight gain during pregnancy was 16.3±4.9 kg and mean weight gain per week was 0.45±0.13 kg/wk. Gestational diabetes mellitus was significantly associated with obese women. Anemia was significantly increased in “poor” weight gain group whereas gestational hypertension, large for gestational age and neonatal Apgar score of 5 minutes under 7 were significantly increased in “excessive” weight gain group.

Conclusion

The adverse pregnancy and neonatal prognosis were associated with abnormal prepregnancy BMI or gestational weight gain in twin pregnancies. It is important to maintain normal prepregnancy BMI and gestational weight gain through appropriate counseling and education.

Keywords: Twin pregnancy, Prepregnancy BMI, Maternal weight gain, Pregnancy outcome

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Table 1.
Baseline characteristics
Prepregnancy BMI Weight gain (IOM) No. (%) Age (yr) BMI (kg/m2) Nulliparity (%) IVF-ET (%) Previous C/Sec (%) Gestational age at delivery (wk) Gestational weight gain (kg) Total Per week
Underweight Poor 38 (50.0) 32.8 ± 2.6 17.8 ± 0.5 92.1 76.3 2.6 36.4 ± 2.0 12.7 ± 2.2 0.35 ± 0.06
  Normal 35 (46.1) 32.0 ± 4.0 17.5 ± 0.6 80.0 60.0 0 36.4 ± 1.4 19.0 ± 2.7 0.52 ± 0.07
  Excessive e 3 (3.9) 31.7 ± 1.9 17.6 ± 0.2 100 100 0 34.8 ± 3.5 26.1 ± 0.6 0.76 ± 0.10
Normal weight Poor 170 (51.5) 33.3 ± 3.3 20.5 ± 1.2 80.0 72.4 5.3 35.9 ± 2.5 12.8 ± 2.7 0.36 ± 0.07
  Normal 135 (40.9) 32.6 ± 3.1 20.6 ± 1.2 84.4 69.6 10.4 36.4 ± 2.0 19.2 ± 2.2 0.53 ± 0.05
  Excessive e 25 (7.6) 32.6 ± 2.7 20.7 ± 1.2 76.0 60.0 16.0 35.8 ± 2.3 26.6 ± 3.1 0.74 ± 0.08
Overweight Poor 14 (25.5) 34.6 ± 1.8 23.9 ± 0.6 57.1 64.3 7.1 35.0 ± 3.4 11.0 ± 2.0 0.31 ± 0.05
  Normal 35 (63.6) 33.6 ± 3.7 23.8 ± 0.5 100 80.0 0 36.7 ± 1.5 17.7 ± 2.1 0.48 ± 0.06
  Excessive e 6 (10.9) 32.3 ± 3.3 23.6 ± 1.5 50.0 66.7 16.7 34.7 ± 3.2 24.8 ± 3.8 0.71 ± 0.07
Obese Poor 15 (38.5) 34.2 ± 3.2 28.1 ± 3.2 73.3 86.7 6.7 35.8 ± 2.9 9.6 ± 1.5 0.27 ± 0.37
  Normal 15 (38.5) 32.9 ± 3.8 27.6 ± 2.1 73.3 46.7 6.7 35.9 ± 2.8 14.3 ± 2.4 0.40 ± 0.06
  Excessive e 9 (8.6) 33.0 ± 4.6 27.3 ± 1.5 77.8 77.8 22.2 35.8 ± 1.2 21.6 ± 1.6 0.60 ± 0.05
Total   500 (100) 33.0 ± 3.3 21.0 ± 2.8 82.0 70.6 6.8 36.1 ± 2.3 16.3 ± 4.9 0.45 ± 0.13

Values are presented as number (%) or mean ± standard deviation. BMI, body mass index; IOM, Institute of Medicine; IVF-ET, in vitro fertilization and embryo transfer; C/Sec, Cesarean section.

