Twins account for a quarter of low-birth-weight babies, approximately half of all twins are premature, and one-sixth of all neonatal deaths are twins 6, 7, 8. It is well known that women with multiple pregnancies suffer from more adverse pregnancy outcomes than those with singleton pregnancies 4, 5. Women carrying inappropriate weight gain are at increased risk of preeclampsia (PE), gestational diabetes mellitus (GDM), preterm birth (PB), fetal growth restriction (FGR), macrosomia, and large-for-gestational-age infants 1, 2, 3. In conclusion, we provide preliminary Chinese GWG optimal range which derived from twin-pregnant women with optimal outcomes(16–21.5 kg for underweight, 15–21.1 kg for normal weight, 13–20 kg for overweight), except for obesity, due to the limited sample size. The association varied with prepregnancy BMI. Excessive weekly GWG increased the risk of gestational hypertension and preeclampsia. Insufficient weekly GWG increased the risk of gestational diabetes mellitus, premature rupture of membranes, preterm birth and fetal growth restriction. Except for the obese group, in the other 3 BMI groups, the overall disease incidence within the recommendation was lower than that outside the recommendation. The optimal GWG calculated in our study was lower than that recommended by the Institute of Medicine. The second step was confirming the proposed optimal range of GWG via compared the incidence of pregnancy complications in groups below or above the optimal GWG and analyzed the relationship between weekly GWG and pregnancy complications to validated the rationality of optimal weekly GWG through logistic regression. The first step was proposing the optimal range of GWG using a statistical-based method (the interquartile range of GWG in the optimal outcome subgroup). We used 2 steps to confirm the optimal range of GWG. They were also stratified according to prepregnancy body mass index (BMI): underweight (< 18.5 kg/m 2), normal weight (18.5–23.9 kg/m 2), overweight (24–27.9 kg/m 2), and obese (≥ 28 kg/m 2). We divided all the participants into two subgroups: the optimal outcome subgroup and the adverse outcome subgroup. There is a lack of data on gestational weight gain (GWG) in twin pregnancies.
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