16 Jul The Relationship between Pre-gravid Obesity and Pregnancy Outcomes in Twin Pregnancies
Objective: Women with twins have an a priori increased risk for many of the complications associated with maternal obesity. Thus, the impact of maternal obesity in twins may differ from that reported in singletons. In addition, given the increased metabolic demands in twin pregnancies, the impact of maternal underweight may be greater in twin compared with singleton gestations. Our objective was to test the hypothesis that the relationship between maternal body mass index (BMI) and adverse pregnancy outcomes differ between twin and singleton gestations.
Methods: This was a retrospective population-based study of all women who had a singleton or twin hospital birth in Ontario, Canada, between April 2012 and March 2016. Data were obtained from the Better Outcomes Registry & Network (BORN) Ontario. The relationship between maternal BMI category and pregnancy complications was assessed separately in twin and singleton gestations. The primary outcome was a composite variable that included any of the following complications: preeclampsia, gestational diabetes or preterm birth before 32 weeks. Relative risk (aRR) and 95% confidence intervals (CI) for adverse outcomes for each BMI category as defined by WHO (using normal weight category as reference) were generated using modified Poisson regression, adjusting for maternal age, nulliparity, smoking, previous preterm birth and fetal sex.
Results: A total of 487,870 women with singleton (n=480,010) and twin (n=7,860) pregnancies met the inclusion criteria. The risk of the primary outcome, preeclampsia, gestational diabetes and cesarean delivery increased with maternal BMI in both singleton and twin gestations, but these associations were weaker in twin compared with singleton gestations. In singleton pregnancies the risk of preterm birth at <320/7 weeks increased with maternal BMI, mainly due to an increased risk of provider-initiated preterm birth. In twin gestations however, underweight (but not high BMI) was associated with the greatest risk of preterm birth at <32 weeks (aRR 1.67, 95%-CI 1.17-2.37), mainly due to an increased risk of spontaneous preterm birth (aRR 2.1, 95%-CI 1.44-3.08). The risk of birth weight >90th percentile increased with maternal BMI while the risk of birth weight <10th percentile was highest in underweight women in both singletons and twins.
Conclusions: In twin pregnancies, underweight women have the highest risk of preterm birth due to increased risk of spontaneous preterm birth, while the association of maternal obesity with adverse pregnancy outcomes is weaker than that observed in singletons.