Perinatal outcomes among twin pregnancies with gestational diabetes mellitus: A nine-year retrospective cohort study

Lin, Dongxin; Fan, Dazhi; Li, Pengsheng; Chen, Gengdong; Rao, Jiaming; Zhou, Zixing; Zhang, Huishan; Luo, Xinrong; Ma, Huiting; Feng, Jian; Lu, Demei; Wang, Limin; Lan, Shiyan; Luo, Chao; Guo, Xiaoling; Liu, Zheng­ping

doi:10.3389/fpubh.2022.946186

Cited by 13 publications

(15 citation statements)

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“…Additionally, levels of diabetogenic hormones of human placental lactogen, which is secreted by the placenta into maternal circulation and serves as a physiologic antagonist to insulin, and estrogen have been reported to be higher in pregnancies with female neonates than with male neonates 30,31 . A previous study found gravidae with GDM were more likely to be associated with dichorionic twins, which have two separate placentas, compared with gravidae with monochorionic twin gestations 32 . In our study, our same‐sex fetal pairs (ie M‐M and F‐F) had relatively equal proportions of MCMA, MCDA and DCDA pairings with no differences in rates of GDM.…”

Section: Discussionmentioning

confidence: 99%

Fetal sex and the development of gestational diabetes mellitus in gravidae with multiple gestation pregnancies

Sassin,

Sangi‐Haghpeykar,

Aagaard

2023

Acta Obstet Gynecol Scand

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IntroductionThere is an increasing incidence of pregnancies with twin gestations. One outcome more likely to occur with multiple gestations is gestational diabetes mellitus. Studies have suggested that in singleton pregnancies, fetal sex may affect insulin resistance. However, the effects of fetal sex in twins and the development of gestational diabetes mellitus are unknown. We hypothesized that rates of gestational diabetes mellitus and degree of insulin resistance might vary in twin gestations based on the fetal sex pairing: male–male, male–female or female–female. We aimed to employ a large population‐based database to ascertain any correlations between fetal sex and gestational diabetes mellitus in multifetal gestations.Material and methodsA two‐hospital, single academic institution database comprised of over 39 000 participants with pregnancy data from August 2011 to January 2022 was employed. All twin deliveries of live‐born neonates >24 weeks’ gestational age from gravidae without preexisting diabetes or twin–twin transfusion syndrome were included. Entries were then grouped based on the fetal sex of the pairing. The presence or absence of gestational diabetes and type of gestational diabetes – diet‐controlled (gestational diabetes mellitus classification A1) vs medication‐controlled (gestational diabetes mellitus classification A2) – were identified. Statistical analysis was performed using a generalized linear mixed method, and a P‐value ≤0.05 was considered statistically significant.ResultsWe identified 1924 twin deliveries that met the inclusion criteria in our database (male–male =652; male–female = 638; female–female = 634). We found no association between fetal sex pairing and the development of gestational diabetes mellitus. There was a significant association between the fetal sex pairing and the type of gestational diabetes mellitus developed, with 32.0% of male–male twins, 33.3% of male–female twins and 58.3% of the female–female twin deliveries associated with medication‐controlled gestational diabetes classification A2: male–female vs female–female (P = 0.05) and male–male vs female–female (P = 0.046).ConclusionsWhile gestational diabetes mellitus is of multifactorial origin, we found a significant association between the fetal sex pairing and the treatment needed for gravidae with twins who develop gestational diabetes mellitus. A higher proportion of female–female twins was associated with gestational diabetes classification A2 compared with male–female or male–male deliveries. Further research on the physiology driving this association is warranted.

