{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:26:43Z","timestamp":1783124803019,"version":"3.54.6"},"reference-count":37,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"unspecified","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate whether twin zygosity influences the association between neonatal outcomes and gestational weight gain (GWG) based on the Chinese guidelines in twin-pregnancy women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A retrospective cohort study. And it is not a clinical trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Women with twin pregnancies living in Wuhan, China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>A total of 5140\u2009women who delivered live and non-malformed twins from 1 January 2011 to 31 August 2017 were included in this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measure<\/jats:title><jats:p>The primary neonatal outcomes included paired small for gestational age (SGA, &lt;10\u2009th percentile birth weight for gestational age and sex), low birth weight (LBW, &lt;2500\u2009g) and gestational age (&lt;33 weeks and &lt;37 weeks). The association between GWG and neonatal outcomes was examined by Logistic regression analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 5140\u2009women were included, of whom 22.24%, 54.78% and 22.98% were below, within and above the Chinese guidelines, respectively. Among the including 10\u2009280 infants, 26.28% of them were monozygotic (MZ) twins and 73.72% of them were dizygotic (DZ) twins. Women with low GWG had a significantly higher proportion of LBW\/LBW and LBW\/NBW infants, a greater likelihood of SGA\/SGA and SGA\/appropriate for gestational age (AGA) infants and a higher incidence of preterm birth. The associations persisted both in MZ and DZ twins, and twin zygosity influenced the degree of association between GWG and SGA, LBW and preterm birth. High GWG was associated with significant risk reductions in SGA\/AGA pairs, LBW\/LBW or LBW\/NBW pairs, and less than 33 gestational weeks. However, high GWG was only associated with reduced risk of LBW\/LBW pairs both in MZ and DZ twins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>GWG below the Chinese recommendations increased the risk of SGA, LBW and preterm birth in both MZ and DZ twins. The effect was more pronounced in MZ twins than that in DZ twin pairs. A high GWG only reduced the risk of LBW\/LBW pairs both in MZ and DZ twins.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2021-056581","type":"journal-article","created":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T15:49:14Z","timestamp":1673365754000},"page":"e056581","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Gestational weight gain and neonatal outcomes in different zygosity twins: a cohort study in Wuhan, China"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6043-2313","authenticated-orcid":false,"given":"Yawen","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingzhu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiming","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Mei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongling","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AiFen","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,1,10]]},"reference":[{"key":"2023020623001020000_13.1.e056581.1","first-page":"327","article-title":"Twin delivery: method, timing and conduct. Best practice & research","volume":"28","author":"Barrett","year":"2014","journal-title":"Clin Obstet Gynecol"},{"key":"2023020623001020000_13.1.e056581.2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2012.02.001"},{"key":"2023020623001020000_13.1.e056581.3","first-page":"1","article-title":"Births: final data for 2016","volume":"67","author":"Martin","year":"2018","journal-title":"Natl Vital Stat Rep"},{"key":"2023020623001020000_13.1.e056581.4","doi-asserted-by":"publisher","DOI":"10.1017\/S0021932003002876"},{"key":"2023020623001020000_13.1.e056581.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0159461","article-title":"LBW and SGA impact longitudinal growth and nutritional status of Filipino infants","volume":"11","author":"Blake","year":"2016","journal-title":"PLoS One"},{"key":"2023020623001020000_13.1.e056581.6","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1016\/j.metabol.2008.07.013","article-title":"Low birth weight and blood pressure","volume":"57 Suppl 2","author":"Lenfant","year":"2008","journal-title":"Metabolism"},{"key":"2023020623001020000_13.1.e056581.7","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2013.223"},{"key":"2023020623001020000_13.1.e056581.8","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12391"},{"key":"2023020623001020000_13.1.e056581.9","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.674812"},{"key":"2023020623001020000_13.1.e056581.10","doi-asserted-by":"publisher","DOI":"10.1375\/1369052012669"},{"key":"2023020623001020000_13.1.e056581.11","article-title":"Pre-pregnancy body mass index, gestational weight gain, and birth weight: a cohort study in China","volume":"10","author":"Yang","year":"2015","journal-title":"PLoS One"},{"key":"2023020623001020000_13.1.e056581.12","unstructured":"National Academy of Sciences . Weight gain during pregnancy: reexamining the guidelines. Washington DC, 2009."