Impact of maternal body mass index and gestational weight gain on maternal and neonatal outcomes in twin pregnancies.

INTRODUCTION: To date, there have only been provisional recommendations about the appropriate gestational weight gain in twin pregnancies. This study aimed to contribute evidence to this gap of knowledge. MATERIAL AND METHODS: Using a cohort of 10 603 twin pregnancies delivered between 2000 and 2015 in the state of Hessen, Germany, the individual and combined impact of maternal body mass index and gestational weight gain on maternal and neonatal outcomes was analyzed using uni- and multivariable logistic regression models. The analysis used newly defined population-based quartiles of gestational weight gain in women carrying twin pregnancies (Q1: <419.4 g/week [low weight gain], Q2-Q3: 419.4-692.3 g/week [optimal weight gain], Q4: >692.3 g/week [high weight gain]) and the World Health Organization body mass index classification. RESULTS: Pre-pregnancy body mass index ≥25 kg/m2 was associated with significantly increased rates of cesarean deliveries (aOR1.2, 95% CI: 1.01-1.41) and pregnancy-induced hypertensive disorders (aOR 1.53, 95% CI: 1.11-2.1) but not with any adverse neonatal outcome. Perinatal mortality (aOR 2.23, 95% CI: 1.38-3.6), preterm birth (aOR 1.88, 95% CI: 1.58-2.25), APGAR'5 < 7 (aOR 1.61, 95% CI: 1.19-2.17) and admissions to the neonatal intensive care unit (aOR 1.6, CI: 1.38-1.85) were increased among women with low gestational weight gain. Rates of cesarean deliveries were high in both women with low (aOR 1.25, 95% CI: 1.05-1.48) and high gestational weight gain (aOR 1.17, 95% CI: 1.01-1.35). A high gestational weight gain was also associated with higher rates of hypertensive disorders in pregnancy (aOR 2.32, 95% CI: 1.79-3.02) and postpartum hemorrhage (aOR 1.72, 95%CI: 1.12-2.63). The risk of preterm birth, low Apgar scores and NICU admissions showed a converse linear relation with pre-pregnancy body mass index in women with low gestational weight gain. CONCLUSIONS: In twin pregnancies, nonoptimal weekly maternal weight gain seems to be strongly associated with maternal and neonatal adverse outcomes. Since gestational weight gain is a modifiable risk factor, health care providers have the opportunity to counsel pregnant women with twins and target their care accordingly. Additional research to confirm the validity and generalizability of our findings in different populations is warranted.

Systematic Reviews on the Prevention of Adverse Pregnancy Outcomes Related to Maternal Obesity to Improve Evidence-Based Counselling.

Background: Health professionals and their patients should understand the importance of evidence. In the case of gestational diabetes mellitus, which is often associated with an abnormally high body mass index, the immediate and long-term outcome of women and their offspring depends in part on advice and implementation of lifestyle changes before, during and after pregnancy. Methods: Up to September 2023, MEDLINE, CENTRAL, and WEB OF SCIENCE were used to identify systematic reviews and meta-analyses on the prevention of gestational diabetes. The ROBIS and AMSTAR criteria were analyzed for all systematic reviews. Results: A total of 36 systematic reviews were identified. Dietary interventions, physical activity or a combined approach all reduced adverse pregnancy outcomes such as gestational diabetes, pregnancy-induced hypertension and related morbidities. Within the randomized controlled trials included in the 36 systematic reviews, the type, intensity and frequency of interventions varied widely. The primary outcomes, reporting and methodological quality of the 36 systematic reviews and meta-analyses also varied.The meta-analysis with the highest ROBIS and AMSTAR-2 scores was selected to design an icon array based on a fact box simulating 100 patients. Conclusions: We propose a methodology for selecting the best evidence and transforming it into a format that illustrates the benefits and harms in a way that can be understood by lay patients, even if they cannot read. This model can be applied to counselling for expectant mothers in low and high-income countries, regardless of socioeconomic status, provided that women have access to appropriately trained healthcare providers.

Systematic review on music interventions during pregnancy in favor of the well-being of mothers and eventually their offspring.

OBJECTIVE: Mental health affects maternal well-being and indirectly affects the development of fetal brain structures and motor and cognitive skills of the offspring up to adulthood. This study aimed to identify specific characteristics of music interventions that improve validated maternal outcomes. DATA SOURCES: Randomized controlled trials and systematic reviews investigating music interventions during pregnancy were identified from the start of data sources up to December 2023 using MEDLINE, the Cochrane Central Register of Controlled Trials, or Web of Science. STUDY ELIGIBILITY CRITERIA: Using Covidence, 2 reviewers screened for randomized controlled trials with ≥3 music interventions during pregnancy and applied either the Perceived Stress Scale score, State-Trait Anxiety Inventory score, Edinburgh Postnatal Depression Scale score, or blood pressure as outcomes. METHODS: The Cochrane risk-of-bias tool 2, the checklist to assess Trustworthiness in RAndomised Clinical Trials, and the reversed Cohen d were applied. This review was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42022299950). RESULTS: From 251 detected records, 14 randomized controlled trials and 2375 pregnancies were included. Music interventions varied from 3 to 84 active or passive sessions with either patient-selected or preselected music and a duration of 10 to 60 minutes per session. Thereby, 2 of 4 studies observed a significant decrease in the Perceived Stress Scale, 8 of 9 studies observed a significant decrease in the State-Trait Anxiety Inventory, and 3 of 4 studies observed a significant decrease in the Edinburgh Postnatal Depression Scale. Blood pressure was significantly reduced in 3 of 4 randomized controlled trials. The Cochrane risk-of-bias tool 2 was "high" in 5 of 14 studies or "with concerns" in 9 of 14 studies. Stratifying the Cohen d in 14 intervention arms suggested a big effect in 234 of 469 mothers on blood pressure and in 244 of 489 mothers on maternal anxiety and a medium effect in 284 of 529 mothers on maternal anxiety. Small or very small effects on blood pressure, the Edinburgh Postnatal Depression Scale, and the Perceived Stress Scale were observed in 35 of 70, 136 of 277, and 374 of 784 mothers-to-be, respectively. CONCLUSION: Our study found a general positive effect of music interventions on maternal stress resilience. This was independent of the music but was influenced by the frequency and empathy of the performances. How far music interventions may improve postnatal development and skills of the offspring should be increasingly evaluated with follow-ups to interrupt vicious epigenetic circles during global pandemics, violent conflicts, and natural catastrophes. El resumen está disponible en Español al final del artículo.

