medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2024, Number 05

<< Back Next >>

Ginecol Obstet Mex 2024; 92 (05)

Maternal and perinatal outcomes associated with multiple pregnancy in patients with gestational diabetes

Ramírez NE, Campo CMN, Sanín BJE, Londoño MJA, Echavarría RLG, Cuesta CDP, Merino CSC

Language: Spanish
References: 24
Page: 177-188
PDF size: 218.80 Kb.


ABSTRACT

Objective: To evaluate and compare the association between gestational diabetes and adverse maternal-perinatal outcomes in patients with multiple pregnancies.
Materials and Methods: Retrospective cohort study, undertaken in patients with twin pregnancy, without diagnosed comorbidities, admitted to a reference center in Me- dellín, Colombia, from January 2013 to January 2017. Maternal and perinatal outcomes were compared until discharge of the newborn of mothers with and without gestational diabetes. For statistical analysis, crude and adjusted associations were estimated.
Results: A total of 87 patients with twin pregnancies were registered: 35 vs 52 with and without gestational diabetes, respectively, among 228 twin pregnancies attended in the study period. Overweight/obesity predominated in both groups (n = 30 of 35) vs (n = 35 of 52); p = 0.112. The variables: primigravida, history of gestational diabetes and macrosomia were significantly more frequent in the gestational diabetes group (p ‹ 0.05). The median gestational age at diagnosis was 27 weeks (interquartile range between 24.3-30). No statistically significant differences were found in the maternal outcomes of both groups. The gestational age at delivery was 35 weeks in both groups (RR: 0.01; -0.90-0.92; p = 0.980). Neonatal deaths were only recorded in the group of pregnant women without gestational diabetes (n = 52 of 87), in 3 (2.9%) of the 104 live births. Birth weight was similar in both groups; However, pregnant women with gestational diabetes had a higher risk of transient tachypnea than the control group (RR: 2.06; 95%CI: 1.08-3-92), even after adjusting for birth weight (RR: 2.59; 95%CI: 1.35-4.57). Gestational diabetes was an independent risk factor for hydroelectrolyte disorders, especially potassium disorders (RR: 8.09; 95%CI: 1.60 -41.01).
Conclusions: Gestational diabetes in women with twin pregnancies is not a factor that, in general, worsens adverse maternal and perinatal outcomes.


REFERENCES

  1. ACOG. Gestational diabetes mellitus. ACOG PracticeBulletin No. 190. American College of Obstetricians andGynecologists. Obstet Gynecol 2018; 131 (2): e49-64.https://doi.org/ghsnb8

  2. Cozzolino M, Serena C, Maggio L, et al. Analysis of themain risk factors for gestational diabetes diagnosed withInternational Association of Diabetes and Pregnancy StudyGroups (IADPSG) criteria in multiple pregnancies. J EndocrinolInvest 2017; 40 (9): 937-43. doi: https://doi.org/gbs596

  3. Dinham GK, Henry A, Lowe SA, et al. Twin pregnanciescomplicated by gestational diabetes mellitus: a singlecentre cohort study. Diabet Med 2016; 33 (12): 1659-67.doi: https://doi.org/gj7s7q

  4. Kleinwechter H, Schäfer-Graf U, Bührer C, et al. Gestationaldiabetes mellitus (GDM) - Diagnosis, therapy and follow-upcare: Practice guideline of the German Diabetes Association(Diabetes Gestacional) and the German Associationfor Gynaecology and Obstetrics (Diabetes Gestacionalgg).Diabetol und Stoffwechsel 2014; 9 (1): S202-13. https://doi.org/gksjc7

  5. Hiersch L, Berger H, Okby R, et al. Gestational diabetesmellitus is associated with adverse outcomes in twin pregnancies.Am J Obstet Gynecol 2019; 220 (1): 102.e1-102.e8. https://doi.org/gjtss3

  6. Barchilon-Tiosano L, Sheiner E, Wainstock T, et al. Longtermrisk for maternal cardiovascular morbidities intwin pregnancies complicated with gestational diabetesmellitus–a retrospective cohort study. J Matern NeonatalMed 2021; 34 (16): 2677-81. https://doi.org/mkfd

  7. Foeller M, Zhao S, Szabo A, et al. Neonatal outcomes in twinpregnancies complicated by gestational diabetes comparedwith non-diabetic twins. J Perinatol 2015; 35: 1043-1047.https://doi.org/f72j8d

