Obstetric and perinatal outcome in women with twin pregnancy and gestational diabetes

Abstract

The presence of GDM in twin pregnancy was associated with a higher risk of hypertensive complications, prematurity and macrosomia, but significantly reduces the risk of SGA infants. Prematurity was related to the presence of other associated pregnancy complications.

Twin pregnancies complicated by gestational diabetes mellitus: a single centre cohort study

“…In terms of infant characteristics, the number of large for gestational age infants (using twin charts) decreased with a change in gestational diabetes screening, and there was no association found between gestational diabetes and large for gestational age. In some studies of twin pregnancies, women with gestational diabetes have been found to have higher rates of large for gestational age infants and Caesarean section . By contrast, an Israeli cohort study of twin pregnancies found no difference in Caesarean section rates in women with gestational diabetes compared with no gestational diabetes and a reduction in perinatal mortality in infants born to women with gestational diabetes , which is consistent with our study.…”

“…Women with twin pregnancies and gestational diabetes were found to have higher rates of hypertensive disorders, which is consistent with other studies . However, despite increased rates of gestational diabetes diagnoses with a change in gestational diabetes screening, there was no decrease in hypertensive disorders.…”

“…Although the rate of perinatal death doubled between epochs, we found that maternal gestational diabetes status was not associated with an increased rate of perinatal death, which is in keeping with findings from other studies of twin pregnancies . However, the increased mortality may be due to an increasing prevalence of known monochorionic twin pregnancies attending the hospital; the proportion of which doubled to one third of twin pregnancies from epoch 1 to epoch 2 (despite the larger proportion of unknown chorionicity in epoch 1), particularly with the establishment of the NSW Fetal Therapy Centre undertaking laser for twin‐to‐twin transfusion during this time .…”

“…Twin pregnancy is associated with adverse pregnancy outcomes, including an increased risk of gestational diabetes, pre‐eclampsia and preterm birth . Women with gestational diabetes and women with twin pregnancies frequently have shared risk factors, including older maternal age, obesity, polycystic ovarian syndrome, and the use of assisted reproductive technology . It is uncertain how much gestational diabetes exacerbates the underlying maternal or fetal risks associated with a twin pregnancy.…”

Application of Customized Birth Weight Curves in the Assessment of Perinatal Outcomes in Infants of Diabetic Mothers

“…Many population-based studies evaluating women with pregestational diabetes mellitus (DM) have reported large-for-gestational age (LGA) rates as high as 28-45% [1,3,4] in both type 1 and 2 DM [5]. Among women with gestational DM, the percentage of neonates diagnosed as LGA is also increased by 15-20% [6,7], even in twin pregnancies [8], and the rate of SGA is much lower, around 3 and 2% for type 1 and 2 DM, respectively [5]. …”