Outcomes of twin pregnancies complicated by gestational diabetes: a meta-analysis of observational studies

McGrath, Rachel T.; Hocking, Samantha; Scott, Emma; Seeho, Sean; Fulcher, Gregory; Glastras, Sarah J.

doi:10.1038/jp.2016.254

Cited by 46 publications

(53 citation statements)

References 47 publications

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“…However, we did not find this association in our study. Similar to results from a meta-analysis on GDM in twin pregnancies, our study found no associations to birth weight, gestational age, large or small for gestational age neonates, respiratory distress, neonatal hypoglycemic or low Apgar score [39].…”

Section: Discussionsupporting

confidence: 87%

Burden, associated risk factors and adverse outcomes of gestational diabetes mellitus in twin pregnancies in Al Ain, UAE

Al-Kaabi

Almazrouei

Zoubeidi

et al. 2020

BMC Pregnancy Childbirth

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Background Gestational diabetes mellitus (GDM) in singleton pregnancies represent a high-risk scenario. The incidence, associated factors and outcomes of GDM in twin pregnancies is not known in the UAE. Methods This was five years retrospective analysis of hospital records of twin pregnancies in the city of Al Ain, Abu Dhabi, UAE. Relevant data with regards to the pregnancy, maternal and birth outcomes and incidence of GDM was extracted from two major hospitals in the city. Regression models assessed the relationship between socio-demographic and pregnancy-related variables and GDM, and the associations between GDM and maternal and fetal outcomes at birth. Results A total of 404 women and their neonates were part of this study. The study population had a mean age of 30.1 (SD: 5.3), overweight or obese (66.5%) and were majority multiparous (66.6%). High incidence of GDM in twin pregnancies (27.0%). While there were no statistical differences in outcomes of the neonates, GDM mothers were older (OR: 1.09, 95% CI: 1.06–1.4) and heavier (aOR: 1.02, 95% CI: 1.00 -1.04). They were also likely to have had GDM in their previous pregnancies (aOR: 7.37, 95% CI: 2.76–19.73). The prognosis of mothers with twin pregnancies and GDM lead to an independent and increased odds of cesarean section (aOR: 2.34, 95% CI: 1.03–5.30) and hospitalization during pregnancy (aOR: 1.60, 95% CI: 1.16–2.20). Conclusion More than a quarter of women with twin pregnancies were diagnosed with GDM. GDM was associated with some adverse pregnancy outcomes but not fetal outcomes in this population. More studies are needed to further investigate these associations and the management of GDM in twin pregnancies.

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Section: Discussionsupporting

confidence: 87%

Burden, associated risk factors and adverse outcomes of gestational diabetes mellitus in twin pregnancies in Al Ain, UAE

Al-Kaabi

Almazrouei

Zoubeidi

et al. 2020

BMC Pregnancy Childbirth

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“…Key words: gestational diabetes, pregnancy outcome, singleton, twins T he incidence of gestational diabetes mellitus (GDM) is increasing worldwide because of the increasing prevalence of obesity in women of reproductive age and advanced maternal age. 1 The incidence of GDM may be even greater in twin gestations, a known independent risk factor for GDM. 2,3 GDM is associated with maternal and neonatal complications in singleton pregnancies.…”

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confidence: 99%

Gestational diabetes mellitus is associated with adverse outcomes in twin pregnancies

Hiersch

Berger

Okby

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: Among singleton pregnancies, gestational diabetes mellitus is associated with adverse outcomes. In twin pregnancies, this association may be attenuated, given the higher rate of prematurity and the a priori increased risk of some of these complications. OBJECTIVE: Our aim was to test the hypothesis that gestational diabetes mellitus is less likely to be associated with adverse pregnancy outcomes in twin compared with singleton gestations. METHODS: This retrospective cohort study comprised all twin and singleton live births in Ontario, Canada, 2012e2016. Pregnancy outcomes were compared between women with vs without gestational diabetes mellitus, analyzed separately for twin and singleton births. Adjusted risk ratios and 95% confidence intervals were generated using modified Poisson regression, adjusting for maternal age, nulliparity, smoking, race, body mass index, preexisting hypertension, and assisted reproductive technology. RESULTS: A total of 270,843 women with singleton (n ¼ 266,942) and twin (n ¼ 3901) pregnancies met the inclusion criteria. In both the twin and singleton groups, gestational diabetes mellitus was associated with (adjusted risk ratio, [95% confidence interval]) cesarean delivery (1.11 [1.02e1.21] and 1.20 [1.17e1.23], respectively) and preterm birth at <37 0/7 weeks

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“…The results suggested that twin pregnancies with and without GDM were at a similar risk for adverse outcomes. 23 Optimal glycemic control in twin pregnancies with GDM is also currently unknown. Improved glycemic control through dietary and medication intervention in twin pregnancies with GDM may not improve outcomes such as preeclampsia, early gestational age at delivery, and low birthweight.…”

Section: Discussionmentioning

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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Outcomes of twin pregnancies complicated by gestational diabetes: a meta-analysis of observational studies

Abstract: Identification and subsequent treatment of GDM in twin pregnancy demonstrates a similar risk of adverse perinatal outcomes compared with non-GDM twin pregnancies.

Cited by 46 publications

References 47 publications

Burden, associated risk factors and adverse outcomes of gestational diabetes mellitus in twin pregnancies in Al Ain, UAE

Burden, associated risk factors and adverse outcomes of gestational diabetes mellitus in twin pregnancies in Al Ain, UAE

Gestational diabetes mellitus is associated with adverse outcomes in twin pregnancies

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

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