Table 2.
Frequency of maternal complications
Prepregnancy BMI Weight gain (IOM) Anemia Postpartum hemorrhage Preterm labor Preterm birth PROM Placenta previa Placenta abruption Placenta accreta GH GDM
Underweight Poor 16 (42.1) 3 (7.9) 11 (28.9) 15 (39.5) 4 (10.5) 1 (2.6) 0 (0) 1 (2.6) 4 (10.5) 0 (0)
  Normal 6 (17.1) 1 (2.9) 12 (34.3) 16 (45.7) 10 (28.6) 2 (5.7) 0 (0) 0 (0) 10 (14.3) 0 (0)
  Excessive 2 (66.7) 0 (0) 0 (0) 1 (33.3) 0 (0) 0 (0) 0 (0) 0 (0) 1 (33.3) 0 (0)
Normal weight Poor 1 (24.1) 16 (9.4) 55 (32.4) 85 (50.0) 35 (20.6) 4 (2.4) 1 (0.6) 2 (1.2) 6 (3.5) 10 (5.9)
  Normal 23 (17.0) 14 (10.4) 34 (25.2) 59 (43.7) 16 (11.9) 4 (3.0) 2 (1.5) 2 (0.7) 15 (11.1) 7 (5.2)
  Excessive 6 (24.0) 4 (16.0) 8 (32.0) 12 (48.0) 2 (8.0) 2 (8.0) 3 (12.0) 0 (0) 7 (28.0) 1 (4.0)
Overweight Poor 4 (28.6) 1 (7.1) 6 (42.9) 8 (57.1) 2 (14.3) 0 (0) 0 (0) 0 (0) 1 (7.1) 0 (0)
  Normal 11 (31.4) 6 (17.1) 9 (25.7) 13 (37.1) 8 (22.9) 0 (0) 1 (2.9) 1 (2.9) 5 (14.3) 4 (5.7)
  Excessive 1 (16.7) 1 (16.7) 1 (16.7) 4 (66.7) 1 (16.7) 0 (0) 0 (0) 0 (0) 3 (50.0) 2 (16.7)
Obese Poor 4 (26.7) 10 (33.3) 4 (26.7) 8 (53.5) 2 (13.3) 0 (0) 1 (6.7) 2 (13.3) 2 (13.3) 4 (26.7)
  Normal 3 (20.0) 3 (20.0) 4 (13.3) 7 (46.7) 3 (20.0) 0 (0) 0 (0) 0 (0) 2 (13.3) 3 (20.0)
  Excessive 0 (0) 2 (22.2) 3 (33.3) 7 (77.8) 1 (11.1) 0 (0) 0 (0) 0 (0) 3 (33.3) 1 (11.1)
Total   117 (23.4) 56 (11.2) 145 (29.0) 235 (47.0) 84 (16.8) 13 (2.6) 8 (1.6) 7 (1.4) 54 (10.8) 29 (5.8)

Values are presented as number (%). BMI, body mass index; IOM, Institute of Medicine; PROM, premature rupture of membrane; GH, gestational hypertension; GDM, gestational diabetes mellitus.

Table 3.
Multivariate logistic regression of maternal complications
Prepregnancy BMI Weight gain (IOM) Anemia Postpartum hemorrhage PROM Placenta abruption GH GDM
Underweight Poor 3.68a (2.09–6.48) 0.72 (0.28–1.81) 0.910 (0.39–2.12) 0.00 (0.00) 0.93 (0.41–2.16) 0.00 (0.00)
  Normal 1.08 (0.53–2.21) 0.30 (0.07–1.28) 3.41a (1.76–6.60) 0.00 (0.00) 1.59 (0.72–3.52) 0.00 (0.00)
  Excessive 7.09a (1.23–40.89) 0.00 (0.00) 0.00 (0.00) 0.00 (0.00) 2.40 (0.39–14.63) 0.00 (0.00)
Normal weight Poor 1.56a (1.03–2.36) 0.96 (0.56–1.65) 1.80a (1.12–2.88) 0.40 (0.07–2.39) 0.26a (0.13–0.53) 0.94 (0.46–1.95)
  Normal 1 1 1 1 1 1
  Excessive 1.53 (0.76–3.20) 1.75 (0.74–4.15) 0.51 (0.17–1.55) 6.19a (1.47–26.04) 3.28a (1.54–7.00) 0.86 (0.19–3.93)
Overweight Poor 2.09 (0.84–5.19) 0.88 (0.19–4.02) 0.79 (0.24–2.66) 0.00 (0.00) 0.59 (0.13–2.72) 0.00 (0.00)
  Normal 2.45a (1.33–4.52) 1.61 (0.77–3.39) 2.56a (1.29–5.11) 2.30 (0.380–13.87) 1.291 (0.59–2.84) 0.87 (0.27–2.79)
  Excessive 0.84 (0.17–4.03) 2.47 (0.48–12.58) 0.97 (0.19–5.05) 0.00 (0.00) 8.94a (2.54–31.41) 3.53 (0.67–18.65)
Obese Poor 1.72 (0.71–4.16) 4.98a (2.03–12.23) 0.95 (0.29–3.14) 4.69 (0.68–32.48) 1.00 (0.31–3.27) 5.02a (1.83–13.73)
  Normal 1.39 (0.52–3.67) 2.71 (0.99–7.42) 1.59 (0.57–4.45) 0.00 (0.00) 1.51 (0.47–4.81) 4.40a (1.48–13.07)
  Excessive 0.00 (0.00) 2.33 (0.71–7.62) 0.80 (0.17–3.73) 0.00 (0.00) 3.58a (1.22–10.56) 2.38 (0.48–11.87)

