Observational studyAnnals of medicine2026
Gestational weight gain and perinatal outcomes in twin pregnancies: evidence-based insights from a Chinese population cohort.
Observational study in Annals of medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTwin pregnancies carry perinatal risks. Gestational weight gain (GWG) is modifiable, but Institute of Medicine (IOM) twin recommendations may not suit Chinese women.
methodA retrospective cohort study included 3109 twin pregnancies delivered at Northwest Women's and Children's Hospital in Xi'an, China, during 2018-2022. Pre-pregnancy BMI was classified according to WHO criteria, with Chinese criteria used in sensitivity analyses. Optimal BMI-specific GWG ranges were defined as the interquartile range among low-risk pregnancies. GWG adequacy (below/within/above) was evaluated against study-derived and IOM-recommended ranges. Associations were estimated using multivariable generalized estimating equations, with threshold-effect and smooth-curve analyses to assess nonlinearity.
resultsOptimal GWG ranges were: underweight, 15.91-23.68 kg; normal, 14.80-21.46 kg; overweight, 12.95-19.98 kg; obese, 7.03-17.76 kg. GWG below range increased risks of moderate preterm birth (MPTB) (OR 1.62, 95% CI 1.29-2.04), very preterm birth (VPTB) (OR 1.90, 95% CI 1.34-2.70), low birth weight (LBW) (OR 1.87, 95% CI 1.61-2.17), and small for gestational age (SGA) (OR 1.31, 95% CI 1.08, 1.59). Excessive GWG raised large for gestational age (LGA) risk (OR 1.98, 95% CI 1.59, 2.46) but lowered LBW (OR 0.69, 95% CI 0.59-0.81) and SGA (OR 0.75, 95% CI 0.60, 0.95). Nonlinear analyses showed U-shaped risks for MPTB, VPTB, and Apgar ≤ 7; inverted U-shaped for gestational age and birth weight; J-shaped for LGA.
conclusionsBMI-specific GWG recommendations derived from this large Chinese twin cohort are lower than IOM values. Both inadequate and excessive GWG increase adverse perinatal risks.
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