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422: Gestational weight gain in twin pregnancies: does achievement of body mass index-specific weight gain recommendations reduce preterm birth and neonatal morbidity?
Poster Session III
ajog.org 422 Gestational weight gain in twin pregnancies: does achievement of body mass index-specific weight gain recommendations reduce preterm birth and neonatal morbidity? Candice W. Greenan1, Colleen Christensen1, Barbara Wojciechowski2, Rosalea Taam1, Roger B. Newman1 1
Medical University of South Carolina, Charleston, SC, 2Ralph H. Johnson VA Medical Center, Charleston, SC
OBJECTIVE: To determine whether achievement of body mass index
(BMI)-specific weight gain recommendations is associated with a reduced risk of preterm birth (PTB) and improved neonatal outcomes among twin gestations. STUDY DESIGN: A retrospective cohort study of twin gestations delivered at the Medical University of South Carolina from 20002010. 588 women who delivered 24 weeks gestation in all prepregnancy BMI categories were included. Women with major fetal anomalies, fetal aneuploidy, twin-twin transfusion syndrome, cotwin fetal demise, and incomplete prenatal weight records were excluded. BMI-specific weight gain recommendations derived from Luke et al, J Reprod Med, 2003 were applied to each woman based on pre-pregnancy BMI. Women were assigned the designation of achieved or underachieved based on total weight gain and gestational age at delivery. Maternal and neonatal outcomes were compared between the groups. Our sample provides 80% power to detect a 50% difference in the rate of PTB < 32 weeks (p<0.05). RESULTS: BMI-specific weight gain goals were achieved by 49.3 % of women. The achieved group had a 2.5 fold reduction in the rate of preterm birth < 32 weeks (13 vs 34%). African Americans, women with an underweight pre-pregnancy BMI and women with a lower number of prenatal visits were significantly less likely to achieve recommended weight gain goals (Table 1). Women who achieved weight gain recommendations were significantly less likely to deliver any twin with a birth weight less than the tenth percentile for gestational age (larger twin, 0.3 vs 4.0 %, smaller twin 10.3 vs 21.5%). Composite neonatal morbidity, days on the respirator, length of hospital stay and rate of neonatal intensive care unit admission were significantly decreased in the achieved group. CONCLUSION: Achievement of BMI specific weight gain recommendations can decrease the incidence of preterm birth < 32 weeks and improve neonatal outcomes in twin gestations.
STUDY DESIGN: A retrospective cohort study in which we identified all cases of twin gestation in Calgary that had evidence of cervical shortening (<25mm) or dilation on second trimester endovaginal ultrasound or clinical exam before 24 weeks gestation. Pregnancies receiving a rescue cervical cerclage were compared to pregnancies that were expectantly managed. Exclusion criteria were: prophylactic cerclage, cervical changes occuring after 24 weeks gestation, placement of a cerclage after 24 weeks, major congenital anomaly of a fetus or fetal demise. Primary outcome was gestational age at birth. Neonatal outcomes included: birth weight, admission to the NICU, neonatal demise and neonatal morbidities including grade 3-4 intraventricular hemorrhage, necrotizing enterocolitis, stage 3 or higher retinopathy of prematurity and bronchopulmonary dysplasia. RESULTS: Those who received a cerclage were diagnosed at an earlier gestation than those who did not (21+5 vs 23+0 weeks, p<0.001) and had a shorter cervical length (12 vs 18mm, p¼0.02). There was a trend towards increased latency between diagnosis and delivery in the group that received a cerclage, although this did not reach significance (73 vs 60 days, p¼0.13). However, there was no statistically significant difference in gestational age at delivery between the group with a cerclage and wihout (31+5 vs 31+2 weeks gestation, p¼0.84). There was also no statistically significant difference in any of the neonatal morbidities or neonatal mortality between the two groups. CONCLUSION: Placement of a rescue cerclage in twin pregnancies was not more effective in preventing preterm birth and did not improve neonatal morbidity or mortality. Rescue cerclage was also shown to cause no increase in adverse neonatal effects. Although there appears to be no benefit to rescue cerclage in a second trimester twin pregnancy, this provides some evidence that cerclage does not cause harm in twins. Outcomes between the groups with a rescue cerclage and those undergoing expectant management Outcome
