The association between maternal weight gain and spontaneous preterm birth in twin pregnancies

Abstract

Objective: To estimate the association between maternal weight gain and SPTB in twin pregnancies.

Methods: A case-control study of patients with twin pregnancies and a normal prepregnancy BMI (18.5–24.9?kg/m²) in one maternal-fetal medicine practice from 2005 to 2013. We reviewed maternal weight in six time periods: prepregnancy, 12–15 6/7 weeks, 16–19 6/7 weeks, 20–23 6/7 weeks, 24–27 6/7 weeks and 28–31 6/7 weeks. We compared maternal weight gain patterns across pregnancy between patients who did and did not have SPTB <32 weeks. Student’s t-test and chi-square were used for analysis.

Results: In total, 382 patients were included, 29 (7.6%) of whom had SPTB <32 weeks. The baseline height, weight and BMI did not differ between the groups, nor did maternal age, IVF status, race or chorionicity. Patients with SPTB <32 weeks had significantly less weight gain as early as 15 6/7 weeks (2.9?±?4.6 versus 7.3?±?6.6?lb, p?<?0.001), and this continued until 31 6/7 weeks (25.3?±?8.7 versus 30.8?±?10.9?lb, p?=?0.037).

Conclusions: In twin pregnancies with a normal prepregnancy BMI, there is a significant association between SPTB <32 weeks and lower maternal weight gain, particularly prior to 16 weeks. Future studies are needed to test if prepregnancy or early nutritional interventions in twin pregnancies can reduce the risk of preterm birth and improve neonatal outcomes in this high-risk population.     

The association between maternal height and pregnancy outcomes in twin gestations

Objective: We sought to assess the association between maternal height and the risk of preterm birth, fetal growth restriction and mode of delivery in twin gestations.

Study design: Cohort study of patients with twin pregnancies delivered from 2005 to 2014. We compared pregnancy outcomes between patients of short stature?≤159?cm to those of normal stature?≥160?cm. Patients with monoamniotic twins and major fetal anomalies were excluded. Pearson’s correlation, Chi-square and Student’s t-test were used as appropriate.

Results: Six hundred and sixty-six patients were included, 159 (23.9%) of whom had short stature (mean height 155.8?±?2.5?cm) and 507 (76.1%) of whom had normal stature (mean height 167.2?±?5.5?cm). There were no differences in outcomes between the groups in regards to preterm birth, gestational age (GA) at delivery, birth weight of either twin, preeclampsia, gestational diabetes or cesarean section rate. Results were similar when the groups were stratified by parity. As a continuous variable, maternal height did not correlate with GA at delivery (p=?0.388), cesarean delivery (p?=?0.522) nor the birth weight of the larger (p?=?0.206) or smaller (p?=?0.307) twin.

Conclusion: In twin pregnancies, maternal short stature is not associated with preterm birth, fetal growth restriction or cesarean section rate. This suggests that although anthropometric measurements have long been used to counsel patients in regards to outcomes, patients of short stature should be reassured that their height does not appear to lead to adverse twin pregnancy outcomes.     

The association between maternal biomarkers and pathways to preterm birth in twin pregnancies

Objective: We sought to estimate the association between cervical length (CL) and fetal fibronectin (fFN) and each pathway leading to preterm birth in twin pregnancies.

Methods: Cohort study of 560 patients with twin pregnancies who underwent routine serial CL and fFN screening from 22 to 32 weeks in one maternal fetal medicine practice during 2005–2013. We calculated the association between a short CL (≤20?mm) or positive fFN with overall preterm birth <32 weeks, and then subdivided the analysis into preterm birth <32 weeks from preterm labor, preterm premature rupture of membranes (PPROM) and indicated causes. We excluded cases of monochorionic-monoamniotic placentation, vasa previa, twin–twin transfusion and patients with cerclage.

