Glycemic control and neonatal outcomes in twin pregnancies with gestational diabetes mellitus

Differential Effects of n-3 and n-6 Polyunsaturated Fatty Acids on Placental and Embryonic Growth and Development in Diabetic Pregnant Mice

“…However, in polytocous laboratory animals such as rodents, maternal diabetes has been found to be associated with FGR [ 49 , 50 , 51 ]. In human twin pregnancies, good maternal glycemic control is associated with a higher risk of babies being small for their gestational age in subjects with diabetes than in non-diabetic controls [ 52 ]. These results indicate that pregnancies with multiple embryos may exert different influences on fetal growth, and possible reasons may include a larger placental mass, higher levels of placental hormones, earlier gestational age at birth, and slower fetal growth in polytocous pregnancy than in singleton pregnancy [ 52 ].…”

“…In human twin pregnancies, good maternal glycemic control is associated with a higher risk of babies being small for their gestational age in subjects with diabetes than in non-diabetic controls [ 52 ]. These results indicate that pregnancies with multiple embryos may exert different influences on fetal growth, and possible reasons may include a larger placental mass, higher levels of placental hormones, earlier gestational age at birth, and slower fetal growth in polytocous pregnancy than in singleton pregnancy [ 52 ]. Therefore, increasing embryonic growth is meaningful for polytocous diabetic pregnancy and should not be used for singleton diabetic pregnancy.…”

The impact of gestational diabetes mellitus on the development of pregnancy outcomes in twin pregnancies: a retrospective cohort study conducted at a tertiary hospital

“…However, due to the increased nutritional requirements and different glucose tolerance in twin pregnancies, it is uncertain whether it is appropriate to diagnose and manage these women using the same criteria [15,16]. A recent study by Berezowsky A, et al showed that maintaining good control of blood sugar levels through dietary management in twin pregnancies with GDM did not reduce the risk of GDM-related complications, but instead increased the risk of having a baby with a small size for their gestational age [17].…”

Fetal Catecholamines and Neonatal Hypoglycemia—Key Questions Remain—Reply

“…We respectfully disagree with the statement that “applying the same diagnostic criteria and glycemic targets for neonatal hypoglycemia in singletons and twins may lead to overdiagnosis, overtreatment of gestational diabetes, and potential harm to the neonates.” Although Cai et al do not provide a reference for this statement, we believe it confuses neonatal glycemic targets with gestational glycemic targets, for example as stated by Berezowsky et al, who “question whether the gestational diabetes glycemic targets used in singleton pregnancies also apply to twin pregnancies and support the concern that applying the same diagnostic criteria and glycemic targets in twin pregnancies may result in overdiagnosis and overtreatment of gestational diabetes, and potential neonatal harm.” There is no evidence to suggest that twins and singletons should be treated differently in terms of diagnostic criteria or treatment targets for neonatal hypoglycemia.…”