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Gestational diabetes in twin pregnancy: A predictor of adverse fetomaternal outcomes?

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Abstract

Aim

To compare fetomaternal outcomes between GDM pregnant women with twin versus singleton pregnancies and then between women with GDM versus non-GDM twin pregnancies.

Methods

We performed a retrospective study including GDM pregnant women with both twin and singleton pregnancies followed in our tertiary center between 2011 and 2018. The fetomaternal characteristics of each group were compared. We then compared women with GDM twin pregnancy followed at our institution between 2011 and 2018 to non-GDM twin pregnant women giving childbirth in 2018.

Results

A total of 1127 GDM pregnant women were evaluated: 42 with twin pregnancy and 1085 with singleton pregnancy. Preeclampsia (14.3% vs. 3.3%, p < 0.001) and cesarean delivery (76.2% vs. 36.9%, p < 0.001) were more frequent among women with twin pregnancy. Neonatal morbidity was also more common among neonates delivered from twin pregnant women, including preterm labor (73.8% vs. 7.8%, p < 0.001), hypoglycemia (6% vs. 4.8%, p = 0.043), hyperbilirubinemia (33.3% vs. 9.0%, p < 0.001), RDS (28.6% vs. 2.7%, p < 0.001), admission in NICU (32.1% vs. 4.5%, p < 0.001) and SGA (19.0% vs. 11.0%, p = 0.001). Overall there were no significant differences in fetomaternal morbidity parameters between GDM (n = 42) versus non-GDM (n = 83) twin pregnancies, although SGA infants were more frequent in the latter group (33.9% vs. 19.0%, p = 0.014).

Conclusions

In GDM pregnant women, twin pregnancy seems to be associated with an increased prevalence of neonatal morbidity when compared to singleton pregnancy. On the other hand, in twin pregnancy, diagnosis of GDM does not seem to be associated with poorer fetomaternal outcomes. GDM seems to be protective for the occurrence of SGA neonates in twin pregnancies.

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Abbreviations

ART:

Assisted reproductive technology

BMI:

Body mass index

FPG:

Fasting plasma glucose

GDM:

Gestational diabetes mellitus

IADPSG:

International association for diabetes in pregnancy study group

IGT:

Impaired glucose tolerance

IOM:

Institute of medicine

IU:

International units

LGA:

Large for gestational age

NA:

Not applicable

NICU:

Neonatal intensive care unit

OGTT:

Oral glucose tolerance test

PPDM:

Prepregnancy diabetes mellitus

RDS:

Respiratory distress syndrome

SGA:

Small for gestational age

T2DM:

Type 2 diabetes mellitus

TDD:

Total daily dose

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal

    Sílvia Santos Monteiro, Liliana Fonseca, Tiago S. Santos, Miguel Saraiva, Teresa Pereira, Joana Vilaverde & Jorge Dores

  2. Division of Nutrition, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal

    Fernando Pichel

  3. Division of Obstetrics, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal

    Clara Pinto

Authors
  1. Sílvia Santos Monteiro
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  2. Liliana Fonseca
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  3. Tiago S. Santos
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  4. Miguel Saraiva
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  5. Teresa Pereira
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  6. Joana Vilaverde
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  7. Fernando Pichel
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  8. Clara Pinto
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  9. Jorge Dores
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Contributions

SSM, LF and JD designed the study. LF acquired the data; SSM, LF and JD interpreted the data. SSM and LF drafted the work and all authors revised it critically for important intellectual content. All authors approved the final version submitted and are accountable for all aspects of the work. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sílvia Santos Monteiro.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the local Ethics committee (157-DEFI/156-CES).

Informed consent

Consent to participate was waived by the Ethics Committee due to the retrospective nature of the study and full data anonymization.

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This article belongs to the topical collection Pregnancy and Diabetes, managed by Antonio Secchi and Marina Scavini.

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Monteiro, S.S., Fonseca, L., Santos, T.S. et al. Gestational diabetes in twin pregnancy: A predictor of adverse fetomaternal outcomes?. Acta Diabetol 59, 811–818 (2022). https://doi.org/10.1007/s00592-022-01874-3

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  • DOI: https://doi.org/10.1007/s00592-022-01874-3

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