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Section: Discussionmentioning

confidence: 99%

Fetal sex and the development of gestational diabetes mellitus in gravidae with multiple gestation pregnancies

Sassin,

Sangi‐Haghpeykar,

Aagaard

2023

Acta Obstet Gynecol Scand

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“…Included into this retrospective cohort study were all the women who carried twin pregnancies and gave birth at a large tertiary perinatal center in southwestern China between January 1, 2016 and December 31, 2022. The exclusion criteria included: (1) single pregnancy; (2) lack of first-trimester ultrasound examination for chorionicity or gestational age determination; (3) pre-existing diabetes; (4) missing GDM screening results; (5) birth before gestational 28 weeks; (6) complications related to monochorionic placentation, such as twin-to-twin transfusion syndrome and selective fetal growth restriction; (7) monochorionic monoamniotic twins; (8) reduction in fetuses; and (9) fetal chromosomal or structural anomalies. To avoid confounding effects from pregnancy, only the first delivery during the study period was analyzed.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…GDM increases not only maternal complications, such as pre-eclampsia, premature rupture of membranes (PROM), placental abruption, and postpartum hemorrhage, but also adverse perinatal outcomes, including macrosomia, intrauterine growth retardation (IUGR), neonatal hypoglycemia, and neonatal respiratory distress syndrome [2,3]. Mounting evidence suggests that high body mass index (BMI), advanced maternal age, and assisted reproductive technology (ART) are risk factors for the occurrence of GDM [1,[4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…However, other studies have found no significant associations, or even proposed that fewer adverse outcomes may result from GDM during twin pregnancies [6,[15][16][17]. A retrospective cohort study [6] has found that GDM during twin pregnancies does not increase the risks of preterm birth before 37 weeks, LGA, and neonatal respiratory distress (NRDS). Dave et al [15] have found no association between the GDM during twin pregnancies and the incidence of LGA or NICU admissions.…”

Section: Introductionmentioning

confidence: 99%

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Maternal and neonatal outcomes of twin pregnancies complicated by gestational diabetes mellitus

Zhang,

Mei,

et al. 2023

Endocrine

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Introduction Gestational diabetes mellitus (GDM) is associated with a higher risk of adverse maternal outcomes, but its effects on maternal and perinatal outcomes of twin pregnancies remain conflicting. Methods This retrospective cohort study included all primipara who delivered twin pregnancies at a single tertiary perinatal center between January 1, 2016 and December 31, 2022. Excluded were those who had a single pregnancy, twin pregnancies with pre-existing diabetes, missing information on GDM screening, a delivery before gestational 28 weeks, complications related to monochorionic placentation, multifetal reduction, fetal anomalies, and monochorionic monoamniotic twins. Maternal outcomes included preterm birth, pre-eclampsia, hypothyroidism, preterm premature rupture of membranes (PROM), placental abruption, severe postpartum hemorrhage, and oligohydramnios. Neonatal outcomes included small-for-gestational-age (SGA), large-for-gestational-age (LGA), birthweight, Apgar score, neonatal intensive care unit (NICU) admission, extrauterine growth restriction (EUGR), and neonatal hypoglycemia. Results A total of 3269 twins were delivered, with 897 women (27.4%) diagnosed with GDM during pregnancies; moreover, 72 (8.0%) of these women received insulin treatment. The GDM group showed a significantly higher maternal age at delivery (≥35 years), as well as incidences of overweight and obesity. These factors also elevated the odds of insulin treatment in GDM women with twin pregnancies (OR = 1.881, 95% CI = 1.073–3.295, P = 0.027; OR = 2.450, 95% CI = 1.422–4.223, P < 0.001; OR = 4.056, 95% CI = 1.728–9.522, P < 0.001, respectively). Chronic hypertension prior to pregnancy was identified as a risk factor for GDM during twin pregnancies (OR = 1.896, 95% CI = 1.290–2.785, P < 0.001), although it did not increase the proportion of women requiring insulin treatment (P = 0.808). Aside from a higher incidence of preterm birth before 37 weeks in insulin-treated GDM twins (OR = 2.096, 95% CI = 1.017–4.321, P = 0.045), there were no significant difference in other maternal outcomes (preterm birth before 34 weeks, pre-eclampsia, hypothyroidism, PROM, placental abruption, placenta previa, severe postpartum hemorrhage, and oligohydramnios) between the GDM group and non-GDM group, and between insulin-treated GDM and non-insulin-treated GDM. The rate of newborns with birthweight <1500 g was significantly lower among twins born to GDM women, but the prevalence of EUGR was notably higher. Additionally, the risk of EUGR was elevated in insulin-treated GDM twins (OR = 3.170, 95% CI = 1.639,6.131, P < 0.001). No significant differences were observed between the GDM group and non-GDM group, or between insulin-treated GDM and non-insulin-treated GDM group in terms of mean birthweight, newborn sex ratio, and incidences of other adverse neonatal outcomes, including gestational age at delivery, LGA, birth weight <2500 g, and 1-min and 5-min Apgar scores. Conclusion Maternal age ≥35 years, overweight or obesity, and chronic hypertension are significant risk factors for GDM during twin pregnancies. Women with GDM during twin pregnancies may achieve similar outcomes compared to those without GDM. However, the women with GDM during twin pregnancies receiving insulin therapy may have a higher risk of preterm birth and EUGR.

