Perinatal outcomes in twin pregnancies complicated by gestational diabetes.
chorionicity
diabetes
gestational diabetes
multifetal gestation
preeclampsia
twin gestation
Journal
American journal of obstetrics & gynecology MFM
ISSN: 2589-9333
Titre abrégé: Am J Obstet Gynecol MFM
Pays: United States
ID NLM: 101746609
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
received:
05
03
2021
revised:
30
04
2021
accepted:
04
05
2021
pubmed:
16
5
2021
medline:
18
9
2021
entrez:
15
5
2021
Statut:
ppublish
Résumé
Gestational diabetes in singleton pregnancies increases the risk for large for gestational age infants, hypertensive disorders of pregnancy, and neonatal morbidity. Compared with singleton gestations, twin gestations are at increased risk for fetal growth abnormalities, hypertensive disorders, and neonatal morbidity. Whether gestational diabetes further increases the risk for these outcomes is unclear. We sought to determine the relationship between gestational diabetes and the risk for preeclampsia, fetal growth abnormalities, and neonatal intensive care unit admissions in a large cohort of women with twin pregnancies. We used a retrospective cohort of all twin gestations that were delivered at our institution from 1998 to 2013. We excluded pregnancies delivered before 24 weeks' gestation, monochorionic-monoamniotic twins, and patients with preexisting diabetes for a final cohort of 2573 twin deliveries. Gestational diabetes was defined as 2 abnormal values on a 100 g, 3-hour glucose challenge test as defined by the Carpenter-Coustan criteria or a 1-hour value of 200 mg/dL after a 50 g glucose test. Multivariable Poisson regression models were used to estimate the associations between gestational diabetes and preeclampsia, small for gestational age infants, large for gestational age infants, and admission to the neonatal intensive care unit after adjusting for prepregnancy body mass index, maternal race, maternal age, parity, use of in vitro fertilization, prepregnancy smoking status, and chronic hypertension as confounders. The unadjusted incidence of gestational diabetes was 6.5% (n=167). Women with gestational diabetes were more likely to be aged 35 years or older, living with obesity, and have conceived via in vitro fertilization than women without gestational diabetes. Preeclampsia was more common among women with twin pregnancies complicated by gestational diabetes (31%) than among women with twin pregnancies without gestational diabetes (18%) (adjusted risk ratio, 1.5; 95% confidence interval, 1.1-2.1). A diagnosis of small for gestational age infant was less common among women with gestational diabetes (17%) than among women without gestational diabetes (24%), although the results were imprecise (adjusted risk ratio, 0.8; 95% confidence interval, 0.5-1.1). There was no association between gestational diabetes and the incidence of large for gestational age neonates or neonatal intensive care unit admissions. Among women with gestational diabetes who reached 35 weeks' gestation, 62% (n=60) required medical management. Gestational diabetes is a risk factor for preeclampsia among women with twin pregnancies. Close blood pressure monitoring and patient education are critical for this high-risk group. The association between gestational diabetes and neonatal outcomes among women with twin pregnancies is less precise, although it may reduce the incidence of small for gestational age infants. Prospective studies to determine if glycemic control decreases the risk for preeclampsia in twin pregnancies with gestational diabetes are needed.
Sections du résumé
BACKGROUND
Gestational diabetes in singleton pregnancies increases the risk for large for gestational age infants, hypertensive disorders of pregnancy, and neonatal morbidity. Compared with singleton gestations, twin gestations are at increased risk for fetal growth abnormalities, hypertensive disorders, and neonatal morbidity. Whether gestational diabetes further increases the risk for these outcomes is unclear.
OBJECTIVE
We sought to determine the relationship between gestational diabetes and the risk for preeclampsia, fetal growth abnormalities, and neonatal intensive care unit admissions in a large cohort of women with twin pregnancies.
STUDY DESIGN
We used a retrospective cohort of all twin gestations that were delivered at our institution from 1998 to 2013. We excluded pregnancies delivered before 24 weeks' gestation, monochorionic-monoamniotic twins, and patients with preexisting diabetes for a final cohort of 2573 twin deliveries. Gestational diabetes was defined as 2 abnormal values on a 100 g, 3-hour glucose challenge test as defined by the Carpenter-Coustan criteria or a 1-hour value of 200 mg/dL after a 50 g glucose test. Multivariable Poisson regression models were used to estimate the associations between gestational diabetes and preeclampsia, small for gestational age infants, large for gestational age infants, and admission to the neonatal intensive care unit after adjusting for prepregnancy body mass index, maternal race, maternal age, parity, use of in vitro fertilization, prepregnancy smoking status, and chronic hypertension as confounders.
RESULTS
The unadjusted incidence of gestational diabetes was 6.5% (n=167). Women with gestational diabetes were more likely to be aged 35 years or older, living with obesity, and have conceived via in vitro fertilization than women without gestational diabetes. Preeclampsia was more common among women with twin pregnancies complicated by gestational diabetes (31%) than among women with twin pregnancies without gestational diabetes (18%) (adjusted risk ratio, 1.5; 95% confidence interval, 1.1-2.1). A diagnosis of small for gestational age infant was less common among women with gestational diabetes (17%) than among women without gestational diabetes (24%), although the results were imprecise (adjusted risk ratio, 0.8; 95% confidence interval, 0.5-1.1). There was no association between gestational diabetes and the incidence of large for gestational age neonates or neonatal intensive care unit admissions. Among women with gestational diabetes who reached 35 weeks' gestation, 62% (n=60) required medical management.
CONCLUSION
Gestational diabetes is a risk factor for preeclampsia among women with twin pregnancies. Close blood pressure monitoring and patient education are critical for this high-risk group. The association between gestational diabetes and neonatal outcomes among women with twin pregnancies is less precise, although it may reduce the incidence of small for gestational age infants. Prospective studies to determine if glycemic control decreases the risk for preeclampsia in twin pregnancies with gestational diabetes are needed.
Identifiants
pubmed: 33991708
pii: S2589-9333(21)00091-4
doi: 10.1016/j.ajogmf.2021.100396
pmc: PMC9205386
mid: NIHMS1800098
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
100396Subventions
Organisme : NINR NIH HHS
ID : R01 NR014245
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
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