No cerclage (N= 58 pregnancies) Cerclage (N= 27 pregnancies) p-value
Median gestational age at delivery (weeks) 31+5
31+2
Mean Birth Weight (g)Twin 1Twin 2
1501.71543.9
1629.11696.5
0.470.39
No cerclageN (%, 95% CI)
CerclageN (%, 95% CI)
p-value
Cesarean Delivery
30 (52.6, 39.5-65.4)
16 (64.0, 43.3-80.6)
0.84
0.34
Any neonatal morbidity
35 (62.5, 48.9-74.4)
16 (66.7, 45.3-82.8)
0.72
Neonatal sepsis
4 (7.1, 2.6-17.9)
5 (20.8, 8.7-42.2)
0.12
Neonatal death
6 (10.5, 4.7-21.9)
1 (4.0, 0.5-24.9)
0.43
424 Association between tobacco use and perinatal outcomes in twin gestations Laura Meints1, Maya Todd1, David Akers1 1
University of Kentucky, Lexington, KY
OBJECTIVE: Maternal tobacco use has been associated with adverse
423 Rescue cervical cerclage in twin pregnancies for the prevention of preterm delivery Nancy Soliman1, Verena Kuret1, Amy Metcalfe1, Sumesh Thomas1 1
University of Calgary, Calgary, AB, Canada
OBJECTIVE: To evaluate pregnancy and neonatal outcomes of twin
pregnancies treated with rescue cervical cerclage for premature cervical changes.
pregnancy outcomes, but most available data pertain to singleton gestations. We aim to quantify perinatal risks associated with maternal smoking status in twin gestations. STUDY DESIGN: This study is a secondary analysis of a multicenter, randomized, controlled trial to evaluate 17-OH progesterone (17OHP) in twin gestations to prevent preterm birth (PTB). Exposure was tobacco use during pregnancy. Primary outcome was gestational age at delivery (EGA). Secondary outcomes were indication for delivery, mode of delivery, birthweight, gestational diabetes (GDM), preeclampsia, markers of neonatal morbidity, and neonatal mortality. Descriptive statistics were generated. We performed univariate and multivariable regression to determine the potential association between primary outcome and smoking status. Results were considered significant if p<.05. RESULTS: There were 1316 women included in the analysis: 138 who smoked during pregnancy, 1178 who did not. Women who smoked
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S233
ajog.org 422 Gestational weight gain in twin pregnancies: does achievement of body mass index-specific weight gain recommendations reduce preterm birth and neonatal morbidity? Candice W. Greenan1, Colleen Christensen1, Barbara Wojciechowski2, Rosalea Taam1, Roger B. Newman1 1
Medical University of South Carolina, Charleston, SC, 2Ralph H. Johnson VA Medical Center, Charleston, SC
OBJECTIVE: To determine whether achievement of body mass index
(BMI)-specific weight gain recommendations is associated with a reduced risk of preterm birth (PTB) and improved neonatal outcomes among twin gestations. STUDY DESIGN: A retrospective cohort study of twin gestations delivered at the Medical University of South Carolina from 20002010. 588 women who delivered 24 weeks gestation in all prepregnancy BMI categories were included. Women with major fetal anomalies, fetal aneuploidy, twin-twin transfusion syndrome, cotwin fetal demise, and incomplete prenatal weight records were excluded. BMI-specific weight gain recommendations derived from Luke et al, J Reprod Med, 2003 were applied to each woman based on pre-pregnancy BMI. Women were assigned the designation of achieved or underachieved based on total weight gain and gestational age at delivery. Maternal and neonatal outcomes were compared between the groups. Our sample provides 80% power to detect a 50% difference in the rate of PTB < 32 weeks (p<0.05). RESULTS: BMI-specific weight gain goals were achieved by 49.3 % of women. The achieved group had a 2.5 fold reduction in the rate of preterm birth < 32 weeks (13 vs 34%). African Americans, women with an underweight pre-pregnancy BMI and women with a lower number of prenatal visits were significantly less likely to achieve recommended weight gain goals (Table 1). Women who achieved weight gain recommendations were significantly less likely to deliver any twin with a birth weight less than the tenth percentile for gestational age (larger twin, 0.3 vs 4.0 %, smaller twin 10.3 vs 21.5%). Composite neonatal morbidity, days on the respirator, length of hospital stay and rate of neonatal intensive care unit admission were significantly decreased in the achieved group. CONCLUSION: Achievement of BMI specific weight gain recommendations can decrease the incidence of preterm birth < 32 weeks and improve neonatal outcomes in twin gestations.
