Gestational diabetes mellitus: Metabolic and blood glucose parameters in singleton versus twin pregnancies

Schwartz, David B.; Daoud, Yahya; Zazula, Pauline; Goyert, Gregory; Bronsteen, Richard; Wright, Debra J.; Copes, Joanna

doi:10.1016/s0002-9378(99)70324-8

Cited by 132 publications

(80 citation statements)

References 6 publications

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“…Several studies found that GDM occurs more often in twin pregnancies compared to singleton pregnancies, 8,15,16,29,30 while others found no difference. 13,14 A study by Roach asserted that the presence of every additional fetus increased the risk of GDM by 1.80 fold.…”

Section: Accepted Manuscriptmentioning

confidence: 97%

The impact of chorionicity on maternal pregnancy outcomes

Carter

Bishop

Goetzinger

et al. 2015

American Journal of Obstetrics and Gynecology

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Section: Accepted Manuscriptmentioning

confidence: 97%

The impact of chorionicity on maternal pregnancy outcomes

Carter

Bishop

Goetzinger

et al. 2015

American Journal of Obstetrics and Gynecology

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“…Indeed, higher order gestations are associated with increased rates of GDM; however, the magnitude of this risk is unclear. 19,20 In addition, multifetal gestations are associated with increased rates of preterm labor or premature rupture of membranes, 19 resulting in the need for corticosteroids for fetal lung maturation, which, if complicated by diabetes, may increase the maternal risk of diabetic ketoacidosis.…”

Section: Incidencementioning

confidence: 99%

Diabetic Ketoacidosis in Pregnancy

Sibai

Viteri

2014

Obstetrics &Amp; Gynecology

114

112

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Pregnancies complicated by diabetic ketoacidosis are associated with increased rates of perinatal morbidity and mortality. A high index of suspicion is required, because diabetic ketoacidosis onset in pregnancy can be insidious, usually at lower glucose levels, and often progresses more rapidly as compared with nonpregnancy. Morbidity and mortality can be reduced with early detection of precipitating factors (ie, infection, intractable vomiting, inadequate insulin management or inappropriate insulin cessation, β-sympathomimetic use, steroid administration for fetal lung maturation), prompt hospitalization, and targeted therapy with intensive monitoring. A multidisciplinary approach including a maternal-fetal medicine physician, medical endocrinology specialists familiar with the physiologic changes in pregnancy, an obstetric anesthesiologist, and skilled nursing is paramount. Management principles include aggressive volume replacement, initiation of intravenous insulin therapy, correction of acidosis, correction of electrolyte abnormalities and management of precipitating factors, as well as monitoring of maternal-fetal response to treatment. When diabetic ketoacidosis occurs after 24 weeks of gestation, fetal status should be continuously monitored given associated fetal hypoxemia and acidosis. The decision for delivery can be challenging and must be based on gestational age as well as maternal-fetal responses to therapy. The natural inclination is to proceed with emergent delivery for nonreassuring fetal status that is frequently present during the acute episode, but it is imperative to correct the maternal metabolic abnormalities first, because both maternal and fetal conditions will likewise improve. Prevention strategies should include education of diabetic pregnant women about the risks of diabetic ketoacidosis, precipitating factors, and the importance of reporting signs and symptoms in a timely fashion.

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“…These treatment methods are known to increase the incidence of multiple pregnancies, as well as some negative consequences, including a rise in the risk for GDM (Schwartz et al, 1999). Furthermore, pregnancies established after IVF carry an increased risk for maternal complications (Pinborg et al, 2004) (Shevell et al, 2005).…”

Section: The Influence Of Infertility Treatmentsmentioning

confidence: 99%