},{"key":"2023020623001020000_13.1.e056581.13","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.3635"},{"key":"2023020623001020000_13.1.e056581.14","doi-asserted-by":"crossref","first-page":"357","DOI":"10.3109\/14767058.2016.1173029","article-title":"Inadequate weight gain in obese women and the risk of small for gestational age (SGA): a systematic review and meta-analysis","volume":"30","author":"Xu","year":"2017","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2023020623001020000_13.1.e056581.15","first-page":"366","article-title":"[Maternal and neonatal outcomes according to gestational weight gain in twin pregnancies: Are the IOM guidelines associated with better issues?]","volume":"45","author":"P\u00e9cheux","year":"2017","journal-title":"Gynecol Obstet Fertil Senol"},{"key":"2023020623001020000_13.1.e056581.16","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s10995-016-2134-6","article-title":"Assessing weight gain by the 2009 Institute of medicine guidelines and perinatal outcomes in twin pregnancy","volume":"21","author":"Ozcan","year":"2017","journal-title":"Matern Child Health J"},{"key":"2023020623001020000_13.1.e056581.17","article-title":"Gestational weight gain per pre-pregnancy body mass index and birth weight in twin pregnancies: a cohort study in Wuhan, China","volume":"8","author":"Chen","year":"2018","journal-title":"Sci Rep"},{"key":"2023020623001020000_13.1.e056581.18","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":"Gonz\u00e1lez-Quintero","year":"2012","journal-title":"Am J Perinatol"},{"key":"2023020623001020000_13.1.e056581.19","doi-asserted-by":"crossref","first-page":"390.e1","DOI":"10.1016\/j.ajog.2008.12.018","article-title":"Gestational weight gain among US women who deliver twins, 2001-2006","volume":"200","author":"Chu","year":"2009","journal-title":"Am J Obstet Gynecol"},{"key":"2023020623001020000_13.1.e056581.20","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1097\/AOG.0b013e318232125d","article-title":"Excessive weight gain in term twin pregnancies: examining the 2009 Institute of medicine definitions","volume":"118","author":"Fox","year":"2011","journal-title":"Obstet Gynecol"},{"key":"2023020623001020000_13.1.e056581.21","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.ejogrb.2019.01.010","article-title":"Maternal and neonatal outcomes according to gestational weight gain in twin pregnancies: are the Institute of medicine guidelines associated with better outcomes?","volume":"234","author":"P\u00e9cheux","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2023020623001020000_13.1.e056581.22","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1080\/14767058.2019.1648421","article-title":"Weight gain and pregnancy outcomes in overweight or obese women with twin gestations","volume":"34","author":"Liu","year":"2021","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2023020623001020000_13.1.e056581.23","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1017\/thg.2017.24","article-title":"The Wuhan twin birth cohort (WTBC)","volume":"20","author":"Zhao","year":"2017","journal-title":"Twin Res Hum Genet"},{"key":"2023020623001020000_13.1.e056581.24","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0803354"},{"key":"2023020623001020000_13.1.e056581.25","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/j.1447-0756.2010.01301.x","article-title":"Maternal risk factors for small-for-gestational age newborns in Japanese dichorionic twins","volume":"37","author":"Inde","year":"2011","journal-title":"J Obstet Gynaecol Res"},{"key":"2023020623001020000_13.1.e056581.26","article-title":"Birthweight percentiles for twin birth neonates by gestational age in China","volume":"6","author":"Zhang","year":"2016","journal-title":"Sci Rep"},{"key":"2023020623001020000_13.1.e056581.27","doi-asserted-by":"crossref","first-page":"552","DOI":"10.3109\/14767058.2013.836177","article-title":"Perinatal outcomes based on the Institute of medicine guidelines for weight gain in twin pregnancies","volume":"27","author":"Shamshirsaz","year":"2014","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2023020623001020000_13.1.e056581.28","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1016\/j.ajog.2004.12.071","article-title":"Modifiable risk factors for growth restriction in twin pregnancies","volume":"192","author":"Schwendemann","year":"2005","journal-title":"Am J Obstet Gynecol"},{"key":"2023020623001020000_13.1.e056581.29","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-017-1530-2","article-title":"Examining the provisional guidelines for weight gain in twin pregnancies: a retrospective cohort study","volume":"17","author":"Lutsiv","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"2023020623001020000_13.1.e056581.30","doi-asserted-by":"crossref","first-page":"2182","DOI":"10.3109\/14767058.2015.1079613","article-title":"Maternal and neonatal outcomes in women with twin pregnancies with excessive gestational weight gain","volume":"29","author":"Pettit","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2023020623001020000_13.1.e056581.31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2000.tb13234.x"},{"key":"2023020623001020000_13.1.e056581.32","doi-asserted-by":"publisher","DOI":"10.1375\/1369052012588"},{"key":"2023020623001020000_13.1.e056581.33","doi-asserted-by":"crossref","first-page":"355","DOI":"10.3346\/jkms.2005.20.3.355","article-title":"Genetic and environmental influences on birthweight in a sample of Korean twins","volume":"20","author":"Hur","year":"2005","journal-title":"J Korean Med Sci"},{"key":"2023020623001020000_13.1.e056581.34","doi-asserted-by":"publisher","DOI":"10.1375\/1369052012533"},{"key":"2023020623001020000_13.1.e056581.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.08.019"},{"key":"2023020623001020000_13.1.e056581.36","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1017\/S0001566000014379","article-title":"Hypothesis of an ovular regulation of pregnancy weight-gain","volume":"25","author":"Papiernik","year":"1976","journal-title":"Acta Genet Med Gemellol"},{"key":"2023020623001020000_13.1.e056581.37","first-page":"557","article-title":"Obstetric complications of twin pregnancies. Best practice & research","volume":"18","author":"Rao","year":"2004","journal-title":"Clin Obstet Gynecol"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-056581","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T07:04:53Z","timestamp":1675753493000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-056581"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,10]]},"published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1136\/bmjopen-2021-056581"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-056581","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}