ArticleBMJ open2026
Establishing population-specific gestational weight gain ranges for twin pregnancies and comparing their performance with IOM recommendations: a retrospective cohort study from central China.
Article in BMJ open, 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
objectivesTo establish optimal pre-pregnancy body mass index (BMI)-specific gestational weight gain (GWG) ranges for twin pregnancies and compare their association with maternal and neonatal adverse outcomes against Institute of Medicine (IOM) recommendations.
designRetrospective cohort study. Retrospective cohort study. Adjusted ORs (aORs) with 95% CI were used to quantify associations; average marginal effects (AME) with 95% CI (in percentage points) were used to compare absolute risk differences.
settingPerinatal data from >70 obstetric institutions in Wuhan, China, collected via the Wuhan Maternal and Child Health Service Management Information System.
participants10 636 women with twin deliveries at ≥28 weeks (2011-2023). Pre-pregnancy BMI categorised using Chinese cut-offs: underweight <18.5, normal 18.5-23.9, overweight 24.0-27.9, obesity ≥28.0 kg/m². PRIMARY AND SECONDARY OUTCOME MEASURES: Hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), premature rupture of membranes (PROM), small for gestational age (SGA) and large for gestational age.
resultsOptimal GWG ranges were: underweight 18.0-25.0 kg, normal 14.0-24.0 kg, overweight 12.2-24.0 kg, obesity 13.3-20.0 kg. Compared with IOM guidelines, study-derived ranges showed more favourable risk identification. In normal weight women, excessive GWG increased HDP risk (aOR 1.79, 95% CI 1.49 to 2.14); 13.57% versus 8.79%, AME 5.90 pp (95% CI 3.88 to 7.91 pp). In underweight women, inadequate GWG increased PROM (aOR 1.64, 95% CI 1.05 to 2.57); 14.48% versus 7.51%, AME 4.18 pp (95% CI 0.31 to 8.06 pp) and SGA (aOR 1.72, 95% CI 1.29 to 2.31); 45.58% versus 41.40%, AME 11.74 pp (95% CI 5.55 to 17.94 pp). In overweight women, excessive GWG increased HDP (aOR 1.81, 95% CI 1.21 to 2.70); 24.39% versus 16.32%, AME 9.68 pp (95% CI 2.49 to 16.88 pp) and inadequate GWG increased SGA (aOR 1.60, 95% CI 1.20 to 2.14); 35.15% versus 27.82%, AME 9.85 pp (95% CI CI 3.72 to 15.97 pp), which IOM failed to detect. In obese women, inadequate GWG increased SGA (aOR 2.76, 95% CI 1.37 to 5.53); 27.18% versus 17.16%, AME 17.95 pp (95% CI 5.74 to 30.17 pp), which was missed by IOM.
conclusionsOur findings support adopting region-specific GWG standards for twin pregnancies in Asian populations.
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