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“…The incidence of GDM in twin pregnancies is significantly higher than that in singleton pregnancies [ 8 ], at 21.9% [ 9 ] in multiple pregnancies versus 14.8% [ 10 ] in singleton pregnancies in China. Advanced maternal age, obesity, ART, and Asian ethnicity, regarded as risk factors for GDM in twin pregnancies [ 11 – 13 ], have been widely considered.…”

Section: Introductionmentioning

confidence: 99%

Association between serum lipid profile during the first and second trimester of pregnancy as well as their dynamic changes and gestational diabetes mellitus in twin pregnancies: a retrospective cohort study

Zhang¹,

Zheng²,

Yuan³

et al. 2023

Diabetol Metab Syndr

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Background Abnormal lipid metabolism is associated with gestational diabetes mellitus (GDM) in singleton pregnancies. Data were lacking on twin pregnancies with GDM. We explored the association between serum lipid profiles in the first and second trimesters as well as their dynamic changes and GDM in twin pregnancies. Methods This was a retrospective cohort study of 2739 twin pregnancies that underwent a 75-g oral glucose tolerance test (OGTT) and were selected from the Beijing Birth Cohort Study from June 2013 to May 2021. Cholesterol (CHO), triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were measured at mean 9 and 25 weeks of gestation. We described maternal lipid levels in different tertiles that were associated with the risk of GDM stratified for age, pre-BMI, and fertilization type. GDM patients were divided into two groups according to OGTT: elevated fasting plasma glucose only (FPG group) and the rest of the GDM (non-FPG group). We estimated the relative risk of GDM with multivariable logistic regression models. Results In this study, we found that 599 (21.9%, 599/2739) twin pregnancies developed GDM. They had increased CHO, TG, LDL, and LDL/HDL, decreased HDL levels in the first trimester, and increased TG as well as decreased HDL in the second trimester in univariate analyses, each P < 0.05. In multivariate analysis, when TG > 1.67 mmol/l (upper tertile) in elderly individuals, nonoverweight and ART groups increased the risk of GDM by 2.7-fold, 2.3-fold and 2.2-fold, respectively, compared with TG < 0.96 mmol/l (lower tertile). This effect remained in the abovementioned groups in the second trimester. Moreover, high TGs increased the risk of GDM in the FPG group (OR = 2.076, 95% CI 1.130–3.815) and non-FPG group (OR = 2.526, 95% CI 1.739–3.67) in the first trimester when TG > 1.67 mmol/l, and the rising risk in the non-FPG group as the TG tertile increased remained in the second trimester. HDL predominantly showed a negative association with elevated FPG in the second trimester (p < 0.05). Conclusions Twin pregnancies with GDM have higher lipid levels. Increased TGs in the first and second trimesters are strongly associated with GDM, especially in elderly individuals, nonoverweight and ART groups. Lipid profiles varied among different GDM subtypes.

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Perinatal outcomes among twin pregnancies with gestational diabetes mellitus: A nine-year retrospective cohort study

Cited by 13 publications

References 56 publications

Fetal sex and the development of gestational diabetes mellitus in gravidae with multiple gestation pregnancies

Fetal sex and the development of gestational diabetes mellitus in gravidae with multiple gestation pregnancies

Maternal and neonatal outcomes of twin pregnancies complicated by gestational diabetes mellitus

Association between serum lipid profile during the first and second trimester of pregnancy as well as their dynamic changes and gestational diabetes mellitus in twin pregnancies: a retrospective cohort study

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