Strengths and limitations
This study contributes to the still small range of studies on the effects of obesity and overweight on fetomaternal outcomes in twin pregnancies. By analyzing the outcomes wound healing disorders, uterine atony, postpartum hemorrhage, and asphyxia, four topics were included, which have not yet been addressed frequently or at all in studies on the impact of maternal weight on twin pregnancies. Many studies are conducted analyzing the impact of obesity in general. In this study, obesity has been analyzed further by subdividing this weight group into the three obesity classes as defined by the WHO, allowing a more detailed view on their impacts on fetomaternal outcomes in twin pregnancies. Furthermore, underweight mothers and their offspring were analyzed as well, their risk in twin pregnancies also only being topic to few studies.
The limitations include the retrospective nature of the study. The study population is comparatively small, which might explain why some of the results were not significant in contrast to findings of other similar studies. Furthermore, no statistical analyses to adjust for confounding variables have been performed. The Buergerhospital Frankfurt being a tertiary referral center with the second highest birth rate in Germany and a specialization on multiple pregnancies and their complications, might bias the rates of pregnancy and postpartum complications.