A new care pathway to optimize gestational weight gain in twin pregnancies

Abstract

Background: Maternal gestational weight gain is an important determinant of pregnancy outcomes and may have an even greater role in twin pregnancies because of their higher rate of pregnancy complications and greater nutritional demands. However, data on the optimal week-specific gestational weight gain in twin pregnancies and on interventions that should be applied in cases of inadequate gestational weight gain are limited.

Objective: This study aimed to determine whether a new care pathway that involves monitoring gestational weight gain using a week-specific chart, along with a standardized protocol for managing cases with inadequate gestational weight gain, can optimize maternal gestational weight gain in twin pregnancies.

Methods: In this study, patients with twin pregnancies followed in a single tertiary center between February 2021 and May 2022 were exposed to the new care pathway (postintervention group). Gestational weight gain and clinical outcomes were compared with those of a previously described cohort of patients with twins followed in our clinic before the implementation of the new care pathway (preintervention group). The new care pathway targeted patients and care providers and included educational material, a newly developed body mass index group-specific gestational weight gain chart, and a stepwise management algorithm in cases of inadequate gestational weight gain. The body mass index group-specific gestational weight gain charts were divided into 3 zones: (1) green zone (optimal gestational weight gain at 25th-75th centiles); (2) yellow zone (suboptimal gestational weight gain at 5th-24th or 76th-95th centiles); and (3) gray zone (abnormal gestational weight gain, at <5th or >95th centile). The primary outcome was the overall proportion of patients achieving optimal gestational weight gain at birth.

Results: A total of 123 patients were exposed to the new care pathway and were compared with 1079 patients from the preintervention period. Patients in the postintervention group were more likely to achieve optimal gestational weight gain at birth (60.2% vs 47.7%; adjusted odds ratio, 1.91; 95% confidence interval, 1.28-2.86) and were less likely to achieve low-suboptimal gestational weight gain (7.3% vs 14.7%; adjusted odds ratio, 0.41; 95% confidence interval, 0.20-0.85) or any suboptimal gestational weight gain (26.8% vs 34.8%; adjusted odds ratio, 0.60; 95% confidence interval, 0.39-0.93) at birth. In addition, patients in the postintervention group were less likely to have low-abnormal gestational weight gain anytime during gestation (18.9% vs 29.1%; P=.017) and were more likely to have normal gestational weight gain throughout pregnancy (21.3% vs 14.0%; P=.031) or high-abnormal gestational weight gain anytime during gestation (18.0% vs 11.1%; P=.025), suggesting that in comparison with standard care, the new care pathway is more effective in preventing patients from moving into the low-abnormal zone than the high-abnormal zone. Furthermore, the new care pathway was more effective than standard care in correcting high-suboptimal gestational weight gain and high-abnormal gestational weight gain.

Conclusion: Our findings suggest that the new care pathway may be effective in optimizing maternal gestational weight gain in twin gestations, which may in turn contribute to better clinical outcomes. This is a simple, low-cost intervention that can be easily disseminated among providers caring for patients with twin pregnancies.

Keywords: chart; multifetal; nomogram; optimal; protocol; target; twin; weight gain.