Is Gestational Diabetes Associated with Adverse Pregnancy Outcomes in Women with Twin Pregnancies? - DOH-Net
The Diabetes, Obesity and Hypertension in Pregnancy Research Network (DOH-Net) is a multi-disciplinary research team of obstetrical, midwifery and maternal-fetal medicine specialists.
DOH-Net, research, diabetes, hypertension, obesity, pregnancy, gestational diabetes, diabetes, obesity and hypertension in pregnancy research network, Sunnybrook Health Sciences Centre, St. Michael's Hospital, McMaster University, obstetrics, midwife, maternal-fetal medicine, specialists, researchers, Toronto, Ontario, Canada, Hamilton, Greater Toronto Area, GTA
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Is Gestational Diabetes Associated with Adverse Pregnancy Outcomes in Women with Twin Pregnancies?

Background: Gestational diabetes mellitus (GDM) is associated with adverse outcomes in singleton pregnancies. However, in twin pregnancies, some of these adverse outcomes may be either less clinically relevant due to the earlier gestational age at birth (e.g., macrosomia and shoulder dystocia) or may be common irrespective of GDM (e.g., preeclampsia, caesarean delivery and hypoglycemia). Objective: To test the hypothesis that the association of GDM with adverse pregnancy outcomes is weaker in twin compared with singleton gestations using a large population-based cohort. Methods: We conducted a retrospective cohort study of all women with a twin or singleton pregnancy who gave birth in Ontario, Canada between 2012-2016. Data were obtained from the Better Outcomes Registry & Network Ontario database. Pregnancy outcomes were compared between women with and without GDM separately for twins and singletons. Risk ratios (RR) and 95% confidence intervals (CI) for adverse pregnancy outcomes in women with GDM (using women without GDM as reference) were generated using a modified Poisson regression analysis for twins and singletons. Results: Of the 270,843 women who met inclusion criteria, 266,942 and 3,901 women had a singleton and a twin pregnancy, respectively. The incidence of GDM was 8.3% in twins and 6.3% in singletons. In both the twin and singleton groups, women with GDM had an increased risk (aRR [95%CI]) of cesarean delivery (1.11 [1.02-1.21] and 1.20 [1.17-1.23], respectively) and preterm birth at <370/7 weeks (1.21 [1.08-1.37] and 1.48 [1.39-1.57], respectively) and at <340/7 weeks (1.45 [1.03-2.04] and 1.25 [1.06-1.47], respectively). In singletons, but not in twin gestations, women with GDM were at an increased risk for gestational hypertension (1.66 [1.55-1.77]), preeclampsia (1.26 [1.06-1.50]) and induction of labor (1.68 [1.65-1.72]). With respect to neonatal outcomes, GDM was associated with an increased risk of birthweight >90th% in both twins and singletons (2.53 [1.52-4.23] vs. 1.18 [1.13-1.23]). While GDM was associated with a similar increase in the risk of jaundice in both twins (1.56 [1.10-2.21]) and singletons (1.49 [1.37-1.62), GDM was associated with the following complications only in singletons: neonatal intensive care unit admission (1.44 [1.38-1.50]), respiratory morbidity (1.09 [1.02-1.16] and neonatal hypoglycemia (3.20 [3.01-3.40]). Conclusion: The association of GDM with pregnancy complications differs between singleton and twin pregnancies, possibly due to the higher baseline risk of prematurity and hypertensive complications in twin pregnancies. Still, the current study highlights that GDM is associated with certain adverse maternal and neonatal outcomes as well as accelerated fetal growth also in twin pregnancies.


Contact for this study:

Isabel Arruda, isabel.arruda@sunnybrook.ca