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Wierzejska RE. Review of Dietary Recommendations for Twin Pregnancy: Does Nutrition Science Keep Up with the Growing Incidence of Multiple Gestations? Nutrients 2022; 14:1143. [PMID: 35334799 PMCID: PMC8953105 DOI: 10.3390/nu14061143] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
Recommendations for nutrition and the use of dietary supplements for pregnant women are updated on regular basis but it remains to be seen to what extent they may be applicable in twin pregnancies. The aim of this narrative review is to present the current state of knowledge about the energy and nutrient demand in twin pregnancy. There is general consensus in literature that the energy demand is higher than in a singleton pregnancy, but there is a lack of position statements from scientific societies on specific energy intake that is required. In turn, recommended maternal weight gain, which favors the normal weight of the neonate, has been determined. There is even a larger knowledge gap when it comes to vitamins and minerals, the body stores of which are theoretically used up faster. The greatest number of studies so far focused on vitamin D, and most of them concluded that its concentration in maternal blood is lower in twin as compared to singleton pregnancy. Few randomized studies focus on iron supplementation and there are no other studies that would assess dietary interventions. In light of a growing incidence of multiple pregnancies, more studies are necessary to establish the nutritional demands of the mother and the course of action for adequate supplementation.
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Affiliation(s)
- Regina Ewa Wierzejska
- Department of Nutrition and Nutritional Value of Food, National Institute of Public Health NIH-National Research Institute, Chocimska St. 24, 00-791 Warsaw, Poland
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Isaacson A, Diseko M, Mayondi G, Mabuta J, Davey S, Mmalane M, Makhema J, Jacobson DL, Luckett R, Shapiro RL, Zash R. Prevalence and outcomes of twin pregnancies in Botswana: a national birth outcomes surveillance study. BMJ Open 2021; 11:e047553. [PMID: 34675010 PMCID: PMC8532549 DOI: 10.1136/bmjopen-2020-047553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aims to evaluate the prevalence and outcome of twin pregnancies in Botswana. SETTING The Tsepamo Study conducted birth outcomes surveillance at 8 government-run hospitals (~45% of all births in Botswana) from August 2014 to June 2018 and expanded to 18 hospitals (~70% of all births in Botswana) from July 2018 to March 2019. PARTICIPANTS Data were collected for all live-born and stillborn in-hospital deliveries with a gestational age (GA) greater than 24 weeks. This analysis included 117 593 singleton and 3718 twin infants (1859 sets (1.6%)) born to 119 477 women between August 2014 and March 2019 and excluded 73 higher order multiples (23 sets of triplets and 1 set of quadruplets). OUTCOMES MEASURED Our primary outcomes were preterm delivery (<37 weeks GA), very preterm delivery (<32 weeks GA) and stillbirth (APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score of 0, 0, 0). RESULTS Women with twin pregnancies had a similar median number of antenatal care visits (9 vs 10), but were more likely to deliver in a tertiary centre (54.8% vs 45.1%, p<0.001) and more likely to have a cesarean-section (54.6% vs 22.0%, p<0.001) than women with singletons. Compared with singletons, twin pregnancies had a higher risk of preterm delivery (<37 weeks GA) (47.6% vs 16.7%, adjusted risk ratio (aRR) 2.8, 95% CI 2.7 to 2.9) and very preterm delivery (<32 weeks) (11.8% vs 4.0%, aRR 3.0 95% CI 2.6 to 3.4). Among all twin pregnancies, 128 (6.9%) had at least one stillborn infant compared with 2845 (2.4%) stillbirths among singletons (aRR 2.8, 95% CI 2.3 to 3.3). CONCLUSION Adverse birth outcomes are common among twins in Botswana, and are often severe. Interventions that allow for earlier identification of twin gestation and improved antenatal management of twin pregnancies may improve infant and child survival.
