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

作者全名："Zhang, Zhengyu; Mei, Lingwei; Li, Li; Xiao, Jumei; Wu, Xiaoxin; Yuan, Yuan"

作者地址："[Zhang, Zhengyu] Zhejiang Univ, Affiliated Hosp 1, Sch Med, Med Records Dept, Hangzhou 310003, Peoples R China; [Mei, Lingwei; Li, Li; Xiao, Jumei] Chongqing Med Univ, Women & Childrens Hosp, Chongqing Hlth Ctr Women & Children, Dept Obstet & Gynecol, Chongqing 401147, Peoples R China; [Wu, Xiaoxin] Zhejiang Univ, Affiliated Hosp 1, Collaborat Innovat Ctr Diag & Treatment Infect Dis, Sch Med,Natl Clin Res Ctr Infect Dis,State Key Lab, 79 Qing Chun Rd, Hangzhou 310003, Zhejiang, Peoples R China; [Yuan, Yuan] Chongqing Med Univ, Chongqing Hlth Ctr Women & Children, Med Dept, Women & Childrens Hosp, Chongqing 401147, Peoples R China"

通信作者："Wu, XX (通讯作者)，Zhejiang Univ, Affiliated Hosp 1, Collaborat Innovat Ctr Diag & Treatment Infect Dis, Sch Med,Natl Clin Res Ctr Infect Dis,State Key Lab, 79 Qing Chun Rd, Hangzhou 310003, Zhejiang, Peoples R China.; Yuan, Y (通讯作者)，Chongqing Med Univ, Chongqing Hlth Ctr Women & Children, Med Dept, Women & Childrens Hosp, Chongqing 401147, Peoples R China."

来源：ENDOCRINE

ESI学科分类：BIOLOGY & BIOCHEMISTRY

WOS号：WOS:001101558400001

JCR分区：Q2

影响因子：3

年份：2023

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：GDM; Twin pregnancy; Preterm birth; Insulin

摘要："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."

基金机构：Chongqing municipal health; Health Committee maternal and child management project [2023FY205]; Natural Science Foundation of Zhejiang Province [LQ21H190004]

基金资助正文：This study was funded by Chongqing municipal health and Health Committee maternal and child management project (grant number 2023FY205) and Natural Science Foundation of Zhejiang Province (grant number LQ21H190004).