Perinatal outcomes based on the institute of medicine guidelines for weight gain in twin pregnancies.

OBJECTIVE: To estimate the impact of the Institute of Medicine's (IOM) weight gain recommendations on perinatal outcomes in twin pregnancies. METHODS: In this multicenter cohort study, using the 2009 IOM guidelines, we examined pregnancy outcomes in 570 uncomplicated diamniotic twin pregnancies. Subjects were grouped according to pre-pregnancy body mass index. Perinatal outcomes were assessed based on whether maternal weekly weight gain was less than, at, or in excess of the recommended IOM guidelines. RESULTS: In women with a normal pre-pregnancy BMI, patients whose weight gain met the IOM recommendations had a significantly higher mean gestational age at delivery; less prematurity and larger birth weight infants compared to women whose weekly weight gain was less or excess than the recommended IOM guidelines. Similarly, when compared with their low weight gain counterparts, overweight women with appropriate weight gain had improved outcomes including higher mean gestational age at delivery, higher birth weight infants and less prematurity. In obese women, the amount of pregnancy weight gain did not impact perinatal outcomes. CONCLUSION: Our results confirm that weekly maternal weight gain according to the IOM guidelines results in improved outcomes in twin pregnancies. Importantly, women with a normal or overweight pre-pregnancy BMI whose weekly weight gain was less than recommended, had increased risks of prematurity and lower birth weight infants. Similarly, women with a normal pre-pregnancy BMI whose weekly weight gain was excess than recommended had increased risks of prematurity and lower birth weight infants.

Fetal hydronephrosis as a predictor of neonatal urologic outcomes.

OBJECTIVES: The ability to predict surgically relevant fetal renal hydronephrosis is limited. We sought to determine the most efficacious second- and third-trimester fetal renal pelvis anteroposterior diameter cutoffs to predict the need for postnatal surgery. METHODS: We retrospectively reviewed the medical records of mothers and neonates who had a prenatal sonographic examination in our Perinatal-Pediatric Urology Clinic and received follow-up care. Hydronephrosis was defined as a renal pelvis anteroposterior diameter of 5 mm or greater in the second trimester and 7 mm or greater in the third trimester. Hydronephrosis was subdivided into mild, moderate, and severe. RESULTS: Of 8453 fetuses, 96 met the criteria and were referred to our clinic. Isolated hydronephrosis was diagnosed in 74 fetuses, of which 53 received postnatal follow-up evaluations. The areas under the receiver operating characteristic curves for predicting postnatal surgery in the second and third trimesters were 0.770 and 0.899, respectively. The second-trimester renal anteroposterior diameter threshold that best predicted post-natal surgery was 9.5 mm (sensitivity, 71.4%; specificity, 81.1%). The third-trimester threshold that best predicted postnatal surgery was 15.0 mm (sensitivity, 85.7%; specificity, 94.6%). CONCLUSIONS: The fetal renal anteroposterior diameter on second- and third-trimester sonography is predictive of an increased risk for neonatal urologic surgery. Surgical risk is best predicted by a third-trimester renal anteroposterior diameter threshold of 15 mm.