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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (3): 376-382    DOI: 10.31083/j.ceog.2020.03.5352
Original Research Previous articles | Next articles
Influence of pre-pregnancy body mass index and gestational weight gain in twin pregnancies on blood glucose, serum lipid and perinatal outcomes
F. Wang1, Z.X. Liang1, W.R. Mao2, S.N. He1, D.Q. Chen1, *()
1Women’s Hospital, Zhejiang University School of Medicine, 1# Xueshi Road, Shangcheng District, Hangzhou, Zhejiang Province, 310006, P. R. China
2YuYao People’s Hospital of Zhejiang Province, 800# Chendong Road, Yuyao, Zhejiang Province, 310006, P. R. China
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Abstract  

Objective: To explore the influence of pre-pregnancy body mass index (pBMI) and gestational weight gain (GWG) on maternal outcomes in twin pregnancies. Methods: Clinical data of women with twin pregnancies delivered in Women’s Hospital School of Medicine Zhejiang University from January 2014 to December 2014 were collected and retrospectively analyzed. The women were classified into three groups according to pre-pregnancy body mass index based on WHO guidelines, and gestational weight gain based on the Institute of Medicine (IOM) classification. The characteristics, blood glucose, serum lipid and obstetrical outcomes were compared among the groups of women. Results: Three hundred and twelve eligible women with twin pregnancies were identified. Fifty-nine of the women were underweight, 226 had a normal weight, and 27 were overweight or obese. Fasting blood glucose, OGTT-1H, glycosylated hemoglobin, triglycerides in second and third trimester in overweight or obese group were significantly higher when compared with the normal weight group. Overweight or obese increased the risk of hypertension (OR2.86; 95% CI, 1.15-7.13) and intrahepatic cholestasis (OR, 4.01; 95% CI, 1.51-10.84) compared with normal weight. GWG among women with twin pregnancies was low (n = 125), moderate (n = 143) or high (n = 43) based on pBMI. High GWG increased the risk of preterm birth (< 32weeks gestation) (OR, 5.49; 95% CI 1.47-20.44) while low GWG increased the risk of low birth weight (< 2500 g) (OR, 1.95; 95% CI, 1.20-3.19).Multivariate linear analysis showed gestational weeks, GWG and gestational hypertension had effects on birth weight (P < 0.05). Conclusion: Pre-pregnancy overweight or obese in women with twin pregnancies adversely influence glucose levels, serum lipid concentrations and perinatal outcomes. Preterm and birth weight are adversely influenced by excessive or insufficient GWG.

Key words:  Pre-pregnancy body mass index      Gestational weight gain      Twin pregnancies      Blood glucose      Serum lipid      Birth weight      Preterm birth     
Submitted:  10 August 2019      Accepted:  31 October 2019      Published:  15 June 2020     
*Corresponding Author(s):  DAN-QING CHEN     E-mail:  chendq@zju.edu.cn

Cite this article: 

F. Wang, Z.X. Liang, W.R. Mao, S.N. He, D.Q. Chen. Influence of pre-pregnancy body mass index and gestational weight gain in twin pregnancies on blood glucose, serum lipid and perinatal outcomes. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(3): 376-382.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.03.5352     OR     https://ceog.imrpress.com/EN/Y2020/V47/I3/376