Values are presented as odds ratio (95% confidence interval). BMI, body mass index; IOM, Institute of Medicine; PROM, premature rupture of membrane; GH, gestational hypertension; GDM, gestational diabetes mellitus.

a P<0.05. Multivariate logistic regression controlling for age, nulliparity, in vitro fertilization and embryo transfer, gestational age at delivery and previous Cesarean section. In placenta abruption cases, gestational hypertension was added to these controlling factors.

Table 4.
Frequency of neonatal complications
Prepregnancy BMI Weight gain (IOM) Number (%) Birth weight (g) NICU admission Apgar Apgar 5 min 1 min Apgar 5 < 7 min SGA LGA
Underweight Poor 76 (50.0) 2335.5 ± 356.3 16 (21.1) 7.5 ± 1.0 8.7 ± 0.8 4 (5.3) 8 (10.5) 1 (1.3)
  Normal 70 (46.1) 2418.7 ± 380.8 15 (21.4) 7.3 ± 1.2 8.7 ± 0.7 9 (0) 5 (7.1) 5 (7.1)
  Excessive 6 (3.9) 2383.3 ± 825.5 2 (33.3) 6.8 ± 1.8 8.0 ± 1.5 2 (33.3) 0 (0) 2 (33.3)
Normal weight Poor 340 (51.5) 2338.9 ± 466.4 89 (26.2) 7.0 ± 1.5 8.4 ± 1.2 26 (7.6) 31 (9.1) 13 (3.8)
  Normal 270 (40.9) 2479.3 ± 419.5 46 (17.0) 7.2 ± 1.2 8.6 ± 0.9 11 (4.1) 11 (4.1) 20 (7.4)
  Excessive 50 (7.6) 2538.4 ± 551.8 16 (32.0) 6.9 ± 1.5 8.2 ± 1.4 7 (14.0) 3 (6.0) 8 (16.0)
Overweight Poor 28 (25.5) 2286.1 ± 617.0 9 (32.1) 6.8 ± 1.5 8.1 ± 1.2 5 (17.9) 1 (3.6) 0 (0)
  Normal 70 (63.6) 2523.4 ± 366.1 13 (18.6) 7.4 ± 1.1 8.6 ± 1.0 4 (5.7) 5 (7.1) 5 (7.1)
  Excessive 12 (10.9) 2191.7 ± 577.6 8 (66.7) 6.5 ± 1.2 8.3 ± 0.9 0 (0) 1 (8.3) 2 (16.7)
Obese Poor 30 (38.5) 2487.0 ± 586.4 7 (23.3) 7.0 ± 1.4 8.5 ± 1.0 3 (10.0) 0 (0) 4 (13.3)
  Normal 30 (38.5) 2391.0 ± 516.8 5 (16.7) 7.0 ± 1.1 8.3 ± 1.0 2 (6.7) 2 (6.7) 3 (10.0)
  Excessive 18 (8.6) 2558.3 ± 493.8 5 (27.8) 6.8 ± 1.7 8.0 ± 1.4 4 (22.2) 0 (0) 4 (22.2)
Total   1,000 (100) 2412.0 ± 459.3 231 (23.1) 7.1 ± 1.3 8.5 ± 1.0 68 (6.8) 67 (6.7) 67 (6.7)

Values are presented as number (%) or mean ± standard deviation. BMI, body mass index; IOM, Institute of Medicine; NICU, neonatal intensive care unit; SGA, small for gestational age; LGA, large for gestational age.