Results: The overall rate of preterm birth <32 weeks was 6.9% (3.9% from preterm labor, 1.6% from PPROM and 1.4% indicated). A short cervix was associated with preterm birth <32 weeks arising from preterm labor (12.4% versus 2.0%, p?<?0.001), but not PPROM (1.9% versus 1.3%, p?=?0.651). Positive fFN was associated with preterm birth <32 weeks both from preterm labor (17.0% versus 2.4%, p?<?0.001) as well as from PPROM (5.7% versus 1.0%, p?=?0.034). Neither was significantly associated with preterm birth <32 weeks from indicated causes.

Conclusions: The mechanism leading toward preterm influences the accuracy of screening tests chosen to assess risk in twin pregnancies. A shortened cervical length and positive fFN is associated with spontaneous preterm labor and birth <32 weeks. However, PPROM does not appear to be preceded by a short cervix, but is preceded by a positive fFN. Neither test is associated with an indicated preterm birth.     

The effect of maternal anemia on maternal and neonatal outcomes in twin pregnancies

Objective: The objective of this study is to investigate the effect of second trimester anemia on maternal and perinatal outcomes in twin pregnancies.

Methods: A retrospective population-based study was conducted, comparing maternal and neonatal outcomes in women carrying twins, with second trimester anemia (defined as hemoglobin?<?10?g/dl) to those without anemia (defined as hemoglobin?>?or equal to 10?g/dl). Deliveries occurred in a tertiary medical center in 2013.

Results: During the study period, there were 307 twin deliveries. Hemoglobin levels were available for 247 (80.4%) twins; 66 (26.7%) of these had anemia (<10?g/dl) during the second trimester. Women with second trimester anemia had a higher parity (p=?0.03), and needed more blood transfusions than those with hemoglobin level >?or equal to 10?g/dl (OR?=?1.6; 95% CI 1.11–2.43, p?<?0.001). No significant differences were noted between the groups regarding other obstetrical outcomes or regarding perinatal outcomes.

Conclusion: Second trimester anemia in women carrying twins is associated with a high parity and increases the risk for blood transfusions. However, in our population, maternal anemia in twin gestations does not increase the risk for adverse perinatal outcome.     

The likelihood of adverse outcomes in triplet pregnancies estimated by pregravid maternal characteristics

OBJECTIVE: To estimate the likelihood of adverse outcomes in triplet pregnancies by a score comprising pregravid maternal characteristics. DESIGN: A cross-sectional study. SETTING: Triplets database collected by Matria Healthcare, Inc. PATIENT(S): A scoring system was constructed, assigning 1 point for the presence of a risk factor (nulliparity, stature <165 cm, and age <35 years) and 0 for the absence of a risk factor. Data related to 2,887 triplet sets were analyzed. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Total triplet birth weight <4,500 and delivery at 27-32 weeks. RESULT(S): We identified 18% of triplets' mothers (score 3) in whom the likelihood for adverse results is 50%-90% higher and the likelihood for optimal results is 40% to 70% lower than background rates. CONCLUSION(S): A pregravid maternal profile could estimate the likelihood of adverse outcomes and be used for consulting patients at risk of having or carrying a triplet pregnancy.     

Risk factors for adverse outcomes in spontaneous versus assisted conception twin pregnancies

OBJECTIVE: To evaluate risk factors for adverse outcomes in spontaneous vs. assisted conception twin pregnancies. DESIGN: Historical cohort study. SETTING: Four academic tertiary medical centers. PATIENT(S): Women with twin pregnancies, including 2,143 spontaneous and 424 assisted conception; 2,492 nonreduced and 75 reduced. INTERVENTION(S): None (observational). MAIN OUTCOME MEASURE(S): Preeclampsia, preterm premature rupture of membranes, birth <32 weeks and <30 weeks, low birth weight, very low birth weight, and slowed midgestation fetal growth (<10th percentile between 20 and 28 weeks). RESULT(S): Among nonreduced pregnancies, assisted conception was not significantly associated with any adverse outcomes; among nulliparas, the risk for preeclampsia was increased regardless of method of conception; among spontaneous conceptions, the risks for preterm premature rupture of membranes, low birth weight, very low birth weight, and slowed midgestation fetal growth were increased. Among all pregnancies, fetal reduction increased risks for birth <32 weeks and <30 weeks, low birth weight, very low birth weight, and slowed midgestation fetal growth. Among nulliparas with assisted conceptions, fetal reduction increased the risks for birth <30 weeks, very low birth weight, and slowed midgestation fetal growth. CONCLUSION(S): These findings indicate that in twin pregnancies, assisted conception is not a risk factor for adverse outcomes, but rather specific factors that are more common among these pregnancies, such as nulliparity and fetal reduction, increase risks.     