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Affiliation(s)
- Arielle Isaacson
- Harvard Medical School, Boston, Massachusetts, USA
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Modiegi Diseko
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Gloria Mayondi
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Judith Mabuta
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Sonya Davey
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mompati Mmalane
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Denise L Jacobson
- Center for Biostatistics and AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Luckett
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Roger L Shapiro
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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The relationship between maternal body mass index and pregnancy outcomes in twin compared with singleton pregnancies. Int J Obes (Lond) 2019; 44:33-44. [PMID: 30992520 DOI: 10.1038/s41366-019-0362-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/22/2019] [Accepted: 03/10/2019] [Indexed: 11/08/2022]
Abstract
OBJECIVE Women with twins have an a priori increased risk for many of the complications associated with maternal obesity. Thus, the impact of maternal obesity in twins may differ from that reported in singletons. In addition, given the increased metabolic demands in twin pregnancies, the impact of maternal underweight may be greater in twin compared with singleton gestations. Our objective was to test the hypothesis that the relationship between maternal pre-pregnancy body mass index (BMI) and adverse pregnancy outcomes differ between twin and singleton gestations. METHODS This was a retrospective population-based study of all women who had a singleton or twin hospital birth in Ontario, Canada, between April 2012 and March 2016. Data were obtained from the Better Outcomes Registry & Network (BORN) Ontario. The relationship between maternal BMI category and pregnancy complications was assessed separately in twin and singleton gestations. The primary outcome was a composite variable that included any of the following complications: preeclampsia, gestational diabetes, or preterm birth before 320/7 weeks. Relative risk (aRR) and 95% confidence intervals (CI) for adverse outcomes for each BMI category as defined by WHO (using normal weight category as reference) were generated using modified Poisson regression, adjusting for maternal age, nulliparity, smoking, previous preterm birth, and fetal sex. RESULTS A total of 487,870 women with singleton (n = 480,010) and twin (n = 7860) pregnancies met the inclusion criteria. The risk of the composite primary outcome, preeclampsia, gestational diabetes, and cesarean delivery increased with high maternal BMI in both singleton and twin gestations, but these associations were weaker in twin compared with singleton gestations (association of BMI ≥ 40.0 kg/m2 with primary outcome: aRR = 3.10, 95%-CI 2.96-3.24 in singletons compared with aRR = 1.74, 95%-CI 1.37-2.20 in twins). In singleton pregnancies the risk of preterm birth at < 320/7 weeks increased with maternal BMI, mainly due to an increased risk of provider-initiated preterm birth. In twin gestations, however, underweight (but not overweight or obesity) was associated with the greatest risk of preterm birth at < 32 weeks (aRR 1.67, 95%-CI 1.17-2.37), mainly due to an increased risk of spontaneous preterm birth (aRR 2.10, 95%-CI 1.44-3.08). CONCLUSION In healthy women with twin pregnancies, underweight is associated with the greatest risk for preterm birth, while the association of maternal obesity with adverse pregnancy outcomes is weaker than that observed in singletons.
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Regan AK, Gissler M, Magnus MC, Håberg SE, Ball S, Malacova E, Nassar N, Leonard H, Pereira G. Association between interpregnancy interval and adverse birth outcomes in women with a previous stillbirth: an international cohort study. Lancet 2019; 393:1527-1535. [PMID: 30827781 DOI: 10.1016/s0140-6736(18)32266-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/27/2018] [Accepted: 09/07/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND WHO recommends that women wait at least 2 years after a livebirth and at least 6 months after a miscarriage or induced abortion before conceiving again, to reduce the risk of adverse birth outcomes in the subsequent pregnancy. No recommendation exists for the optimal interval after a stillbirth. We investigated the association between interpregnancy interval after stillbirth and birth outcomes in the subsequent pregnancy. METHODS In this international cohort study, we used data from birth records from Finland (1987-2016), Norway (1980-2015), and Western Australia (1980-2015). Consecutive singleton pregnancies in women whose most recent pregnancy had ended in stillbirth of at least 22 weeks' gestation were included in the analysis. Interpregnancy interval was defined as the time between the end of pregnancy (delivery date) and the start of the next pregnancy (delivery date of next pregnancy minus gestational age at birth). We calculated odds ratios (ORs) for stillbirth, preterm birth, and small-for-gestational-age birth by interpregnancy interval by country, adjusted for maternal age, parity, decade of delivery, and gestational length of the previous pregnancy. A fixed-effects meta-analysis was used to estimate pooled ORs. FINDINGS We identified 14 452 births in women who had a stillbirth in the previous pregnancy; median interpregnancy interval after stillbirth was 9 months (IQR 4-19). 9109 (63%) women conceived within 12 months of the stillbirth. Of the 14 452 births, 228 (2%) were stillbirths, 2532 (18%) were preterm births, and 1284 (9%) were small-for-gestational-age births. Compared with an interpregnancy interval of 24-59 months, intervals shorter than 12 months were not associated with increased odds of subsequent stillbirth (pooled adjusted OR 1·09 [95% CI 0·63-1·91] for <6 months; 0·90 [0·47-1·71] for 6-11 months), preterm birth (0·91 [0·75-1·11] for <6 months; 0·91 [0·74-1·11] for 6-11 months), or small-for-gestational-age birth (0·66 [0·51-0·85] for <6 months; 0·64 [0·48-0·84] for 6-11 months). Further, we noted no difference in the association between interpregnancy interval and birth outcomes by gestational length of the previous stillbirth. INTERPRETATION Conception within 12 months of a stillbirth was common and was not associated with increased risk of adverse outcomes in the subsequent pregnancy. These findings could be used when counselling women who are planning future pregnancies after a stillbirth and for informing future recommendations for pregnancy spacing in a high-income setting. FUNDING National Health and Medical Research Council (Australia), and Research Council of Norway.
