80 Maternal weight gain and triplet birthweight

$104 SMFM Abstracts 77

THE COST OF TWIN PREGNANCY: MATERNAL & NEONATAL FACTORS B LUKE 1, R MISIUNAS 1, L MIN 1, T KINOSHI 2, MJ O'SULLIVAN 3, FR WITTER 4, RB NEWMAN5: 1University of Michigan, Obstetrics & Gynecology, Ann Arbor, MI; 2University of Miami, Health Information Management, Miami, FL; 3University of Miami, Obstetrics a n d Gynecology, Miami, FL; 4Johns Hopkins University, Gynecology a n d Obstetrics, Baltimore, MD; 5Medical University of South Carolina, Department of Obstetrics a n d Gynecology, Charleston, SC OBJECTIVE: To evaluate factors affecting birth charges for m o t h e r a n d newborns in twin pregnancies. STUDY DESIGN: As p a r t of an o n g o i n g collaborative study of twins, clinical a n d financial data was obtained on 1080 pregnancies from 1995 to present from four medical centers in Bahinmre, MD, Miami, EL, Ann Arbor, MI, a n d Charleston, SC. Regression modeling was used to evaluate the effect of maternal a n d neonatal factors on birth charges. RESULTS: The study population was 51% white, 46% _>30yrs of age; 32% overweight or obese; 45% primiparas, 24% infertility treatments, 16% monochorionic. As shown below, m o t h e r ' s birth length of stay (MLOS, days), mother's birth charges (MotherS), average twin length of stay (TwLOS, days), and average twin birth charges (Tw$) all decreased with advancing gestation, reaching a nadir at 38-39 wks a n d rising fl~ereaftei: In models controlling tbr year, study site, a n d length of gestation, mother's birth charges were significantly increased with cesarean delivery (+$3,427, P < .001) a n d preeclampsia (+$3,516, P < .001): average twin charges were increased with rate of fetal growth <10th%ile (singleton reference) before 20 wks (+$7,101, P = .004) a n d between 20-28 wks (+$13,064, P < .001). CONCLUSION: These findings indicate that the lowest birth charges a n d LOS for both m o t h e r a n d h e r twins is at 38-39 wks' gestation, a n d that growth retardation contributes substantially to both birth LOS and charges. Table MLOS

Wks <28 28-29 30-31 32-33 34-35 36-37 38-39 _>40 All Wks

78

December 2001 Am J Obstet Gynecol

10.1 9.7 8.6 7.1 5.4 4.8 4.4 5.9 5.8

MOTHERS

$14,426 $13,346 $12,738 $12,857 $10,469 $9,086 $8,065 $11,864 $10,310

BWT

TWLOS

829 1,224 1,520 1,904 2,240 2,627 2,842 2,834 2,321

60.6 54.8 32.3 17.9 10.1 6.1 5.0 5.7 13.1

79

THE EFFECT OF FETAL R E D U C T I O N O N INTRAUTERINE GROWTH AND PREGNANCY OUTCOME IN TWINS b LUKE SCD ~, D MARTIN'-', VH GONZALEZ-QUINTERO 2, L TOLAYMAT2, M O'SULLIVAN2, RB NEWMAN3, J MAULDIN 3, ER WITTER 4, G HANKINS 5, M D'ALTON 6, EA REECE7; tUniversity of Michigan, Obstetrics & Gynecology, Ann Arbor, MI; 2University of Miami, Obstetrics a n d Gynecology, Miami, FL; 3Medical University of South Carolina, Department of Obstetrics a n d Gynecology, Charleston, SC; 4Johns Hopkins University, Gynecology a n d Obstetrics, Baltimore, MD; 5University of Texas Medical Branch at Galveston, Obstetrics & Gynecology, Galveston, TX; 6Columbia University, New York, NY; 7Temple University, Obstetrics, Gynecology & Reproductive Science, Philadelphia, PA OBJECTIVE: To evaluate the effect of fetal r e d u c t i o n o n intrauterine growth a n d length of gestation. STUDY DESIGN: As p a r t of an o n g o i n g collaborative study, maternal, tetal, a n d neonatal information was obtained from the medical records on all nmltiple p r e g n a n c i e s at seven medical centers in Baltimore, Mianri, A n n Arbor, Charleston, Galveston, New York, a n d Philadelphia. The study sample included 2,938 twin pregnancies (2,862 n o n r e d u c e d a n d 76 reduced). The reduced g r o u p included 54 pregnancies reduced from triplets, 17 reduced from quadruplets, a n d 5 pregnancies reduced from quintuplets or higher. RESULTS: Wmnen who undep, vent [i~tal reduction were more likely to be printiparous (77% vs 39%), white (78% vs 36%), older (78% vs 37% ->30 years), of low or normal pregravid weight for height (79% vs 67%), to have private or H M O insurance (88% vs 50%), a n d to have h a d infertility treatment (96% vs 12%) a n d cerclage (12% vs 3%). Based o n analysis of covariance, adjusting for c o n f o u n d i n g variables, length of gestation was 35.5 _+3.4 weeks tor n o n r e d u c e d pregnancies, 34.8 -+ 3.6 weeks for pregnancies reduced from triplets or quadruplets, a n d 29.5 _+ 5.9 weeks for pregnancies reduced from quintuplets or higher (P < .0001). Average birthweight was 2,285 _+ 621g tor n o n r e d u c e d pregnancies, 2,088 +_697g for pregnancies reduced from triplets or quadruplets, a n d 1,394 +_957g for pregnancies reduced from quintuplets or higher (P< .0001). In reduced pregnancies, the average twin pair rate of fetal growth by mid-gestation (between 20-28 weeks) was more likely to be below the singleton 10th%ile (AOR 2.45, 95% C1, 1.29-4.64), a n d delivery before 32 weeks' gestation was significantly more likely (AOR 2.88, 95% CI, 1.63-5.09). CONCLUSION: These findings suggest that fetal reduction, particularly from quintuplets or higher, results in significant slowing of i n t r a u t e r i n e growth, as well as a higher risk for early preterm birth.