Table 1  — Maternal characteristics by pBMI (underweight, normal and overweight or obese) in twin pregnancies
Underweight(n = 59) Normal weight(n = 226) Overweight(n = 27) P value
Maternal age(yrs) 29.04 ± 3.05 30.50 ± 4.05 32.00 ± 3.40 0.013
Maternal age ≥ 35yrsa 3 (5.08) 34 (15.04) 5 (18.52) > 0.05
Nulliparousa 47 (79.7) 173 (76.6) 21 (77.8) > 0.05
ARTa 21 (35.6) 86 (38.1) 11 (40.7) > 0.05
GWG 17.06 ± 4.40 17.70 ± 5.05 15.56 ± 5.30 > 0.05
Low GWGa 20 (33.9) 95 (40.0) 10 (30.0) > 0.05
Moderate GWGa 30 (50.9) 101 (44.7) 12 (44.4) > 0.05
High GWGa 9 (15.3) 30 (13.3) 5 (18.5) > 0.05
Pregnancy week(wks) 35.28 ± 1.84 35.64 ± 1.99 35.04 ± 1.97 > 0.05
Table 2  — Obstetric outcomes and birth weight by pBMI
Underweight Normal weight Overweight Underweightvs. Normal weight Overweightvs. Normal weight
(n = 59) (n = 226) (n = 27) OR (95%CI) P OR(95%CI) P
GDM 10 (16.9%) 51(22.6%) 10 (37.0%) 0.70 (0.33,1.48) > 0.05 2.02 (0.87,4.68) > 0.05
FBG (mmol/L)* 4.37 ± 0.33 4.49 ± 0.45 4.68 ± 0.52 - - - -
OGTT-1H (mmol/L)* 7.82 ± 1.55 8.27 ± 1.55 9.11 ± 1.67 - - - -
OGTT-2H (mmol/L) 6..75 ± 1.45 6.89 ± 1.33 7.28 ± 2.02 - - - -
HbA1c (%)* 4.82 ± 0.34 4.92 ± 0.33 5.06 ± 0.57 - - - -
≥ 2abnormalvalues in OGTT* 2 (3.4%) 15 (6.6%) 5 (18.5%) - - - -
Gestational hypertension 6 (10.2%) 29 (12.8%) 8 (29.6%) 0.77 (0.30,1.95) > 0.05 2.86 (1.15,7.13) 0.041
ICP 8 (13.6%) 18 (8.0%) 7 (25.9%) 1.81 (0.75,4.40) > 0.05 4.04 (1.51,10.84) 0.009
Preterm birth <32w 4 (6.8%) 9 (4.0%) 1 (3.7%) 1.75 (0.52,5.91) > 0.05 0.93 (0.11,7.62) > 0.05
Preterm birth <35w 16 (27.1%) 52 (23.0%) 5 (18.5%) 1.25 (0.65,2.39) > 0.05 0.76 (0.27,2.11) > 0.05
Mode of delivery by C-section 58 (98.3%) 218 (96.5%) 25 (92.6%) 2.13 (0.26,17.36) > 0.05 0.46 (0.09,2.28) > 0.05
Mean weight of twins 2.34 ± 0.36 2.40 ± 0.43 2.44 ± 0.40 - - - -
weight of twins (2500-3999g) 14 (23.7%) 68 (29.7%) 11 (40.7%) 0.72 (0.37,1.40) > 0.05 1.60 (0.71,3.62) > 0.05
weight of twins(<2500g) 30 (50.9%) 90 (39.3%) 10 (37.0%) 1.56 (0.88,2.78) > 0.05 0.89 (0.39,2.03) > 0.05
Average weight of the heavier twin 2.46 ± 0.39 2.53 ± 0.46 2.59 ± 0.39 - - - -
Average weight of the lightertwin 2.22 ± 0.37 2.23 ± 0.43 2.23 ± 0.42 - - - -
Table 3  — Blood glucose, serum lipids during pregnancy by pBMI
Underweight (n = 59) Normal weight(n = 226) Overweight (n = 27) P
FBG (mmol/L) 4.37 ± 0.33 4.49 ± 0.45 4.68 ± 0.52 0.008
OGTT-1H (mmol/L) 7.82 ± 1.55 8.27 ± 1.55 9.11 ± 1.67 0.002
OGTT-2H (mmol/L) 6..75 ± 1.45 6.89 ± 1.33 7.28 ± 2.02 > 0.05
HbA1c (%) 4.82 ± 0.34 4.92 ± 0.33 5.06 ± 0.57 0.014
≥2 abnormal values in OGTTa 2 (3.39) 15 (6.64) 5 (18.52) 0.035
Secondtrimester
TC (mmol/L) 7.03 ± 1.08 6.79 ± 1.13 6.16 ± 1.10 0.004
TG (mmol/L) 2.48 ± 0.79 2.92 ± 1.10 3.28 ± 1.01 0.002
LDL-C (mmol/L) 4.08 ± 0.96 3.91 ± 1.00 3.43 ± 0.87 0.015
HDL-C (mmol/L) 2.38 ± 0.57 2.28 ± 0.49 2.01 ± 0.48 0.009
Thirdtrimester
TC (mmol/L) 7.07 ± 1.36 6.93 ± 1.44 6.59 ± 1.13 > 0.05
TG (mmol/L) 3.74 ± 1.11 4.53 ± 1.91 4.51 ± 1.72 0.008
LDL-C (mmol/L) 4.17 ± 1.06 3.78 ± 1.17 3.62 ± 0.84 0.038
HDL-C (mmol/L) 1.86 ± 0.45 1.80 ± 0.65 1.66 ± 0.41 > 0.05
Figure 1.  — Mean lipid concentrations during second/third pregnancy trimesters by pre-pregnancy BMI categories. *: P < 0.05 (Triglycerides/HDL in third trimester vs second trimester in three groups).

Table 4  — Obstetric outcomes of three GWG groups
Low GWG Moderate GWG High GWG Low vs. Moderate P High vs. Moderate P
(n = 125) (n = 143) (n = 44) OR (95%CI) OR (95%CI)
Gestational hypertension 16 (12.8%) 19 (13.3%) 8 (18.2%) 0.96 (0.47,1.96) 0.906 1.45 (0.59,3.59) 0.419
ICP 16 (12.8%) 14 (9.8%) 3 (6.8%) 1.35 (0.63,2.90) 0.436 0.67 (0.19,2.46) 0.764
GDM 30 (24.0%) 27 (18.9%) 14 (31.8%) 1.36 (0.76,2.44) 0.307 2.01 (0.94,4.28) 0.070
Gestationalweek 35.46 ± 1.96 35.72 ± 1.79 35.57 ± 2.28
Mode of delivery by C-section 119 (95.2%) 139 (97.2%) 43 (97.7%)
Preterm birth<32w 4 (3.2%) 4 (2.8%) 6 (13.6%) 1.15 (0.28,4.69) 0.847 5.49 (1.47,20.44) 0.016*
Preterm birth<35w 35 (28.0%) 28 (19.6%) 10 (22.7%) 1.60 (0.91,2.82) 0.105 1.21 (0.53,2.74) 0.650
Average weight of twins* 2.31 ± 0.41 2.46 ± 0.38 2.43 ± 0.49
Weight of twins(2500-3999 g) 31 (24.8%) 46 (32.2%) 15 (34.1%) 0.70 (0.41,1.19) 0.184 1.09 (0.53,2.23) 0.812
Weight of twins(<2500 g) 65 (52.0%) 51 (35.7%) 14 (31.8%) 1.95 (1.20,3.19) 0.007* 0.84 (0.41,1.73) 0.639
Average weight of the heavier twin 2.41 ± 0.43 2.60 ± 0.41 2.58 ± 0.50
Average weight of the lighter twin 2.21 ± 0.40 2.48 ± 0.42 2.28 ± 0.50
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