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Affiliation(s)
- Annette K Regan
- School of Public Health, Curtin University, Perth, WA, Australia.
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland; Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Maria C Magnus
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Department of Population Health Sciences, Bristol Medical School, Bristol, UK; Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Siri E Håberg
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Stephen Ball
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - Eva Malacova
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Natasha Nassar
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, NSW, Australia
| | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, WA, Australia
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Abstract
The nutritional status of a woman during pregnancy and lactation is not only critical for her health but for future generations. Although a nutritionist or registered dietitian can help facilitate dietary counseling and interventions, physicians also need to be cognizant of nutritional needs during pregnancy because they differ significantly compared with nonpregnant populations. Furthermore, an individualized approach to nutritional counseling that considers a woman's nutritional status and body mass index is recommended.
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Affiliation(s)
- Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2175, Chicago, IL 60611, USA.
| | - Priya Rajan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2175, Chicago, IL 60611, USA
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Marangoni F, Cetin I, Verduci E, Canzone G, Giovannini M, Scollo P, Corsello G, Poli A. Maternal Diet and Nutrient Requirements in Pregnancy and Breastfeeding. An Italian Consensus Document. Nutrients 2016; 8:E629. [PMID: 27754423 PMCID: PMC5084016 DOI: 10.3390/nu8100629] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/19/2016] [Accepted: 10/08/2016] [Indexed: 12/11/2022] Open
Abstract
The importance of lifestyle and dietary habits during pregnancy and breastfeeding, for health of mothers and their offspring, is widely supported by the most recent scientific literature. The consumption of a varied and balanced diet from the preconceptional period is essential to ensure both maternal well-being and pregnancy outcomes. However, the risk of inadequate intakes of specific micronutrients in pregnancy and lactation is high even in the most industrialized countries. This particularly applies to docosahexaenoic acid (DHA), iron, iodine, calcium, folic acid, and vitamin D, also in the Italian population. Moreover, the risk of not reaching the adequate nutrient supply is increased for selected groups of women of childbearing age: those following exclusion diets, underweight or overweight/obese, smokers, adolescents, mothers who have had multiple or close pregnancies, and those with previous unfavorable pregnancy outcomes.
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Affiliation(s)
| | - Irene Cetin
- Department of Mother and Child Hospital Luigi Sacco, Center for Fetal Research Giorgio Pardi, Department of Biomedical and Clinical Sciences University of Milan-Italian Society of Perinatal Medicine (SIMP), Milano 20157, Italy.
| | - Elvira Verduci
- Department of Pediatrics, Department of Health Sciences, San Paolo Hospital, University of Milan-Italian Society of Pediatrics (SIP), Milano 20142, Italy.
| | - Giuseppe Canzone
- Obstetrics and Gynecology Unit, S. Cimino Hospital-Italian Society of Gynecology and Obstetrics (SIGO), Termini Imerese, Palermo 90018, Italy.
| | - Marcello Giovannini
- Department of Pediatrics, San Paolo Hospital, Department of Health Science, University of Milan-Italian Society of Pediatric Nutrition (SINUPE), Milano 20142, Italy.
| | - Paolo Scollo
- Division of Gynecology and Obstetrics, Maternal and Child Department, Cannizzaro Hospital-Italian Society of Gynecology and Obstetrics (SIGO), Catania 95126, Italy.
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo-Italian Society of Pediatrics (SIP), Palermo 90127, Italy.
| | - Andrea Poli
- NFI-Nutrition Foundation of Italy, Milano 20124, Italy.