Table 5.
Multivariate logistic regression of neonatal complications
Prepregnancy BMI Weight gain (IOM) NICU admission Apgar 5 < 7 min SGA LGA
Underweight Poor 2.27 (0.93–5.52) 1.49 (0.29–7.68) 2.44 (0.94–6.33) 0.17 (0.02–1.33)
  Normal 1.33 (0.52–3.39) 0.00 (0.00) 1.74 (0.58–5.23) 0.78 (0.27–2.248)
  Excessive 0.11 (0.00–2700.28) 6.91 (0.34–139.48) 0.00 (0.00) 7.86a (1.25–49.41)
Normal weight Poor 1.29 (0.69–2.41) 1.54 (0.56–4.26) 2.21a (1.08–4.54) 0.48 (0.23–1.00)
  Normal 1 1 1 1
  Excessive 1.19 (0.38–3.73) 3.89a (1.06–14.3) 1.84 (0.49–6.97) 2.75a (1.11–6.80)
Overweight Poor 0.67 (0.10–4.70) 2.57 (0.43–15.49) 0.84 (0.10–6.90) 0.00 (0.00)
  Normal 1.14 (0.41–3.16) 2.95 (0.74–11.86) 1.65 (0.55–4.94) 0.99 (0.35–2.78)
  Excessive 11.21a (1.66–75.90) 0.00 (0.00) 2.70 (0.31–23.93) 2.71 (0.50–14.73)
Obese Poor 1.25 (0.30–5.31) 1.85 (0.22–15.40) 0.00 (0.00) 1.55 (0.46–5.10)
  Normal 0.34 (0.06–1.97) 0.73 (0.05–12.02) 1.83 (0.38–8.87) 1.36 (0.36–5.07)
  Excessive 0.87 (0.21–3.56) 11.72a (2.65–51.82) 0.00 (0.00) 4.40a (1.29–14.96)

Values are presented as odds ratio (95% confidence interval). BMI, body mass index; IOM, Institute of Medicine; NICU, neonatal intensive care unit; SGA, small for gestational age; LGA, large for gestational age.

a P<0.05. Multivariate logistic regression controlling for age, nulliparity, in vitro fertilization and embryo transfer, gestational age at delivery and previous Cesarean section.

Table 6.
Multivariate logistic regression of maternal and neonatal complications
Weight gain (IOM) Anemia Preterm birth Placenta abruption GH NICU admission Apgar 5 min < 7 SGA LGA
Poor 1.51a (1.10–2.08) 1.09 (0.00–5.98) 0.63 (0.16–2.46) 0.37a (0.22–0.61) 1.31 (0.80–2.15) 1.53 (0.69–3.40) 1.52 (0.88–2.62) 0.49a (0.26–0.89)
Normal 1 1 1 1 1 1 1 1
Excessive 1.03 (0.57–1.84) 0.52 (0.00–6.00) 3.12 (0.86–11.33) 3.27a (1.86–5.75) 1.66 (0.73–3.76) 3.43a (1.28–9.23) 1.22 (0.40–3.65) 3.05a (1.53–6.08)

Values are presented as odds ratio (95% confidence interval). IOM, Institute of Medicine; GH, gestational hypertension; NICU, neonatal intensive care unit; SGA, small for gestational age; LGA, large for gestational age.

a P<0.05. Multivariate logistic regression controlling for age, nulliparity, in vitro fertilization and embryo transfer, gestational age at delivery, previous Cesarean section and prepregnancy BMI. In placenta abruption cases, gestational hypertension was added to these controlling factors.

Table 7.
Multivariate logistic regression of maternal complications
Prepregnancy BMI y Anemia Postpartum hemorrhage Placenta accreta GH GDM
Underweight 1.76a (1.18–2.63) 0.49 (0.23–1.05) 1.32 (0.26–6.71) 2.01a (1.12–3.61) 0.00 (0.00)
Normal weight 1 1 1 1 1
Overweight 1.65a (1.04–2.63) 1.46 (0.80–2.66) 1.74 (0.32–9.39) 2.13a (1.16–3.89) 0.86 (0.35–2.11)
Obese 0.32 (0.39–1.36) 3.30a (1.83–5.94) 3.54 (0.87–14.37) 3.27a (1.62–6.59) 4.49a (2.29–8.80)

Values are presented as odds ratio (95% confidence interval). BMI, body mass index; GH, gestational hypertension; GDM, gestational diabetes mellitus.

a P<0.05. Multivariate logistic regression controlling for age, nulliparity, in vitro fertilization and embryo transfer, gestational age at delivery, previous Cesarean section and gestational weight gain per week.

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