  8. Alkaabi J, Almazrouei R, Zoubeidi T, et al. Burden, associatedrisk factors and adverse outcomes of gestationaldiabetes mellitus in twin pregnancies in Al Ain, UAE. BMCPreg Childbirth 2020; 20 (1): 4-11. https://doi.org/mkff

  9. Corsello G, Piro E. The world of twins: An update. J MaternNeonatal Med 2010; 23( Suppl 3): 59-62. https://doi.org/fjmxcn

  10. Hiersch L, Berger H, Okby R, et al. Incidence and risk factorsfor gestational diabetes mellitus in twin versus singletonpregnancies. Arch Gynecol Obstet 2018; 298 (3): 579-87.https://doi.org/gd3359

  11. Dave ED, Bodnar LM, Vani K, et al. Perinatal outcomes intwin pregnancies complicated by gestational diabetes.Am J Obstet Gynecol MFM 2021; 3 (5): 100396. https://doi.org/gj2b3k

  12. Ram M, Berger H, Lipworth H, et al. The relationship betweenmaternal body mass index and pregnancy outcomes in twincompared with singleton pregnancies. Int J Obes 2020; 44:33-44. https://doi.org/10.1038/s41366-019-0362-8

  13. Sheehan ACM, Umstad MP, Cole S, et al. Does gestationaldiabetes cause additional risk in twin pregnancy? Twin ResHum Genet 2019; 22 (1): 42-7. doi: https://doi.org/mkfg

  14. Ashwal E, Berger H, Hiersch L, et al. Gestational diabetesand fetal growth in twin compared with singleton pregnancies.Am J Obstet Gynecol 2021; 225 (4): 420.e1-420e3.https://doi.org/mkfh

  15. Fox NS, Gerber RS, Saltzman DH, CK, et al. Glycemic controlin twin pregnancies with gestational diabetes: Are we improvingor worsening outcomes? J Matern Neonatal Med2016; 29 (7): 1041-5. https://doi.org/gj7s7n

  16. Mei Y, Yu J, Wen L, et al. Perinatal outcomes and offspringgrowth profiles in twin pregnancies complicated by gestationaldiabetes mellitus: A longitudinal cohort study.Diabetes Res Clin Pract 2021; 171: 108623. https://doi.org/10.1016/j.diabres.2020.108623

  17. Hung TH, Hsieh TT, Shaw SW, et al. Risk factors and adversematernal and perinatal outcomes for women with dichorionictwin pregnancies complicated by gestational diabetesmellitus: A retrospective cross-sectional study. J DiabetesInvestig 2021; 12 (6): 1083-91. https://doi.org/mkfj

  18. Hiersch L, Shah BR, Berger H, et al. Developing twin-specific75-g oral glucose tolerance test diagnostic thresholds forgestational diabetes based on the risk of future maternaldiabetes: a population-based cohort study. BJOG An IntJ Obstet Gynaecol 2021; 128 (12): 1975-85. https://doi.org/gj6zhh

  19. Mcgrath RT, Hocking SL, Scott ES, et al. Outcomes of twinpregnancies complicated by gestational diabetes: A metaanalysisof observational studies. J Perinatol 2017; 37 (4):360-8. https://doi.org/f9kq5s

  20. Guillén-Sacoto MA, Barquiel B, Hillman N, et al. Metabolicsyndrome and impaired glucose metabolism during earlypostpartum after twin pregnancies complicated by gestationaldiabetes mellitus: Is the risk comparable to singletonpregnancies? Diabetes Metab 2019; 45 (4): 390-3. https://doi.org/mkfm

  21. Akiba Y, Miyakoshi K, Ikenoue S, et al. Glycemic andmetabolic features in gestational diabetes: Singleton versustwin pregnancies. Endocr J 2019; 66 (7): 647-51. https://doi.org/mkfk

  22. Okby R, Weintraub AY, Sergienko R, et al. Gestational diabetesmellitus in twin pregnancies is not associated withadverse perinatal outcomes. Arch Gynecol Obstet 2014;290 (4): 649-54. https://doi.org/f6gx3s

  23. Weiner E, Barber E, Feldstein O, et al. The placentalcomponent and neonatal outcome in singleton vs. twinpregnancies complicated by gestational diabetes mellitus.Placenta 2018; 63: 39-44. https://doi.org/gc62gz

  24. Rebarber A, Dolin C, Fields JC, et al. Screening approach forgestational diabetes in twin pregnancies. Am J Obstet Gynecol2014; 211 (6): 639.e1-639.e5. https://doi.org/f2wf55




2020     |     www.medigraphic.com