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Evaluation of treatment strategies and pregnancy outcome among GDM twin versus GDM singleton pregnancy

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International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Objective

To compare the treatment strategies and pregnancy outcomes between women with gestational diabetes mellitus carrying twin and singleton pregnancies.

Method

We conducted a retrospective chart review of women with singleton and twin pregnancy; those visited Sunil’s Diabetes Care n’ Research Centre, Nagpur, and Gupte Hospital Pune, between 2006 and 2019, for the treatment of gestational diabetes mellitus (GDM). Propensity scores for baseline characteristics were used to assemble a matched-pairs cohort of women with twin and singleton pregnancies.

Results

A subset of 132 singleton cases was obtained from 801 records that matched with 44 cases of twin pregnancy, with a ratio of 3:1. Treatment modalities, insulin dose, and mode of delivery differed insignificantly between the two groups. Univariate analysis showed significantly higher risk of Premature Baby Unit (PBU) admission > 48 h (OR 2.687; 95% CI 1.064–6.784; p = 0.0364) and small for gestational age newborns (OR 5.286; 95% CI 2.826–9.887; p < 0.0001) in twin pregnancies, and lower risk of premature birth (OR 0.225; 95% CI 0.127–0.402; p < 0.0001) and large for gestational age newborns (OR 0.239; 95% CI 0.068–0.841; p < 0.0257). In a multiple regression analysis, twin pregnancies were found to be the strongest predictors of small for gestational age infant (OR 3.960; 95% CI 1.928–8.135; p < 0.0001).

Conclusion

Although treatment strategies and insulin doses differ insignificantly between gestational diabetes mellitus women carrying twin and singleton pregnancies, their treatment should be planned to achieve glycemic goals.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

References

  1. Mcgrath RT, Hocking SL, Scott ES, et al. Outcomes of twin pregnancies complicated by gestational diabetes: a meta-analysis of observational studies. J Perinatol. 2017;37:360–8.

    Article  CAS  Google Scholar 

  2. Seshiah V, Balaji V, Balaji MS, et al. Pregnancy and diabetes scenario around the world: India. Int J Gynaecol Obstet. 2009;104:S35–8.

    Article  Google Scholar 

  3. Smits J, Monden C. Twinning across the developing world. PLoS One. 2011;6(9):e25239.

    Article  CAS  Google Scholar 

  4. Weissman A, Drugan A. Glucose tolerance in singleton, twin and triplet pregnancies. J Perinat Med. 2016;44:893–7.

    Article  CAS  Google Scholar 

  5. Retnakaran R, Shah BR. Impact of twin gestation and fetal sex on maternal risk of diabetes during and after pregnancy. Diabetes Care. 2016;39:e110–1.

    Article  CAS  Google Scholar 

  6. Corrado F, Caputo F, Facciolà G, Mancuso A. Gestational glucose intolerance in multiple pregnancy. Diabetes Care. 2003;26(5):1646. https://doi.org/10.2337/diacare.26.5.1646.

  7. Hiersch L, Yogev Y. Impact of gestational hyperglycemia on maternal and child health. Curr Opin Clin Nutr Metab Care. 2014;17:255–60.

    Article  CAS  Google Scholar 

  8. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358:1991–2002.

  9. Aviram A, Guy L, Ashwal E, et al. Pregnancy outcome in pregnancies complicated with gestational diabetes mellitus and late preterm birth. Diabetes Res Clin Pract. 2016;113:198–203.

    Article  Google Scholar 

  10. Rauh-Hain JA, Rana S, Tamez H, et al. Risk for developing gestational diabetes in women with twin pregnancies. J Matern Fetal Neonat Med. 2009;22:293–9.

    Article  Google Scholar 

  11. Simoes T, Queiros A, Correia L, et al. Gestational diabetes mellitus complicating twin pregnancies. J Perinat Med. 2011;39:437–40.

    Article  Google Scholar 

  12. Foeller ME, Zhao S, Szabo A, et al. Neonatal outcomes in twin pregnancies complicated by gestational diabetes compared with non-diabetic twins. J Perinatol. 2015;35:1043–7.

    Article  CAS  Google Scholar 

  13. Buhling KJ, Henrich W, Starr E, et al. Risk for gestational diabetes and hypertension for women with twin pregnancy compared to singleton pregnancy. Arch Gynecol Obstet. 2003;269:33–6.

    Article  Google Scholar 

  14. Francisco C, Wright D, Benko Z, et al. Competing-risks model in screening for pre-eclampsia in twin pregnancy by maternal characteristics and medical history. Ultrasound Obstet Gynecol. 2017;50:501–6.