Adverse perinatal outcomes associated with trial of labor after cesarean section at term in pregnancies complicated by maternal obesity

Introduction: Obesity is associated with higher risks for intrapartum complications. Therefore, we sought to determine if trial of labor after cesarean section (TOLAC) will lead to higher maternal and neonatal complications compared to repeat cesarean section (RCD).

Methods: This was a retrospective cohort analysis of singleton nonanomalous births between 37 and 42 weeks GA complicated by maternal obesity (body mass index (BMI)?≥?30?kg/m²) and history of one or two previous cesarean deliveries. Outcomes were compared between TOLAC and RCD. The maternal outcomes of interest included blood transfusion, uterine rupture, hysterectomy, and intensive care unit admission. Neonatal outcomes of interest included 5-minute Apgar score <7, prolonged assisted ventilation, neonatal intensive care unit admission, neonatal seizures, and neonatal death.

Results: There were 538,264 pregnancies included. Compared with RCD, TOLAC was associated with an absolute increase in the following neonatal outcomes: low 5-min Apgar score (0.6%, p?p?p?=?.037), and neonatal death (0.2 per 1000 births, p?=?.028). Additionally, TOLAC was associated with an absolute increase in following maternal outcomes: blood transfusion (0.1%, p?p?p?=?.011).

Conclusions: TOLAC among obesity pregnancies at term increases the risk of maternal and neonatal complications compared with RCD.     

The association between fetal fibronectin and spontaneous preterm birth in twin pregnancies with a shortened cervical length*

Objective: To estimate the association between a positive fetal fibronectin (fFN) and spontaneous preterm birth (SPTB) in twin pregnancies with a shortened cervical length (CL).

Study design: Retrospective cohort study of asymptomatic twin pregnancies managed by a single MFM practice from 2005 to 2016. We included all women with a shortened CL ≤25?mm at 22–28 weeks, and compared outcomes between women with a positive and negative fFN result.

Results: One hundred fifty-five patients were included, 129 (83.2%) of whom had a negative fFN and 26 (16.8%) of whom had a positive fFN. Baseline characteristics were similar between groups, except for the CL at the time of diagnosis of short cervix (15?mm in the positive fFN group versus 20?mm in the negative fFN group, p?=?.002). The risk of SPTB <32 weeks was significantly higher in the positive fFN group (46.2 versus 12.6%, aOR 3.54, 95% CI 1.26, 9.92) and the mean gestational age at delivery was significantly earlier (31.1 versus 35.2 weeks, p?Conclusions: In asymptomatic women with twin pregnancies and a shortened CL, a positive fFN is significantly associated with SPTB and can modify the risk substantially. If performing a screening CL assessment in a twin pregnancy, fFN testing should be done concurrently.     

The association between maternal factors and perinatal outcomes in triplet pregnancies

OBJECTIVE: The purpose of this study was to evaluate the associations between maternal factors and outcomes in triplet pregnancies. STUDY DESIGN: This was a historic cohort study of 194 triplet pregnancies of >or=24 weeks of gestation that were delivered from 1983 through 2001 from five medical centers. RESULTS: In analyses that were limited to pregnancies with all live-born triplets (178 pregnancies), women with a previous good outcome (>2500 g + >37 weeks of gestation) had longer gestations (+7.9 days, P =.03), better rates of fetal growth (+4.9 g/wk, P <.0001), and higher birth weights (+153 g, P <.0001). Maternal weight gains of <36 pounds by 24 weeks of gestation were associated with lower birth weights (-197 g, P <.0001), and fetal growth rates at 相似文献   

Obesity and adverse pregnancy outcomes in twin pregnancies

Abstract

Objective: To compare pregnancy outcomes in twin pregnancies based on maternal pre-pregnancy body mass index (BMI).