Lifestyle Interventions to Improve Pregnancy Outcomes: a Systematic Review and Specified Meta-Analyses.

To compare the impact of lifestyle interventions for overweight and obese pregnant women a systematic review and meta-analysis was conducted using pre-registration and audit of the interventions as selection criteria. PubMed, Web of Science and CENTRAL were searched for randomized controlled trials examining diet, exercise, combined interventions or associated behavioral therapy. Trials were selected if they reported one of the primary outcomes (gestational diabetes, hypertensive disorders, perinatal mortality, admission to neonatal intensive care unit). Results were established from the total group and separately from pre-registered or clinically audited studies. Out of 1304 titles, 28 randomized controlled trials were included. Among the primary outcomes only hypertensive disorders were significantly reduced by exercise in the total group: odds ratio 0.52 (95% confidence interval 0.28 to 0.96, four trials, 1324 participants). When behavioral therapy supported combined interventions, maternal weight gain, (Standardized Mean Difference -0.16 kilogram; 95% confidence interval -0.28 to -0.04, four trials, 2132 participants) and neonatal birthweight, (Standardized Mean Difference -0.4 gram; 95% confidence interval -0.62 to -0.18, five trials, 1058 participants), were significantly reduced within the total group and both specified meta-analyses. Higher frequencies of physical activity improved the results. Risk of bias, assessed with the Cochrane Tool, was low to moderate. Elements of behavioral therapy might better prevent adverse effects of maternal obesity when combined with lifestyle interventions. Unfortunately, high heterogeneity due to different intervention and population characteristics was a limiting factor. Future studies should also focus on increased intensities of physical activity.

Risk Factors for Maternal Body Mass Index and Gestational Weight Gain in Twin Pregnancies.

Objective This retrospective cohort study analyzes risk factors for abnormal pre-pregnancy body mass index and abnormal gestational weight gain in twin pregnancies. Methods Data from 10 603/13 682 twin pregnancies were analyzed using uni- and multivariable logistic regression models to determine risk factors for abnormal body mass index and weight gain in pregnancy. Results Multiparity was associated with pre-existing obesity in twin pregnancies (aOR: 3.78, 95% CI: 2.71 - 5.27). Working in academic or leadership positions (aOR: 0.57, 95% CI: 0.45 - 0.72) and advanced maternal age (aOR: 0.96, 95% CI: 0.95 - 0.98) were negatively associated with maternal obesity. Advanced maternal age was associated with a lower risk for maternal underweight (aOR: 0.95, 95% CI: 0.92 - 0.99). Unexpectedly, advanced maternal age (aOR: 0.98, 95% CI: 0.96 - 0.99) and multiparity (aOR: 0.6, 95% CI: 0.41 - 0.88) were also associated with lower risks for high gestational weight gain. Pre-existing maternal underweight (aOR: 1.55, 95% CI: 1.07 - 2.24), overweight (aOR: 1.61, 95% CI: 1.39 - 1.86), obesity (aOR: 3.09, 95% CI: 2.62 - 3.65) and multiparity (aOR: 1.64, 95% CI: 1.23 - 2.18) were all associated with low weight gain. Women working as employees (aOR: 0.85, 95% CI: 0.73 - 0.98) or in academic or leadership positions were less likely to have a low gestational weight gain (aOR: 0.77, 95% CI: 0.64 - 0.93). Conclusion Risk factors for abnormal body mass index and gestational weight gain specified for twin pregnancies are relevant to identify pregnancies with increased risks for poor maternal or neonatal outcome and to improve their counselling. Only then, targeted interventional studies in twin pregnancies which are desperately needed can be performed.

How to improve health literacy to reduce short- and long-term consequences of maternal obesity?

Aim: To demonstrate the global challenge of maternal obesity and to propose models to increase awareness and health literacy. Methods: The regional perinatal data base and the international literature were reviewed to demonstrate the rising rates of maternal overweight and obesity causing major public health problems in low and high-resourced countries. A preliminary systematic review analyzing interventions in maternal obesity and a fact box based on a recent Cochrane review on dietary interventions were performed. Results: Between 2000 and 2015, the regional rates of maternal overweight and obesity have significantly increased, and the rate of morbid maternal obesity has even doubled. Pregnant women were insufficiently informed about the health risks and international recommendations for weight gain associated with pre-pregnancy body mass index. Scientific publications and guidelines of professional boards have not yet interrupted the vicious cycle of transgenerational transfer of associated health risks for the offspring. For the first time we propose a fact box to translate the results from a Cochrane review about dietary interventions into a transparent information for health care providers and patients which could help to improve awareness. Conclusions: Improving health literacy and translating clinical science into models which are understandable by policy makers, health care providers and parents is a challenge mainly if health risks are modifiable during gestation and could prevent the increasing burden of obesity for future societies.