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Maternal and pediatric nutrition

Association between pre-pregnancy BMI and neonatal weight outcomes in twin pregnancies resulting from assisted reproductive technology: a 10-year cohort study

European Journal of Clinical Nutrition volume 75, pages 1465–1474 (2021)Cite this article

Subjects

Abstract

Background/Objectives

To examine the effect of pre-pregnancy maternal body mass index (BMI) on neonatal weight outcomes of twin infants who were conceived by assisted reproductive technology (ART).

Subjects/Methods

A 10-year (2006–2015) Chinese sample of 3431 mothers and their twin infants conceived by ART from a retrospective cohort were included. The effects of pre-pregnancy maternal BMI on gestational age and birth weight were assessed by generalized linear model and generalized estimating equation model.

Results

Compared with a normal weight group, pre-pregnancy maternal underweight was associated with lower birth weight and increased risk of small for gestational age (SGA) in twins conceived by ART (birth weight: difference −59.22 g, 95% CI −93.16 to −25.27 g; SGA: RR 1.25, 95% CI 1.09 to 1.43). Pre-pregnancy maternal obesity was associated with higher birth weight and increased risk of preterm birth (birth weight: difference 65.82 g, 95% CI 10.66 to 120.99 g; preterm birth: RR 1.19, 95% CI 1.03–1.37). A nonlinear relationship between pre-pregnancy maternal BMI and SGA was observed. The risk of SGA decreased with the pre-pregnancy maternal BMI up to the turning point (BMI = 21) (RR 0.90, 95% CI 0.86–0.95).

Conclusions

Among mothers undergoing ART, pre-pregnancy maternal obesity is associated with higher birth weight and higher risk of preterm birth for twin pregnancy, and pre-pregnancy maternal underweight is associated with lower birth weight and higher risk of SGA. Women preparing for ART should maintain a normal BMI to lower the chances of adverse neonatal outcomes.

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Fig. 1: Dose–response relationship between the pre-pregnancy maternal BMI and SGA in twins.

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Acknowledgements

We thank the staff from Assisted Reproduction Center and Department of Obstetrics of Northwest Women’s and Children’s Hospital for their assistance with the data collection.

Funding

This research was supported by “the Fundamental Research Funds for the Central Universities” (China) (No. xzy012019116), the Key Research and Development Program of Shaanxi Province (No. 2020SF-031), and the National Natural Science Foundation of China (No. 81771657).

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Authors and Affiliations

  1. Translational Medicine Center, Northwest Women’s and Children’s Hospital, Xi’an, 710061, Shaanxi, People’s Republic of China

    Pengfei Qu, Doudou Zhao, Juanzi Shi & Wenhao Shi

  2. Assisted Reproduction Center, Northwest Women’s and Children’s Hospital, Xi’an, 710003, Shaanxi, People’s Republic of China

    Pengfei Qu, Doudou Zhao, Juanzi Shi & Wenhao Shi

  3. Departments of Pediatrics and Neonatology, Children’s Hospital of Fudan University, Shanghai, People’s Republic of China

    Pengfei Qu

  4. Department of obstetrics, Northwest Women’s and Children’s Hospital, Xi’an, 710003, Shaanxi, People’s Republic of China

    Yang Mi

  5. Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061, Shaanxi, People’s Republic of China

    Shaonong Dang

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  1. Pengfei Qu
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  2. Doudou Zhao
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Contributions

The authors’ contributions are as follows: PQ, WS, YM, and JS conceived and designed the study; PQ drafted the manuscript; WS and JS revised the manuscript; PQ and DZ collected and cleared the data. PQ, and SD analysed the data. All authors have approved the final version of the manuscript.

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Correspondence to Juanzi Shi or Wenhao Shi.

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Qu, P., Zhao, D., Mi, Y. et al. Association between pre-pregnancy BMI and neonatal weight outcomes in twin pregnancies resulting from assisted reproductive technology: a 10-year cohort study. Eur J Clin Nutr 75, 1465–1474 (2021). https://doi.org/10.1038/s41430-021-00862-0

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