Methods: Historical cohort study of all twin pregnancies >24 weeks managed by one maternal-fetal medicine practice from 2005 to 2012. We compared pregnancy outcomes between pre-pregnancy obese (BMI ≥30?kg/m²) and normal weight women (BMI 18.5–24.99?kg/m²). We also compared pre-pregnancy normal weight women to overweight women (BMI 25–29.99?kg/m²) and underweight women (BMI <18.5?kg/m²). Chi square, Fisher’s exact test, Student’s t-test, and one-way ANOVA were used as appropriate. A p value of <0.05 was considered significant.

Results: Five hundred fourteen patients with twin pregnancies were included. Pre-pregnancy obesity was associated with gestational hypertension (34.1% versus 17.9%, p?=?0.011), preeclampsia (27.3% versus 14.4%, p?=?0.028), and gestational diabetes (22.2% versus 4.7%, p?<?0.001). Pre-pregnancy overweight was associated with gestational diabetes (13.7% versus 4.7%, p?=?0.002). Pre-pregnancy underweight was not associated with any adverse pregnancy outcomes. Comparing outcomes across normal weight, overweight, and obese women, the rates of gestational diabetes and gestational hypertension increased significantly across the three groups.

Conclusion: In patients with twin pregnancy, pre-pregnancy obesity is associated with adverse pregnancy outcomes, including gestational diabetes, gestational hypertension, and preeclampsia.     

Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy with dichorionic diamniotic twin pregnancies

Objective: The aim of our study was to investigate the predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP) with dichorionic diamniotic (DCDA) twin pregnancies.

Methods: This study was a retrospective study of women diagnosed with ICP and DCDA twin pregnancies in Chengdu’s women and children’s central hospital. These patients were subdivided into mild and severe ICP groups according to total bile acid (TBA) level. The clinical characteristics and perinatal outcomes were collected and compared between the two groups. Logistic regression analysis was developed to evaluate predictors of adverse perinatal outcomes.

Results: About 134 cases were included in the study. Eighty-four cases were in the mild ICP group, and the other 50 cases were in the severe ICP group. Level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TBIL), and direct bilirubin (DBIL) in the severe ICP group were significant higher than those in the mild ICP group. The rate of delivery before 34 gestational weeks, meconium-stained amniotic fluid, and composite adverse neonatal outcome were higher in the severe ICP group than those in the mild ICP group. After adjusting for confounders, ICP onset gestational age (GA)?<30 weeks and AST >200U/l were associated with GA at delivery <34 weeks. ALP >400U/l was an independent risk factor of meconium-stained amniotic fluid. ICP onset GA <30 weeks was an independent risk factor of composite adverse neonatal outcome.

Conclusion: ICP onset GA <30 weeks, TBA >40 µmol/l, AST >200U/l, and ALP >400U/l were associated with composite adverse perinatal outcomes in ICP with DCDA twin pregnancies. For those patients with these characteristics, fetal surveillance and treatment should be enhanced.     

