Gestational weight gain adequacy among twin pregnancies in France

Abstract

The objective of this paper is to describe gestational weight gain (GWG), to assess the applicability of the 2009 Institute of Medicine (IOM) guidelines, and to derive a GWG adequacy classification within a French cohort. We included twins from the national, prospective, population-based JUmeaux MODe d'Accouchement (JUMODA) cohort study (2014-2015). Following the IOM approach, we selected a 'standard' population of term pregnancies with 'optimal' birthweight (≥2500 g; n = 2562). GWG adequacy (insufficient; adequate; excessive) was defined using IOM recommendations (normal body mass index [BMI]: 16.8-24.5 kg [also utilized for underweight BMI]; overweight: 14.1-22.7 kg; obese: 11.4-19.1 kg). Additionally, using the IOM approach, we determined the 25th and 75th percentiles of GWG in our standard population to create a JUMODA-derived GWG adequacy classification. GWG and GWG adequacy were described, overall and by BMI and parity. In the JUMODA standard population of term twin livebirths with optimal birthweight, mean GWG was 16.1 kg (standard deviation 6.3). Using IOM recommendations, almost half (46.5%) of the women had insufficient and few (10.0%) had excessive GWG, with similar results regardless of BMI or parity. The 25th and 75th percentiles of GWG in the JUMODA standard population (underweight: 13-21 kg; normal weight: 13-20 kg; overweight: 11-19 kg; obese: 7-16 kg) were lower than the IOM recommendations. The IOM recommendations classified a relatively high percentage of French women as having insufficient and a low percentage as having excessive GWG. Additional research to evaluate recommendations in relation to adverse perinatal outcomes is needed to determine whether the IOM recommendations or the JUMODA-derived classification is more appropriate for French twin gestations.

Keywords: Institute of Medicine; body mass index; classification; gestational weight gain; pregnancy; pregnancy weight gain; twins.

Figure 1

Distribution of GWG (kg) in the JUMODA standard population (N = 2562) of term (37–42 weeks gestational age) twin livebirths with mean twin birthweight ≥2500 g (France, 2014–2015). GWG, gestational weight gain

Figure 2

GWG adequacy in the JUmeaux MODe d'Accouchement (JUMODA) standard population according to the 2009 IOM recommendations and a JUMODA‐derived classification. For both classifications, GWG adequacy was defined based on the 25th and 75th percentiles of GWG within a standard population as: insufficient (below 25th percentile), adequate (25th–75th percentile), or excessive (above 75th percentile). The IOM recommendations were derived from a historical US cohort of women giving birth at 37–42 weeks with mean twin birthweight ≥2500 g (1979–1999) and are: normal weight: 16.8–24.5 kg (also utilized for underweight women as separate recommendation not provided); overweight: 14.1–22.7 kg; obese: 11.4–19.1 kg. The JUMODA‐derived classification was derived from the JUMODA standard population of term (37–42 weeks gestational age) twin livebirths with mean twin birthweight ≥2500 g (2014–2015) and are; underweight: 13–21 kg; normal weight: 13–20 kg; overweight: 11–19 kg; obese: 7–16 kg. ^¶BMI (kg/m²): underweight: <18.5; normal weight: 18.5–24.9; overweight: 25–29.9; obese: ≥30. BMI, body mass index (prepregnancy); GWG, gestational weight gain; IOM, Institute of Medicine.