STUDY DESIGN: A retrospective cohort study in which we identified all cases of twin gestation in Calgary that had evidence of cervical shortening (<25mm) or dilation on second trimester endovaginal ultrasound or clinical exam before 24 weeks gestation. Pregnancies receiving a rescue cervical cerclage were compared to pregnancies that were expectantly managed. Exclusion criteria were: prophylactic cerclage, cervical changes occuring after 24 weeks gestation, placement of a cerclage after 24 weeks, major congenital anomaly of a fetus or fetal demise. Primary outcome was gestational age at birth. Neonatal outcomes included: birth weight, admission to the NICU, neonatal demise and neonatal morbidities including grade 3-4 intraventricular hemorrhage, necrotizing enterocolitis, stage 3 or higher retinopathy of prematurity and bronchopulmonary dysplasia. RESULTS: Those who received a cerclage were diagnosed at an earlier gestation than those who did not (21+5 vs 23+0 weeks, p<0.001) and had a shorter cervical length (12 vs 18mm, p¼0.02). There was a trend towards increased latency between diagnosis and delivery in the group that received a cerclage, although this did not reach significance (73 vs 60 days, p¼0.13). However, there was no statistically significant difference in gestational age at delivery between the group with a cerclage and wihout (31+5 vs 31+2 weeks gestation, p¼0.84). There was also no statistically significant difference in any of the neonatal morbidities or neonatal mortality between the two groups. CONCLUSION: Placement of a rescue cerclage in twin pregnancies was not more effective in preventing preterm birth and did not improve neonatal morbidity or mortality. Rescue cerclage was also shown to cause no increase in adverse neonatal effects. Although there appears to be no benefit to rescue cerclage in a second trimester twin pregnancy, this provides some evidence that cerclage does not cause harm in twins. Outcomes between the groups with a rescue cerclage and those undergoing expectant management Outcome
No cerclage (N= 58 pregnancies) Cerclage (N= 27 pregnancies) p-value
Median gestational age at delivery (weeks) 31+5
31+2
Mean Birth Weight (g)Twin 1Twin 2
1501.71543.9
1629.11696.5
0.470.39
No cerclageN (%, 95% CI)
CerclageN (%, 95% CI)
p-value
Cesarean Delivery
30 (52.6, 39.5-65.4)
16 (64.0, 43.3-80.6)
0.84
0.34
Any neonatal morbidity
35 (62.5, 48.9-74.4)
16 (66.7, 45.3-82.8)
0.72
Neonatal sepsis
4 (7.1, 2.6-17.9)
5 (20.8, 8.7-42.2)
0.12
Neonatal death
6 (10.5, 4.7-21.9)
1 (4.0, 0.5-24.9)
0.43
424 Association between tobacco use and perinatal outcomes in twin gestations Laura Meints1, Maya Todd1, David Akers1 1
University of Kentucky, Lexington, KY
OBJECTIVE: Maternal tobacco use has been associated with adverse
423 Rescue cervical cerclage in twin pregnancies for the prevention of preterm delivery Nancy Soliman1, Verena Kuret1, Amy Metcalfe1, Sumesh Thomas1 1
University of Calgary, Calgary, AB, Canada
OBJECTIVE: To evaluate pregnancy and neonatal outcomes of twin
pregnancies treated with rescue cervical cerclage for premature cervical changes.
pregnancy outcomes, but most available data pertain to singleton gestations. We aim to quantify perinatal risks associated with maternal smoking status in twin gestations. STUDY DESIGN: This study is a secondary analysis of a multicenter, randomized, controlled trial to evaluate 17-OH progesterone (17OHP) in twin gestations to prevent preterm birth (PTB). Exposure was tobacco use during pregnancy. Primary outcome was gestational age at delivery (EGA). Secondary outcomes were indication for delivery, mode of delivery, birthweight, gestational diabetes (GDM), preeclampsia, markers of neonatal morbidity, and neonatal mortality. Descriptive statistics were generated. We performed univariate and multivariable regression to determine the potential association between primary outcome and smoking status. Results were considered significant if p<.05. RESULTS: There were 1316 women included in the analysis: 138 who smoked during pregnancy, 1178 who did not. Women who smoked
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S233