Incidence and risk factors for gestational diabetes mellitus in twin versus singleton pregnancies

Hiersch, Liran; Berger, Howard; Okby, Rania; Ray, Joel G.; Geary, Michael; McDonald, Sarah D.; Murry-Davis, Beth; Riddell, Catherine; Halperin, Ilana; Hasan, Haroon; Barrett, Jon; Melamed, Nir; Doh-Net, for; Investigators, Soon

doi:10.1007/s00404-018-4847-9

Cited by 53 publications

(54 citation statements)

References 28 publications

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“…Elevated levels of UA and a higher prevalence of GDM in twin pregnancies, compared with those in their singleton counterparts, have been reported previously. 24,25 Thus, the inclusion of twin pregnancies may overestimate the relationship between GDM and the chosen markers of kidney function. Therefore, twin pregnancies were excluded from the study (n = 9).…”

Section: Patients and Methods Subjectmentioning

confidence: 99%

<p>Association of Serum Uric Acid, Urea Nitrogen, and Urine Specific Gravity Levels at 16–18 Weeks of Gestation with the Risk of Gestational Diabetes Mellitus</p>

Li¹,

Liu

et al. 2020

DMSO

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To evaluate the associations of serum uric acid (UA), urea nitrogen (UN), and urine specific gravity (USG) levels in the first trimester of pregnancy with the risk of gestational diabetes mellitus (GDM). Patients and Methods: A retrospective cohort study was conducted in 1,769 pregnant women aged 31.55 ± 3.91 years. UA, UN, and USG levels were measured during the 16-18th week of gestation. GDM was diagnosed by an oral 75 g glucose tolerance test during the 24-28th week of gestation. Results: A multivariate adjusted logistic regression analysis showed that UA levels in the highest quartile increased the risk of GDM by 55.7% (odds ratio [OR]: 1.557, 95% confidence interval [CI]: 1.055-2.298; p = 0.026) compared to those in the lowest quartile. USG levels in the second, third, and fourth quartiles increased the risk of GDM by 67.6% (95% CI: 1.090-2.421), 112.4% (95% CI: 1.446-3.119), and 94.5% (95% CI: 1.314-2.880), respectively, compared to those in the first quartile (p trend = 0.001). No significant association between UN levels and the GDM risk was observed. When the extreme composite biomarker score quartiles were compared, the adjusted OR (95% CI) for GDM was 1.909 (95% CI: 1.332-2.736). Age-stratified analyses revealed similar results in women aged ≤35 years only, but not in those aged >35 years. Conclusion: Higher levels of UA and USG and a higher composite kidney function biomarker score during the 16-18th week of gestation were positively and independently associated with an increased risk of GDM.

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Section: Patients and Methods Subjectmentioning

confidence: 99%

<p>Association of Serum Uric Acid, Urea Nitrogen, and Urine Specific Gravity Levels at 16–18 Weeks of Gestation with the Risk of Gestational Diabetes Mellitus</p>

Li¹,

Liu

et al. 2020

DMSO

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“…One of the main objectives of the present study was to investigate the risk factors for GDM in women with DC twin pregnancies. Advanced maternal age (>34 years) and high prepregnancy BMI (>24.9 kg/m 2 ) are the two most recognized risk factors for GDM 20,23,31 . According to our previous study of women with singleton pregnancies 23 , the rates of maternal age >34 years, GDM in women aged ≤34 years and GDM in women aged >34 years were 45%, 6% and 13%, respectively.…”

Section: Estimation Of Minimum Sample Sizementioning

confidence: 99%

“…Therefore, clinicians require not only updated, but consistent information to counsel and manage these patients. Second, prior studies were mainly carried out on American and European populations [3][4][5][6][7][8][9][10][11][12][13][14]16,17,[20][21][22] , whereas only one was on Asian women 15 . Third, our recent study showed that risk factors for GDM women with singleton pregnancies included maternal age >34 years, pre-pregnancy body mass index (BMI) >24.9 kg/m 2 , a prior history of fetal death, chronic hypertension, genetic amniocentesis and artificial reproductive technology 23 .…”

Section: Introductionmentioning

confidence: 99%

“…It is unclear whether a similar risk profile is present in women with twin pregnancy. Finally, many prior studies that utilized birth registries were often with incomplete information, coding errors and misclassification 8,14,17,20 . Furthermore, some studies failed to control confounding variables, such as conception methods, reproductive history, maternal demographics and concurrent pregnancy complications, because this information was absent or unavailable from their birth registries or databases 3,11,13,15,22 .…”

Section: Introductionmentioning

confidence: 99%

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Risk factors and adverse maternal and perinatal outcomes for women with dichorionic twin pregnancies complicated by gestational diabetes mellitus: A retrospective cross‐sectional study

