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Epidemiology and Population Health

Pregnancy weight gain in twin gestations and maternal and child health outcomes at 5 years

International Journal of Obesity volume 45, pages 1382–1391 (2021)Cite this article

Subjects

Abstract

Objective

Current guidelines for maternal weight gain in twin pregnancy were established in the absence of evidence on its longer-term consequences for maternal and child health. We evaluated the association between weight gain in twin pregnancies and the risk of excess maternal postpartum weight increase, childhood obesity, and child cognitive ability.

Methods

We used 5-year follow-up data from 1000 twins born to 450 mothers in the Early Childhood Longitudinal Study—Birth Cohort, a nationally representative U.S. cohort of births in 2001. Pregnancy weight gain was standardized into gestational age- and prepregnancy body mass index (BMI)-specific z-scores. Excess postpartum weight increase was defined as ≥10 kg increase from prepregnancy weight. We defined child overweight/obesity as BMI ≥ 85th percentile, and low reading and math achievement as scores one standard deviation below the mean. We used survey-weighted multivariable modified Poisson models with a log link to relate gestational weight gain z-score with each outcome.

Results

Excess postpartum weight increase occurred in 40% of mothers. Approximately 28% of twins were affected by overweight/obesity, and 16 and 14% had low reading and low math scores. There was a positive linear relationship between pregnancy weight gain and both excess postpartum weight increase and childhood overweight/obesity. Compared with a gestational weight gain z-score 0 SD (equivalent to 20 kg at 37 weeks gestation), a weight gain z-score of +1 SD (27 kg) was associated with 6.3 (0.71, 12) cases of excess weight increase per 1000 women and 4.5 (0.81, 8.2) excess cases of child overweight/obesity per 100 twins. Gestational weight gain was not related to kindergarten academic readiness.

Conclusions

The high prevalence of excess postpartum weight increase and childhood overweight/obesity within the recommended ranges of gestational weight gain for twin pregnancies suggests that these guidelines could be inadvertently contributing to longer-term maternal and child obesity.

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Fig. 1: Relation between gestational weight gain z-score and health outcomes for mothers and children.

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Computer code and data will not be available due to data use agreements with the U.S. Department of Education.

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Author information

Authors and Affiliations

  1. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Lisa M. Bodnar, Abigail R. Cartus & Sara M. Parisi

  2. Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Lisa M. Bodnar & Katherine P. Himes

  3. Magee-Womens Research Institute, Pittsburgh, PA, USA

    Lisa M. Bodnar & Katherine P. Himes

  4. Division of Epidemiology and Biostatistics, School of Public Health, University of California at Berkeley, Berkeley, CA, USA

    Barbara Abrams

  5. Oregon Health Sciences University-Portland State University School of Public Health, Portland, OR, USA

    Cara L. Eckhardt

  6. School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA

    Betty Braxter

  7. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada

    Jennifer A. Hutcheon

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  1. Lisa M. Bodnar
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Corresponding author

Correspondence to Lisa M. Bodnar.

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Conflict of interest

This study is supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) R01 HD094777 to LMB and JAH. JAH holds a Canada Research Chair in Perinatal Population Health from the Canadian Federal Government. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare no other competing interests.

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Bodnar, L.M., Cartus, A.R., Parisi, S.M. et al. Pregnancy weight gain in twin gestations and maternal and child health outcomes at 5 years. Int J Obes 45, 1382–1391 (2021). https://doi.org/10.1038/s41366-021-00792-8

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