{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T17:02:45Z","timestamp":1780074165391,"version":"3.54.0"},"reference-count":39,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Maternal and Child Nutrition and Health Research Project of the Chinese Center for Disease Control and Prevention","award":["NO. 2021FY023"],"award-info":[{"award-number":["NO. 2021FY023"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,8]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To establish optimal pre-pregnancy body mass index (BMI)-specific gestational weight gain (GWG) ranges for twin pregnancies and compare their association with maternal and neonatal adverse outcomes against Institute of Medicine (IOM) recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study. Retrospective cohort study. Adjusted ORs (aORs) with 95%\u2009CI were used to quantify associations; average marginal effects (AME) with 95%\u2009CI (in percentage points) were used to compare absolute risk differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Perinatal data from &gt;70 obstetric institutions in Wuhan, China, collected via the Wuhan Maternal and Child Health Service Management Information System.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>10\u2009636\u2009women with twin deliveries at \u226528 weeks (2011\u20132023). Pre-pregnancy BMI categorised using Chinese cut-offs: underweight &lt;18.5, normal 18.5\u201323.9, overweight 24.0\u201327.9, obesity \u226528.0\u2009kg\/m\u00b2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), premature rupture of membranes (PROM), small for gestational age (SGA) and large for gestational age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Optimal GWG ranges were: underweight 18.0\u201325.0\u2009kg, normal 14.0\u201324.0\u2009kg, overweight 12.2\u201324.0\u2009kg, obesity 13.3\u201320.0\u2009kg. Compared with IOM guidelines, study-derived ranges showed more favourable risk identification. In normal weight women, excessive GWG increased HDP risk (aOR 1.79, 95%\u2009CI 1.49 to 2.14); 13.57% versus 8.79%, AME 5.90 pp (95%\u2009CI 3.88 to 7.91 pp). In underweight women, inadequate GWG increased PROM (aOR 1.64, 95%\u2009CI 1.05 to 2.57); 14.48% versus 7.51%, AME 4.18 pp (95%\u2009CI 0.31 to 8.06 pp) and SGA (aOR 1.72, 95%\u2009CI 1.29 to 2.31); 45.58% versus 41.40%, AME 11.74 pp (95%\u2009CI 5.55 to 17.94 pp). In overweight women, excessive GWG increased HDP (aOR 1.81, 95%\u2009CI 1.21 to 2.70); 24.39% versus 16.32%, AME 9.68 pp (95%\u2009CI 2.49 to 16.88 pp) and inadequate GWG increased SGA (aOR 1.60, 95%\u2009CI 1.20 to 2.14); 35.15% versus 27.82%, AME 9.85 pp (95%\u2009CI CI 3.72 to 15.97 pp), which IOM failed to detect. In obese women, inadequate GWG increased SGA (aOR 2.76, 95%\u2009CI 1.37 to 5.53); 27.18% versus 17.16%, AME 17.95 pp (95%\u2009CI 5.74 to 30.17 pp), which was missed by IOM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings support adopting region-specific GWG standards for twin pregnancies in Asian populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-112189","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:05:17Z","timestamp":1780070717000},"page":"e112189","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Establishing population-specific gestational weight gain ranges for twin pregnancies and comparing their performance with IOM recommendations: a retrospective cohort study from central 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Health, School of Arts and Sciences, Tufts University, Medford, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China"},{"name":"Clinical Medical Research Center for Birth Defect Prevention and Treatment in Wuhan, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Qiu","sequence":"additional","affiliation":[{"name":"Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanzhou","family":"Peng","sequence":"additional","affiliation":[{"name":"Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical 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