Higher odds of gestational diabetes among women with multiple pregnancies: a nationwide register-based cohort study in Finland

Abstract

Introduction The association between multiple pregnancies and the risk of gestational diabetes mellitus (GDM) has been moderately studied. The aim of this study is to evaluate whether women with multiple pregnancies are at a higher risk of developing GDM using nationwide high-quality registers. Materials and methods In this retrospective cohort study, data from the National Medical Birth Register (MBR) was used to evaluate the odds of GDM as a result of multiple pregnancies. We included all pregnancies with a tested GDM recorded in the MBR between 2004 and 2018. A total of 397,810 pregnancies were included in this study. Logistic regression model was used to assess the odds for GDM among multiple pregnancies, when compared to singleton pregnancies. Odds ratios (ORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) between the groups were compared. The model was adjusted with maternal BMI and in vitro fertilisation (IVF) treatments. Results A total of 5825 multiple pregnancies and a tested GDM were observed. In the control group, there were 391,985 singleton pregnancies with a tested GDM. Of these, 1791 (30.7%) multiple pregnancies were associated with a diagnosis of GDM. GDM was more common among women with multiple pregnancies (30.7 vs. 25.9%, aOR 1.28; CI 1.21–1.36). Conclusion The results of this study show that women with multiple pregnancies have a higher odds of developing GDM and should be monitored to prevent the development of GDM.

Previous induced abortion or miscarriage is associated with increased odds for gestational diabetes: a nationwide register-based cohort study in Finland

“…The model was adjusted for covariates that were found to be risk factors for GDM based on the previous studies. The selected covariates included the following: maternal age, categorized maternal body mass index (BMI) using the WHO classification, maternal smoking status, IVF [ 4 ] and multiple pregnancies [ 5 ].…”

Characteristics of the oral glucose tolerance test in women with different pre-pregnancy body mass index and the effect of gestational diabetes mellitus on twin pregnancy outcomes

“…The simultaneous growth of two fetuses may cause a greater degree of endocrine and metabolic changes, increasing the possibility of glucose metabolism disorders. 10 The current study has shown that fasting, OGTT1h, and OGTT2h blood glucose levels in women with twin pregnancies are higher than in those with singleton pregnancies, suggesting blood glucose levels during the second trimester of twin pregnancy is higher than that in a singleton pregnancy. In terms of the overall incidence of GDM, the incidence of GDM in 1985 cases of twin pregnancy included in this study was 21.01%, which is close to the 20.4% reported in a previous study conducted in China.…”

Trends in the use for labor analgesia in twin pregnancies: A nationwide register-based analysis in Finland

“…Confounding factors, such as higher maternal age and body mass index, gestational diabetes, and a higher proportion of instrumental vaginal deliveries (possibly requiring more pain relief in advance) among women with twin pregnancies might partly explain the higher proportion [13] , but the aORs still showed markedly increased odds for epidural analgesia among women with twin pregnancies. However, according to a recent study in Finland, women with gestational diabetes, to which women with twins are at higher risk [14] , had no higher proportion for labor analgesia [15] .…”

“…The utilization of the DAG approach aids in the selection of covariates to be incorporated into conventional statistical methods, thereby minimizing the potential bias in the resulting estimate [12] . The variables incorporated into the DAGs were selected by considering established risk factors and hypothesized causal pathways [13] , [14] , [15] , [16] , [17] . DAGitty automatically provides suggested sets of adjustment variables that may impact the primary outcome.…”