80

MATERNAL WEIGHT GAIN AND TRIPLET BIRTI-IWEIGHT BARBARA LUKE l, CLARK NUGENT l, COSMAS VAN DE VEN 1, DIBE MARTIN:~, MARY O'SULLIVAN 2, SANDRA EARDLEY3, FRANK WITTER 4, JILL MAULDIN 5, ROGER NEWMAN5; ]University of Michigan, Obstetrics & Gynecology, Ann Arbor, MI; 2University of Miami, Obstetrics a n d Gynecology, Miami, FL; 3Southern Illinois University, Springfield, IL; 4Johns Hopkins University, Gynecology a n d Obstetrics, Baltimore, MD; 5Medical University of South Carolina, Department of Obstetrics a n d Gynecology, Charleston, SC OBJECTIVE: To evaluate associations between maternal weight gain, birtbweight (BWT) a n d length of gestation (GA) in triplet pregnancies. STUDY DESIGN: This historical c o h o r t study was based on triplet pregnancies of >24 wks GA from Baltimore, MD, Miami, FL, Ann Arbor, MI, Charleston, SC, a n d Springfield, IL b o r n between 1983-2001. RESULTS: The study population of 198 triplet pregnancies was 79% white, non-Hispanic, 11% Hispanic, a n d 10% black; 57% primiparas, a n d 70% intertility treatments. Mean BWT was 1,658 _+540g; 37% <1,500g. Mean GAwas 32.2 +_ 3.6 wks; 23% <30 wks a n d 65% <34 wks. Mothers averaged 30.3 _+ 5.3 years of age, 146.4 _+36.5 lbs pregravid weight a n d 43.1 -+ 16.6 lbs gain. Women with infertility treatments were older (31.1 years m 28.4 years), less likely to smoke (4% vs 15%) a n d more likely to be primiparas (67% vs 36%). Twenty pregnancies were complicated by intrauterine fetal demise; these pregnancies were significandy shorter (29.0 vs 32.5 wks), a n d more likely to be complicated by preterm premature laapture of membranes (51% vs 38%) mad the need for cerclage (25% vs 12%). Analyses linrited to p r e g n a n c i e s with all liveborn infants (N = 178), controlling for c o n t o u n d i n g factors, indicated that rate of maternal weight gain before 28 wks was significantly associated with average triplet BWT (+159g/lb/wk 0-20 wks, P< .0001 a n d + 1 3 2 g / l b / w k 20-28 wl~s, P < .0001, vs +1.6g/lb/wk 28 weeks
TW$

$190,342 $149,404 $70,614 $31,553 $16,053 $8,616 $5,005 $5,166 $25,925

THE EFFECT OF PLACENTAL CHORIONICITY ON EARLY CHILDHOOD MENTAL AND M O T O R DEVELOPMENT OF TWINS BARBARA LUKE t, RUTA MISIUNAS l, ELAINE ANDERSON l, BARBARA BURPEE 2, SHIRLEY G O G L I O T T I 2, EILEEN MOLLENS; 1University of Michigan, Obstetrics & Gynecology, Alan Arbm, MI; 2University of Michigan, Physical Medicine and Rehabilitation, A n n Arbor, MI; 3University of Michigan, Pediatrics Department, Ann Arbor, MI OBJECTIVE: To evaluate the mental a n d m o t o r d e v e l o p m e n t of twin children. STUDY DESIGN: As p a r t of an o n g o i n g prospective study of twins, maternal, fetal, a n d n e o n a t a l i n f o r m a t i o n was obtained, a n d follow-up evaluations using the mental a n d m o t o r scales of the Bayley Scales of Infant Development were done. The effects of placental choriorlicity were evaluated using logistic a n d linear regression nmdeling, controlling for differences in baseline characteristics. RESULTS: The study sample included 136 twin children, of which all h a d reached 8 months of age (corrected for prematnrity), a n d 100 of which h a d reached 18 months of age (corrected fbr prematurity). Mean birthweight was 2,342g (813g-3,610g); 8% were 36 weeks; 13% were nmnochorionic (MC) a n d 87% were dichorionic (DC). Adjusting for gendex, MC twins h a d slower rates of tetal growth (-1.0 g/week to 20 weeks, P = .01; -3.2 g/week 20-28 weeks, NS; a n d -6.7 g/week 28 weeks to birth, P = .001), shorter gestations (4.5 days, P < .0001), a n d lower birthweights (-152.2 g, P < .0001). At 8 months of age MC twins averaged lower mental (-5.7 _+2.2 points, P = .01) a n d m o t o r scores (-10.9 _+ 3.3, P = .001). At 18 months, MC twins still evidenced lower mental a n d m o t o r scores (-6.4 + 3.7 points, P = .09 a n d -5.4 _+2.9 points, P - .07), but because of small sample sizes the differences were of borderline significance. Overall, MC children were more likely to be rated as nfildly or significantly delayed (OR 4.69, 95% CI, 2.60-8.44). CONCLUSION: T h e s e findings suggest that MC children are at significantly higher risk for mental a n d m o t o r delays during early childhood, a n d highlight the i m p o r t a n c e of 1) r e d u c i n g prenatal t~tctors that could potentiate these adverse effects, a n d 2) early postnatal screening a n d interventions.