Maternal pre-gravid body mass index and obstetric outcomes in twin gestations

• Published in: Journal of perinatology Vol. 34; no. 6; pp. 425 - 428
• Main Authors: Al-Obaidly, S, Parrish, J, Murphy, K E, Maxwell, C
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.06.2014; Nature Publishing Group
• Subjects: 692/699/2743/393; 692/700/1750/1747; Adult; Body mass; Body Mass Index; Body size; Body weight; Cesarean section; Cholestasis; Cohort Studies; Complications; Complications and side effects; Confidence intervals; Delivery, Obstetric - methods; Demographic aspects; Diabetes mellitus; Diabetes, Gestational - etiology; Electronic records; Female; Gallbladder diseases; Gestational Age; Gestational diabetes; Glucose; Gynecology; Health aspects; Health risks; Hemorrhage; Humans; Hypertension; Hypertension, Pregnancy-Induced - etiology; Infant, Newborn; Infant, Very Low Birth Weight; Intensive care; Medicine; Medicine & Public Health; Neonates; Newborn babies; Obesity; Obesity - complications; Obstetrics; original-article; Overweight; Overweight - complications; Patient outcomes; Pediatric Surgery; Pediatrics; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, Twin - statistics & numerical data; Pregnant women; Premature birth; Retrospective Studies; Risk; Risk factors; Subgroups; Twins; Underweight; Womens health; Canada; gestational hypertension; twins; gestational diabetes (GDM); body mass index; preterm delivery; neonatal intensive care unit (NICU)
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2014.29

Objective: The aim of this study is to evaluate the impact of maternal pre-gravid and/or first trimester overweight and obesity, and the adverse obstetrics outcome in twin pregnancies. Study design: This is a retrospective study of women who delivered viable twins after 23 weeks of gestation with available prepregnancy body mass index (BMI) and/or were at their earliest visit during the first trimester of pregnancy in the period 2007–2011. The patients were divided into four subgroups according to their BMI (underweight, normal weight, overweight and obese) according to the WHO classification and their outcomes were compared. Obstetrical outcomes of interest including gestational diabetes, gestational hypertension, preterm birth, antepartum hemorrhage, intrahepatic cholestasis of pregnancy, method of delivery and neonatal intensive care unit (NICU) admission were all studied and compared. Result: Electronic records of 1228 pregnant subjects who delivered twins were abstracted. Five hundred and four patients with twin gestations with available BMI were identified (underweight BMI<18.5% ( n =22), normal weight BMI 18.5–24.9% ( n =260), overweight 25–29.9% ( n =114) and obese ⩾30% ( n =108)). Obstetric complications occurred more often in the overweight and obese groups as compared with the normal weight group. There was an increased risk of gestational diabetes in overweight and obese women (odds ratio (OR), 3.3; 95% confidence interval (CI) 1.52–7.3; P= 0.001) and (OR, 3.2; 95% CI, 1.41–7.1; P =0.002), respectively. There was an increased risk of gestational hypertension in the obese group compared with the normal weight group (OR, 2.29; 95% CI, 1.1–4.7; P =0.02) but not in the overweight group (OR, 1.71; 95% CI, 0.8–3.6; P =0.1). In addition, an increased risk of very preterm delivery (<32 weeks) in the overweight group and obese groups was seen when compared with the normal weight group (OR, 2.2; 95% CI, 1.18–4.20; P =0.014 and OR, 2; 95% CI, 1.024–3.91; P =0.04, respectively). Increased rate of cesarean section in the obese group was seen when compared with the normal weight group (OR, 2; 95% CI, 1.2–3.4; P =0.006). Risks of antepartum hemorrhage, intrahepatic cholestasis and NICU admission were similar between the groups. Conclusion: In addition to the known obstetrics complications associated with twin gestations, the pregnancy outcomes in twins are further adversely influenced by increased maternal prepregnancy BMI.