    Article  CAS  Google Scholar 

  15. Rouse DJ. Twins are not a per se indication for cesarean delivery. Obstet Gynecol. 2017;129:974–5.

    Article  Google Scholar 

  16. Gonzalez Gonzalez NL, Goya M, Bellart J, et al. Obstetric and perinatal outcome in women with twin pregnancy and gestational diabetes. J Matern Fetal Neonat Med. 2012;25:1084–9.

    Article  Google Scholar 

  17. Guillen MA, Herranz L, Barquiel B, et al. Influence of gestational diabetes mellitus on neonatal weight outcome in twin pregnancies. Diabet Med. 2014;31:1651–6.

    Article  CAS  Google Scholar 

  18. Lai FY, Johnson JA, Dover D, et al. Outcomes of singleton and twin pregnancies complicated by pre-existing diabetes and gestational diabetes: a population-based study in Alberta, Canada, 2005–11. J Diabetes. 2016;8:45–55.

    Article  Google Scholar 

  19. Okby R, Weintraub AY, Sergienko R, et al. Gestational diabetes mellitus in twin pregnancies is not associated with adverse perinatal outcomes. Arch Gynecol Obstet. 2014;290:649–54.

    Article  Google Scholar 

  20. Fox NS, Gerber RS, Saltzman DH, et al. Glycemic control in twin pregnancies with gestational diabetes: are we improving or worsening outcomes? J Matern Fetal Neonatal Med. 2016;29:1041–5.

    Article  Google Scholar 

  21. Ooi S, Wong VW. Twin pregnancy with gestational diabetes mellitus: a double whammy? Diabetes Care. 2018;41:e15–6.

    Article  Google Scholar 

  22. Callesen NF, Ringholm L, Stage E, Damm P, Mathiesen ER. Insulin requirements in type 1 diabetic pregnancy: do twin pregnant women require twice as much insulin as singleton pregnant women? Diabetes Care. 2012;35(6):1246–8.

    Article  CAS  Google Scholar 

  23. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15:539–53.

  24. Lakshmi KC. Immunological causes of bad obstetric history. J of Evidence Based Med & Hlthcare. 2014;1:2086–99.

    Article  Google Scholar 

  25. Paul VK, Deorari AK, Singh M. Management of low birth weight babies. In: Parthasarathy A, editor. IAP Textbook of Pediatrics. 2nd ed. New Delhi: Jaypee Brothers; 2002. p. 60.

  26. Mahalakshmi MM, Bhavadharini B, Maheswari K, et al. Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: a situational analysis study (WINGS-3). Indian J Endocr Metab. 2016;20:491–6.

    Article  CAS  Google Scholar 

  27. Disorders related to short gestation and low birth weight, not elsewhere classified; P07; Chapter XVI Certain Conditions Originating in the Perinatal Period; International statistical classification of diseases and related health problems- 10th revision (ICD-10), Fifth edition, 2016, 3 v. WHO Library Cataloguing-in-Publication Data.

  28. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and Development; WHO Library Cataloguing-in-Publication Data; ISBN 92 4 154693 X; NLM Classification: WS 103; World Health Organization 2006.

  29. Hussain K, Blankenstein O, De Lonlay P, et al. Hyperinsulinaemic hypoglycaemia: biochemical basis and the importance of maintaining normoglycaemia during management. Arch Dis Child. 2007;92(7):568–70.

    Article  Google Scholar 

  30. Soon BT. The global action report on preterm birth. Geneva: World Health Organization. 2012.

  31. World Health Organization. Neonatal and perinatal mortality : country, regional and global estimates. World Health Organization. 2006. https://apps.who.int/iris/handle/10665/43444

  32. Hiersch L, Berger H, Okby R, et al. Gestational diabetes mellitus is associated with adverse outcomes in twin pregnancies. Am J Obstet Gynecol. 2019;220(102):e1-8.

    Google Scholar 

  33. Poulain C, Duhamel A, Garabedian C, et al. Outcome of twin pregnancies associated with glucose intolerance. Diabetes Metab. 2015;41:387–92.

    Article  CAS  Google Scholar 

  34. Dinham GK, Henry A, Lowe SA, et al. Twin pregnancies complicated by gestational diabetes mellitus: a single centre cohort study. Diabet Med. 2016;33:1659–67.

    Article  CAS  Google Scholar 

  35. Schwartz DB, Daoud Y, Zazula P, et al. Gestational diabetes mellitus: metabolic and blood glucose parameters in singleton versus twin pregnancies. Am J Obstet Gynecol. 1999;181(4):912–4.

