Does Gestational Diabetes Cause Additional Risk in Twin Pregnancy?

Abstract

It has been suggested that the risk of adverse perinatal outcomes in twin pregnancies is exacerbated by concomitant gestational diabetes mellitus (GDM). This study aimed to assess the risk incurred by twin pregnancy and by a diagnosis of GDM, separately, on the development of poor perinatal outcomes. A retrospective cohort study was conducted on all pregnant women at a tertiary center between 2016 and 2017. The impact of GDM and twin pregnancies on perinatal outcomes — birth weight above the 90th centile for gestational age, cesarean delivery, clinical neonatal hypoglycemia, and premature delivery (before 37 weeks’ gestation) — was assessed using univariate and multivariate analyses. Overall, 13,527 women were eligible for the study; 11,915 were uncomplicated singleton pregnancies; 1379 of these had GDM; 194 were twin pregnancies, and 39 of these had GDM. Univariate analyses showed that twin pregnancies were associated with a higher risk of all perinatal outcomes except macrosomia. In the multivariate analyses, twin pregnancy was a much higher predictor of cesarean delivery (OR 8.40, 95% CI [6.25, 11.49], p < .0001) and preterm birth (OR 58.82, 95% CI [31.25, 125], p < .0001) compared to GDM but GDM was a higher predictor of neonatal hypoglycemia (OR 4.87, 95% CI [3.74, 6.29], p < .0001). Twin pregnancy is more strongly associated with all adverse perinatal outcomes except macrosomia. GDM does not increase risk of adverse perinatal outcomes except for neonatal hypoglycemia.

Risk factors and adverse maternal and perinatal outcomes for women with dichorionic twin pregnancies complicated by gestational diabetes mellitus: A retrospective cross‐sectional study

“…Studies that focused on the effects of GDM in twin pregnancies on perinatal outcomes presented even more conflicting results. In some studies, the rates of preterm birth 4,7,10 , LGA 7,8,10,12 , macrosomia 4,7 , birth trauma 7 , perinatal death 7 , neonatal jaundice 10 , respiratory distress 13,14 and neonatal intensive care unit (NICU) admission 3,9,14 were higher in women with GDM with twin pregnancies than in those without GDM; on the contrary, other studies found no differences in most major perinatal outcomes, such as preterm birth 6,9,15 , LGA 5,9,11,15 , low 5‐min Apgar score (<7) 9,15 and perinatal death 9,15,16 between GDM and non‐GDM twins. Some studies even revealed better outcomes, along with reducing risk for small‐for‐gestational age (SGA) infants, preterm birth <32 gestational weeks, low 5‐min Apgar score and perinatal mortality 6,17 .…”

“…Therefore, clinicians require not only updated, but consistent information to counsel and manage these patients. Second, prior studies were mainly carried out on American and European populations [3][4][5][6][7][8][9][10][11][12][13][14]16,17,[20][21][22] , whereas only one was on Asian women 15 . Third, our recent study showed that risk factors for GDM women with singleton pregnancies included maternal age >34 years, pre-pregnancy body mass index (BMI) >24.9 kg/m 2 , a prior history of fetal death, chronic hypertension, genetic amniocentesis and artificial reproductive technology 23 .…”

Perinatal outcomes in twin pregnancies complicated by gestational diabetes

“…10,13,14 The existing literature of perinatal outcomes of twin pregnancies complicated by gestational diabetes has yielded mixed results. 11,12,[15][16][17][18][19][20][21][22][23][24] Some studies have demonstrated an increased risk of preeclampsia in twin pregnancies complicated by gestational diabetes. 11,15,16,18 Others have not found such a relationship.…”

“…12,17 The impact on fetal growth and risk of small or large for gestational age (LGA) has similarly been inconsistent. 12,[19][20][21][22][23][24] The published studies on gestational diabetes in twin pregnancies have a number of limitations that might contribute to these disparate findings. First, many studies lack information about important confounders such as pre-pregnancy body mass index and chorionicity.…”

Vaginal Progesterone Has No Diabetogenic Potential in Twin Pregnancies: A Retrospective Case-Control Study on 1686 Pregnancies

“…However, the incidence of GDM may be even greater in twin gestations, a known independent risk factor for GDM [ 37 ]. Of note, a wide range (7–20%) of GDM has been reported for twin pregnancies in the literature [ 28 , 38 , 39 , 40 ] and the risk of developing GDM was always increased compared to singleton pregnancies.…”