Association between maternal serum alpha-fetoprotein and adverse outcomes in pregnancies with placenta previa

OBJECTIVE: To determine whether increased maternal serum alpha-fetoprotein (MSAFP) level at 15-20 weeks' gestation is a marker of adverse outcomes in women with placenta previa at delivery. METHODS: We conducted a retrospective cohort study of singleton pregnancies complicated by placenta previa, diagnosed sonographically, and confirmed at delivery. All women had MSAFP screening at 15-20 weeks' gestation and delivered nonanomalous live-born infants at or after 24 weeks' gestation. RESULTS: One hundred seven women with placenta previa delivered during the study. Fourteen (13%, 95% CI 7%, 21%) had MSAFP at least 2.0 multiples of the median (MoM). They were significantly more likely than those with lower MSAFP levels to have one or more of the following outcomes: hospitalization for antepartum bleeding before 30 weeks' gestation (50% versus 15%), delivery before 30 weeks' gestation (29% versus 5%), or preterm delivery for pregnancy-associated hypertension before 34 weeks' gestation (14% versus none). The MSAFP cutoff of 2.0 MoM provided the best combination of sensitivity and specificity for those outcomes, using receiver operating characteristic curves. CONCLUSION: Women with placenta previa who also have high MSAFP levels are at increased risk of bleeding in the early third trimester and preterm birth. We did not find women who required cesarean hysterectomy, including those with placenta accreta, to consistently have elevated MSAFP.     

Preeclampsia in twin gestations: Association with IVF treatments,parity and maternal age

Objective.?To identify maternal factors that increase the risk of preeclampsia in twin gestations and to investigate whether twins conceived by in vitro fertilization (IVF) lead to an increased risk of preeclampsia development.

Materials and methods.?A retrospective population-based cohort study of twin deliveries was performed. Maternal characteristics and perinatal outcomes were evaluated. Patients' data were obtained from a computerized database and analyzed using SPSS statistical package.

Results.?During the study period there were 2628 twin deliveries, and of these 3.1% had severe preeclampsia and 6.16% mild preeclampsia. Patients with severe preeclampsia were more likely to be primiparous, and to have significantly higher frequency of chronic hypertension, gestational diabetes mellitus (GDM), IVF treatments, cesarean delivery, preterm delivery and twin discordancy than in the normotensive patients. Chronic hypertension, pirimiparity, twin discordancy and maternal age were independent risk factors for the development of preeclampsia. In a multivariate regression model including IVF treatment, parity and maternal age as risk factors for preeclampsia, women younger than 35 years that conceived following IVF treatments had an independent risk factor for the development of preeclampsia.

Conclusion.?IVF treatments in primiparous patients and age younger than 35 years are independent risk factors for preeclampsia. Twin discordancy is an additional independent risk factor for the occurrence of preeclampsia.     

Obstetric outcomes of twin pregnancies at advanced maternal age: A retrospective study

Objective

To evaluate obstetric outcomes in twin pregnancies of advanced maternal age (≥35 years).

Obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproductive technology compared with twin pregnancies conceived spontaneously: a prospective follow-up study

Objective

To compare the obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproduction technology (ART) with spontaneously conceived (SC) twin pregnancies.

Study design

A prospective cohort study compared all dichorionic twin pregnancies in nulliparous women following fresh in vitro fertilization/intra-cytoplasmic sperm injection (ICSI) or ICSI cycles at Royan Institute (n = 320) with SC dichorionic twin pregnancies in nulliparous women at Arash Women's hospital (n = 170) from January 2008 to October 2010. These pregnancies were followed-up until hospital discharge following delivery. Obstetric and neonatal outcomes of SC and ART twin pregnancies were compared.

Results

Multivariate analysis, adjusted for maternal age and body mass index, revealed that the obstetric outcomes were similar in both groups. However, the risks of very preterm birth [odds ratio (OR) 5.2, 95% confidence interval (CI) 2.1–12.9], extremely low birth weight (OR 2.2, 95% CI 1.0–3.9), admission to a neonatal intensive care unit (OR 2.0, 95% CI 1.2–3.2) and perinatal mortality (OR 2.3, 95% CI 1.2–4.0) were higher in the ART group.

Conclusions

The maternal outcomes of ART dichorionic twins were comparable with those of SC twins. However, despite the same obstetric management, the rates of very preterm birth, extremely low birth weight, admission to a neonatal intensive care unit and perinatal mortality were significantly higher in the ART group.