Gestational weight gain in triplet pregnancies in the United States

The Institute of Medicine has published national recommendations for optimal pregnancy weight gain ranges for singletons and twins but not for higher-order multiples. A common clinical resource suggests weight gain targets for triplet pregnancies, but they are based on a single, small study conducted over 20 years ago.

We sought to describe contemporary maternal weight gain patterns in triplet gestations in the United States, the weight gain patterns associated with good neonatal outcomes, and how these patterns compare with those of healthy twin pregnancies.

We used data from 7705 triplet pregnancies drawn from the United States live birth and fetal death files (2012‒2018). We calculated total pregnancy weight gain as weight at delivery minus the prepregnancy weight. A good neonatal outcome was defined as delivery at ≥32 weeks' gestation of 3 liveborn infants weighing ≥1500 g with 5-minute Apgar scores of ≥3. We described the weight gain patterns of triplet pregnancies with good neonatal outcomes by calculating week-specific percentiles of the total weight gain distribution for deliveries at 32 to 37 weeks' gestation. For comparative purposes, we plotted these values against the percentiles of a previously published weight gain chart for monitoring and evaluating twin pregnancies from a referent cohort.

Most participants were over weight (26%) or obese (30%), and 42% were normal weight or underweight. The 50th percentile (25th-75th) of total weight gain in triplet pregnancies was 17 (11-23) kg. As the body mass index category increased, the total weight gain declined: underweight or normal weight, median 19 (14-25) kg; overweight, 17 (12-23) kg; obese, 14 (7.7-20) kg. Approximately 46% of triplet pregnancies had a good neonatal outcome (n=3562). For underweight or normal weight triplet pregnancies with good neonatal outcomes, the 50th percentiles of weight gain at 32 weeks' and 36 weeks' gestation were 12.3 kg and 22.7 kg, respectively. The 10th and 90th percentiles were 12.3 kg and 32.7 kg, respectively, at 32 weeks, and 15.0 kg and 34.1 kg, respectively, at 36 weeks. Triplet pregnancies with prepregnancy overweight or obesity and a good neonatal outcome had lower weight gains. Compared with the reference values for pregnancy weight gain from a twin-specific weight gain chart, the median total weight gain in triplet pregnancies with good neonatal outcomes was approximately 3 to 5 kg more than twins, regardless of body mass index.

Our study fills an important gap in understanding how much weight gain can be expected among triplet pregnancies by body mass index category. These descriptive data are a necessary first step to inform science-based triplet gestational weight gain guidelines. Additional research is needed to determine whether monitoring triplet pregnancy weight gain is useful for promoting healthy outcomes for pregnant individuals and children and what targets should be used to optimize maternal and neonatal health.