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Simões T, Queirós A, Correia L, Rocha T, Dias E, Blickstein I. Gestational diabetes mellitus complicating twin pregnancies. J Perinat Med 2011; 39:437-40. [PMID: 21728916 DOI: 10.1515/jpm.2011.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare outcomes of twin pregnancies with and without gestational diabetes mellitus (GDM). STUDY DESIGN We compared 105 twin pregnancies with GDM (7.8% of all twin pregnancies) to 315 controls without GDM, matched for gestational age, chorionicity and year of birth. RESULTS Pre-gravid obesity appears to predispose women to GDM during twin pregnancy [odds ratio (OR) 3.5; 95% confidence interval (CI) 1.7, 7.0]. Overweight and obese women that subsequently developed GDM during their twin gestation were less likely to conceive spontaneously (OR 0.4; 95% CI 0.3, 0.7). Twins from the GDM group had more respiratory distress syndrome (RDS, OR 2.2; 95% CI 1.3, 3.7) and had a three-fold, but not significantly increased perinatal mortality rate. Birth weight characteristics were similar in both groups. CONCLUSION Twin pregnancies complicated by GDM might be associated with pre-pregnancy maternal obesity and are at increased risk of RDS and non-significant increased risk of perinatal death.
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Affiliation(s)
- Teresinha Simões
- Department of Maternal-Fetal Medicine and Maternity Dr. Alfredo da Costa, Lisbon, Portugal
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Abstract
Nutritional concerns in pregnancy are gaining increasing importance as problems with obesity, poor nutrition, and improper weight gain during pregnancy have been shown to result in morbidity for mother and infant during the pregnancy. More recent studies show that the impact of poor nutrition in pregnancy extends for decades to follow for the mother and the offspring. Clearly, prevention of problems is the best approach. This article discusses aspects of, and controversies concerning, prenatal weight gain and specific nutrients, and special patient groups who may benefit from intervention by a registered dietitian.
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Affiliation(s)
- Jean T Cox
- Department of Obstetrics & Gynecology, University of New Mexico, Albuquerque, NM 87131, USA.
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Severine AN, Nóbrega FJD, Juliano Y, Novo NF. Medida de energia total do leite materno de mães de trigêmeos, gêmeos e filhos únicos. REVISTA PAULISTA DE PEDIATRIA 2008. [DOI: 10.1590/s0103-05822008000200010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Comparar a energia total do leite materno de mães de trigêmeos, gêmeos e filhos únicos. MÉTODOS: Estudo transversal e controlado feito com mães usuárias do banco de leite do Hospital Israelita Albert Einstein. Foram analisadas seis amostras de leite materno de mães de trigêmeos, 13 de gêmeos e 17 de filhos únicos, coletadas sob paramentação, conforme normas técnicas da Rede Brasileira de Bancos de Leite Humano. A análise foi realizada por meio do teste de crematócrito e os resultados submetidos à análise de variância de Kuskal-Wallis. RESULTADOS: A energia total do leite materno de mães de trigêmeos apresentou mediana de calorias maior (651kcal/L), quando comparada à do leite de mães de filhos únicos (560kcal/L) (p<0,05). O leite das mães de gêmeos e o de mães de filhos únicos não foram diferentes. Os trigêmeos apresentaram peso ao nascer menor (mediana 1344g) em relação aos filhos únicos (1975g) (p<0,01). Não foi observada diferença estatística em relação à idade gestacional e à idade materna entre os três grupos de neonatos. CONCLUSÕES: Pode-se concluir que o presente estudo, o primeiro na literatura sobre o tema, apontou para a presença de maior valor de energia total no leite de mães de recém-nascidos trigemelares. Futuros estudos são necessários para elucidar os mecanismos envolvidos nesse achado.
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Abstract
The experience of expecting and parenting multiples is decidedly different from that of a singleton pregnancy and parenthood. Multiple births are associated with substantial medical, health care, socio-emotional, developmental, educational and economic consequences for both families and society. This paper aims to advise health professionals on how best to help families prepare for and successfully respond to the demands of multiple pregnancy and the first 5 years of parenthood after the births of twins, triplets or more. Four inter-related principles of good practice are vital to the care of multiple birth families: the involvement of a range of disciplines, of the family and of the multiple birth community; the provision of specialised care; coordinated services; and the building of family competency including the capacity to make informed decisions. Preparation should include education on the special aspects of multiple pregnancy and parenting using multiples-focused resources, health promotion and risk modification strategies, infant care and feeding, child development and advice on securing help and support while ensuring family participation in all care decisions.
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Affiliation(s)
- Linda G Leonard
- University of British Columbia, School of Nursing, Multiple Births Support Program, Vancouver, Canada.
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