{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:37:43Z","timestamp":1788345463539,"version":"build-2803163510"},"reference-count":53,"publisher":"Georg Thieme Verlag KG","issue":"10","funder":[{"name":"Academy of Nutrition and Dietetics Foundation Jean Hankin Nutritional Epidemiology Research"},{"name":"American Society for Nutrition Predoctoral Fellowship"},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development to the University of Texas at Austin","award":["NIH R00HD086304"],"award-info":[{"award-number":["NIH R00HD086304"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:p>\n            Objective\u2003Despite an increase in twin pregnancies in recent decades, the Institute of Medicine twin weight gain recommendations remain provisional and provide no guidance for the pattern or timing of weight change. We sought to characterize gestational weight change trajectory patterns and examine associations with birth outcomes in a cohort of twin pregnancies.<\/jats:p><jats:p>\n            Study Design\u2003Prenatal and delivery records were examined for 320 twin pregnancies from a maternal\u2013fetal medicine practice in Austin, TX 2011-2019. Prenatal weights for those with &gt;1 measured weight in the first trimester and \u22653 prenatal weights were included in analyses. Trajectories were estimated to 32 weeks (mean delivery: 33.7\u2009\u00b1\u20093.3 weeks) using flexible latent class mixed models with low-rank thin-plate splines. Associations between trajectory classes and infant outcomes were analyzed using multivariable Poisson or linear regression.<\/jats:p><jats:p>\n            Results\u2003Weight change from prepregnancy to delivery was 15.4\u2009\u00b1\u20096.3\u2009kg for people with an underweight body mass index, 15.4\u2009\u00b1\u20095.8\u2009kg for healthy weight, 14.7\u2009\u00b1\u20096.9\u2009kg for overweight, and 12.5\u2009\u00b1\u20096.4\u2009kg for obesity. Three trajectory classes were identified: low (Class 1), moderate (Class 2), or high gain (Class 3). Class 1 (24.7%) maintained weight for 15 weeks and then gained an estimated 6.6\u2009kg at 32 weeks. Class 2 (60.9%) exhibited steady gain with 13.5\u2009kg predicted total gain, and Class 3 (14.4%) showed rapid gain across pregnancy with 21.3\u2009kg predicted gain. Compared to Class 1, Class 3 was associated with higher birth weight z-score (\u03b2\u2009=\u20090.63, 95% confidence interval [CI]: 0.31,0.96), increased risk for large for gestational age (IRR\u2009=\u20095.60, 95% CI: 1.59, 19.67), and birth &lt;32 weeks (IRR\u2009=\u20092.44, 95% CI: 1.10, 5.4) that was attenuated in sensitivity analyses. Class 2 was associated with moderately elevated birth weight z-score (\u03b2\u2009=\u20090.24, 95% CI: 0.00, 0.48, p\u2009=\u20090.050).<\/jats:p><jats:p>\n            Conclusion\u2003Gestational weight change followed a low, moderate, or high trajectory; both moderate and high gain patterns were associated with increased infant size outcomes. Optimal patterns of weight change that balance risk during the prenatal, perinatal, and neonatal periods require further investigation, particularly in high-risk twin pregnancies.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2091-1254","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T04:33:57Z","timestamp":1683779637000},"page":"1445-1454","source":"Crossref","is-referenced-by-count":3,"title":["Prenatal Weight Change Trajectories and Perinatal Outcomes among Twin Gestations"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3085-7377","authenticated-orcid":false,"given":"Amy R.","family":"Nichols","sequence":"additional","affiliation":[{"name":"Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sina","family":"Haeri","sequence":"additional","affiliation":[{"name":"Women's Center of Texas, St. David's Healthcare, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Rudine","sequence":"additional","affiliation":[{"name":"Office of Research, St. David's Healthcare, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Burns","sequence":"additional","affiliation":[{"name":"Department of Statistics, University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Rathouz","sequence":"additional","affiliation":[{"name":"Department of Population Health and Biomedical Data Science Hub, The University of Texas at Austin Dell Medical School, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique M.","family":"Hedderson","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven A.","family":"Abrams","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saralyn F.","family":"Foster","sequence":"additional","affiliation":[{"name":"Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Rickman","sequence":"additional","affiliation":[{"name":"Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mollie","family":"McDonnold","sequence":"additional","affiliation":[{"name":"Office of Research, St. David's Healthcare, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9574-6109","authenticated-orcid":false,"given":"Elizabeth M.","family":"Widen","sequence":"additional","affiliation":[{"name":"Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"issue":"17","key":"ref1","first-page":"1","article-title":"Births: final data for 2020","volume":"70","author":"M Osterman","year":"2021","journal-title":"Natl Vital Stat Rep"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1038\/jp.2013.177","article-title":"Gestational weight gain in twin pregnancies and maternal and child health: a systematic review","volume":"34","author":"L M Bodnar","year":"2014","journal-title":"J 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Medicine (IOM) guidelines: a systematic review","volume":"35","author":"D Lin","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"06","key":"ref51","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1111\/1471-0528.17011","article-title":"Gestational weight gain in twin gestations and pregnancy outcomes: a systematic review and meta-analysis","volume":"129","author":"H Lipworth","year":"2022","journal-title":"BJOG"},{"issue":"01","key":"ref52","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1186\/s12884-021-03907-1","article-title":"Should singleton birth weight standards be applied to identify small-for-gestational age twins?: Analysis of a retrospective cohort study","volume":"21","author":"D Lin","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"issue":"05","key":"ref53","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1097\/AOG.0b013e3182318651","article-title":"Trends in cesarean delivery for twin births in the United States: 1995-2008","volume":"118","author":"H C Lee","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref54","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1055\/s-0032-1304824","article-title":"The association of gestational weight gain per institute of medicine guidelines and prepregnancy body mass index on outcomes of twin pregnancies","volume":"29","author":"V H Gonz\u00e1lez-Quintero","year":"2012","journal-title":"Am J Perinatol"}],"container-title":["American Journal of 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