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Background: There is limited evidence regarding optimal gestational weight gain in women with twin pregnancies and gestational diabetes mellitus., Objective: This study aimed to examine the association between gestational weight gain and perinatal outcomes among women with gestational diabetes mellitus and twin pregnancies and to explore the gestational weight gain targets by prepregnancy body mass index category., Study Design: A national population-based cohort study of twin pregnancies with gestational diabetes mellitus was conducted between 2014 and 2020. Women with gestational diabetes mellitus aged between 18 and 45 years with live-born twins without congenital malformations between 24 and 42 weeks of gestation were included in the analysis. Two approaches were used to determine the optimal gestational weight gain targets by body mass index category: an interquartile range method to calculate targets in low-risk gestational diabetes mellitus pregnancies and a logistic model method to identify the odds ratio targets at which a composite adverse outcome decreased., Results: Of 29,308 women with gestational diabetes mellitus and twin pregnancies, 8239 (28.1%) were normal-weight, 7626 (26.0%) were overweight, and 13,443 (45.9%) were obese. The continuous standardized gestational weight gain by 36 weeks was associated with preterm birth <36 weeks, large-for-gestational-age infants, small-for-gestational-age infants, and gestational hypertensive disorders. The interquartile range targets were 13.6 to 20.9 kg, 10.9 to 20.4 kg, and 7.7 to 17.7 kg for normal-weight, overweight, and obese women, respectively. The odds ratio targets were 14.1 to 20.0 kg, 12.1 to 16.0 kg, and 6.1 to 12.0 kg for normal-weight, overweight, and obese women, respectively. Gestational weight gain outside these targets was associated with preterm birth <36 weeks, large-for-gestational-age and small-for-gestational-age infants, and gestational hypertensive disorders, and exhibited significant population attributable fractions for preterm birth <36 weeks, large-for-gestational-age infants, and gestational hypertensive disorders across body mass index categories., Conclusion: Compared with the Institute of Medicine guidelines, more stringent gestational weight gain targets would be beneficial for improved perinatal outcomes in women with gestational diabetes mellitus and twin pregnancies., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Gestational weight gain (GWG) has been understudied among twin pregnancies. This systematic review aimed to review the data on the associations between GWG, based on the 2009 Institute of Medicine (IOM) guidelines and pregnancy outcomes among twin gestations., Methods: A systematic review was performed according to the PRISMA guidelines. A search for eligible studies published from January 2010 to August 2020 was conducted in the EMBASE, PubMed, Web of Science, ScienceDirect, and Cochrane databases. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Data on study characteristics and main findings were extracted independently by two reviewers using a standard form. Outcomes of interest included (spontaneous) preterm birth (PTB), gestational hypertensive disorder (gestational hypertension and eclampsia), and small for gestational age (SGA)., Results: Eighteen observational studies of twin gestations met the inclusion criteria. GWG below the IOM recommendations was reported to be associated with increased PTB and SGA while GWG above the recommendation was associated with increased gestational hypertensive disorder. However, the results were inconsistent. Methodological limitations, such as a retrospective design, the use of weekly GWG, a small sample size and insufficient adjustment, impeded the clarification of the association between GWG and perinatal outcomes. In addition, the optimal GWG for underweight women was not fully studied., Conclusions: The maintenance of weight gain within the 2009 IOM guidelines would decrease the risks of adverse outcomes among twin pregnancies. However, rigorous studies are warranted to provide robust evidence to refine the optimal GWG among twin gestations.