    Article  CAS  Google Scholar 

  36. Rossi AC, Mullin PM, Chmait RH. Neonatal outcomes of twins according to birth order, presentation and mode of delivery: a systematic review and meta-analysis. BJOG. 2011;118(5):523–32. https://doi.org/10.1111/j.1471-0528.2010.02836.x.

    Article  CAS  PubMed  Google Scholar 

  37. Poulain C, Duhamel A, Garabedian C, et al. Outcome of twin pregnancies associated with glucose intolerance. Diabetes Metab. 2015;41(5):387–92.

    Article  CAS  Google Scholar 

  38. Jhaveri RR, Nadkarni TK. Perinatal Outcome of Second Twin with Respect to Mode of Delivery: An Observational Study. J Clin Diagn Res. 2016;10(12):QC26–QC28. https://doi.org/10.7860/JCDR/2016/21688.9112

  39. Shridevi A, Prabhudev P, Bhovi MR. A clinical study of prevalence of gestational diabetes mellitus and associated risk factors at a tertiary care centre in Karnataka, India. Int J Reprod Contracept Obstet Gynecol. 2017;4(6):1840–5.

    Google Scholar 

  40. Kalra P, Kachhwaha CP, Singh HV. Prevalence of gestational diabetes mellitus and its outcome in western Rajasthan. Indian J Endocrinol Metab. 2013;17(4):677–80. https://doi.org/10.4103/2230-8210.113760.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Foeller ME, Zhao S, Szabo A, Cruz MO. Neonatal outcomes in twin pregnancies complicated by gestational diabetes compared with non-diabetic twins. J Perinatol. 2015;35(12):1043–7.

    Article  CAS  Google Scholar 

  42. Alexander GR, Kogan M, Martin J, et al. What are the fetal growth patterns of singletons, twins, and triplets in the United States? Clin Obstet Gynecol. 1998;41(1):115–25.

    Article  Google Scholar 

  43. American College of Obstetricians and Gynecologists Committee on Practice Bulletins--Obstetrics. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes. Obstet Gynecol. 2001;98(3):525–38. Retraction in: Obstet Gynecol. 2013;122(2 Pt 1):405.

  44. Minakami H, Kosuge S, Fujiwara H, et al. Risk of premature birth in multifetal pregnancy. Twin Res. 2000;3(1):2–6.

    Article  CAS  Google Scholar 

  45. Cho HJ, Shin JS, Yang JH, et al. Perinatal outcome in twin pregnancies complicated by gestational diabetes mellitus: a comparative study. J Korean Med Sci. 2006;21:457–9.

    Article  Google Scholar 

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Acknowledgements

We are thankful to Dr. Dhananjay Raje and Ms. Moumita Chakraborty statisticians and the Diabetes Care Foundation of India (Nagpur).

Funding

“No funding received.”

Author information

Authors and Affiliations

  1. Sunil’s Diabetes Care n’ Research Centre Pvt. Ltd, 42, Lendra Park, Ramdaspeth, Nagpur, 440010, Maharashtra, India

    Sunil Gupta, Parvinder Bamrah & Kavita Gupta

  2. Gupte Hospital, 904, Bhandarkar Road, Deccan Gymkhana, 411004, Pune, Maharashtra, India

    Sanjay Gupte

  3. Diabetes Care Foundation of India (Nagpur), Nagpur, Maharashtra, India

    Shlok Gupta

Authors
  1. Sunil Gupta
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  2. Sanjay Gupte
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  3. Shlok Gupta
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  4. Parvinder Bamrah
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  5. Kavita Gupta
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Corresponding author

Correspondence to Sunil Gupta.

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Conflict of interest

The authors declare no conflict of interest.

Ethical Approval

After obtaining the approval from Institutional Ethics Committee, we conducted a retrospective chart review of women with singleton and twin pregnancy, those visited Sunil’s Diabetes Care n’ Research Centre, a tertiary care center for diabetes in Nagpur, Central India, and Gupte Hospital Pune, West India, for the treatment of gestational diabetes mellitus from the year 2006 to 2019.

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Highlights

• The treatment strategies and adverse pregnancy outcomes were compared between twin and singleton gestation in India

• Treatment modalities, insulin dose, and mode of delivery differed insignificantly between the two groups.

• Women with GDM and twin pregnancies were at 3.96 times higher risk for having small for gestational age infant.

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Gupta, S., Gupte, S., Gupta, S. et al. Evaluation of treatment strategies and pregnancy outcome among GDM twin versus GDM singleton pregnancy. Int J Diabetes Dev Ctries 42, 482–488 (2022). https://doi.org/10.1007/s13410-021-00990-0

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  • DOI: https://doi.org/10.1007/s13410-021-00990-0

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