Hung

Hsieh

Shaw

et al. 2020

J of Diabetes Invest

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Aims/Introduction The association between gestational diabetes mellitus (GDM) and adverse maternal and perinatal outcomes in twin pregnancies remains unclear. This study was undertaken to highlight risk factors for GDM in women with dichorionic (DC) twins, and to determine the association between GDM DC twins and adverse maternal and perinatal outcomes in a large homogeneous Taiwanese population. Materials and Methods A retrospective cross‐sectional study was carried out on 645 women with DC twins, excluding pregnancies complicated by one or both fetuses with demise (n = 22) or congenital anomalies (n = 9), who gave birth after 28 complete gestational weeks between 1 January 2001 and 31 December 2018. Univariable and multiple logistic regression analyses were carried out. Results Maternal age >34 years (adjusted odds ratio 2.52; 95% confidence interval 1.25–5.07) and pre‐pregnancy body mass index >24.9 kg/m2 (adjusted odds ratio 2.83, 95% confidence interval 1.47–5.46) were independent risk factors for GDM in women with DC twins. Newborns from women with GDM DC twins were more likely to be admitted to the neonatal intensive care unit (adjusted odds ratio 1.70, 95% confidence interval 1.06–2.72) than newborns from women with non‐GDM DC twins. Other pregnancy and neonatal outcomes were similar between the two groups. Conclusions Advanced maternal age and pre‐pregnancy overweight or obesity are risk factors for GDM in women with DC twins. Except for a nearly twofold increased risk of neonatal intensive care unit admission of newborns, the pregnancy and neonatal outcomes for women with GDM DC twins are similar to those for women with non‐GDM DC twins.

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“… 9 10 11 Hiersch et al recently found that the increased risk of GDM among twin pregnancies was mainly due to a higher incidence of mild, diet-treated GDM, and suggested that the mildly increased glucose intolerance may be a beneficial physiologic response to increased maternal metabolic rates and increased glucose demand for two fetuses. 12 …”

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confidence: 99%

The Association between Glucose Levels and Adverse Pregnancy Outcomes in Nondiabetic Twin Pregnancies

Cheung

Fox

2020

AJP Rep

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Objective The aim of this study is to determine if hyperglycemia in twin pregnancies without gestational diabetes mellitus (GDM) is associated with an increased risk of adverse pregnancy outcomes. Study Design Retrospective cohort study of twin pregnancies in a single Maternal–Fetal Medicine practice between 2005 and 2019 who underwent two-step GDM screening at 24 to 28 weeks. We excluded women with pregestational or gestational diabetes. We examined the association between maternal glycemia and adverse pregnancy outcomes. Glycemia was defined as the 1-hour GCT in all women, and each of the four values of the 3-hour OGTT in women who failed the GCT (≥130 mg/dL). Primary outcomes were preeclampsia, cesarean delivery, and neonatal hypoglycemia in either twin. Statistical tests used included Pearson's correlation, Student's t-test, Mann–Whitney U test, Chi-square test for trend, and logistic regression. Results A total of 847 women underwent a GCT and 246 women underwent an OGTT. Increasing maternal glucose levels had no positive association with adverse outcomes. Women with preeclampsia, cesarean delivery, and neonatal hypoglycemia did not have higher mean GCT or OGTT values than women without these outcomes. There was no increased risk of adverse outcomes with increasing quartiles of the GCT or OGTT values. Conclusion In women with twin pregnancies without GDM, elevated maternal glucose levels are not associated with preeclampsia, cesarean delivery, or neonatal hypoglycemia. The altered physiology of twin gestations may modify the effect of maternal hyperglycemia on perinatal outcomes as compared with singleton pregnancies. Current approaches to screening for and treating GDM during pregnancy might not adequately account for these unique considerations among twins.

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Incidence and risk factors for gestational diabetes mellitus in twin versus singleton pregnancies

Abstract: Women with twins are at increased risk of GDM, mainly due to a higher rate of diet-treated GDM. Despite higher baseline risk of GDM in women with twins, the effect of known risk factors for GDM is similar to that observed in singletons.

Cited by 53 publications

References 28 publications

<p>Association of Serum Uric Acid, Urea Nitrogen, and Urine Specific Gravity Levels at 16–18 Weeks of Gestation with the Risk of Gestational Diabetes Mellitus</p>

<p>Association of Serum Uric Acid, Urea Nitrogen, and Urine Specific Gravity Levels at 16–18 Weeks of Gestation with the Risk of Gestational Diabetes Mellitus</p>

Risk factors and adverse maternal and perinatal outcomes for women with dichorionic twin pregnancies complicated by gestational diabetes mellitus: A retrospective cross‐sectional study

The Association between Glucose Levels and Adverse Pregnancy Outcomes in Nondiabetic Twin Pregnancies

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