Risk Factors for Medical Management of Gestational Diabetes in Twin Pregnancies [35D]

Abstract

INTRODUCTION: Approximately 20–30% of singleton pregnancies affected by gestational diabetes (GDM) require medical management to achieve euglycemia (MMAE). We sought to identify the rate of and risk factors for MMAE in twin pregnancies with GDM. METHODS: We conducted a retrospective cohort study of all twin deliveries from 2005–2013 at Magee-Womens Hospital. Monochorionic monoamniotic twins were excluded. Data were obtained from a perinatal database, chart abstraction, and placental review. GDM was defined using Carpenter-Coustan Criteria or a 1-hour 50 gram Glucola equal/over 180 mg/dL. MMAE for GDM was classified as use of insulin or an oral agent. Prepregnancy obesity, parity, chorionicity, insurance product, advanced maternal age, and in vitro fertilization (IVF) were examined as risk factors. Univariate and multivariable logistic regression were performed. RESULTS: 1,872 twin pregnancies were included in the cohort—79.3% were dichorionic, 30.8% of women were obese, 17.7% conceived with IVF and the average age was 30 years (+/-5.9 y). The overall rate of GDM was 6.1% (n=114) with 59.2% (n=67) requiring MMAE. Among the MMAE cohort, 50.7% were obese, 38.85% were 35 years or older, and 31.3% had conceived with IVF. Only prepregnancy obesity was a risk factor for MMAE (OR 2.3, 95% CI 1.1, 5.0). This remained significant when controlling for maternal age, IVF use, and insurance status (aOR 2.2, 95% CI 1.0, 5.2). CONCLUSION: MMAE seems twice as common in twin versus singleton gestations. Over half of GDM twin gestations required MMAE, and maternal prepregnancy obesity was predictive. This highlights the need for further studies to help risk stratify patients.