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Are adverse neonate outcomes in gestational diabetes mellitus twin gestations decreased compared with nondiabetic twins? Obstet Gynecol 2014 May;123 Suppl 1:46S PMID: 24770197

Pubmed ID

24770197

Abstract

INTRODUCTION: To compare neonate outcomes of twin pregnancies complicated by gestational diabetes mellitus (GDM) or pregestational diabetes with those of nondiabetic twin pregnancies.

METHODS: U.S. birth cohort period linked birth and infant death data 2006-2009 were used to conduct a retrospective cohort study on 5,454 GDM twins diagnosed by standard definitions. They were compared with 60,018 nondiabetic twin gestations. Seven hundred forty-eight pregestational diabetic twins were also compared with nondiabetic twin pregnancies. Exclusions include: eclampsia, lack of prenatal care, suspected aneuploidy, birth weights less than 500 g, and births over 45 weeks of gestation. Neonatal outcomes included: extremes of birth weight, neonatal death, low 5-minute Apgar scores (less than 4), neonatal intensive care unit admission and fetal congenital anomalies. Adjusted odds ratios (ORs) were calculated to assess the effect of GDM on adverse neonatal outcomes when compared with nondiabetic twins while controlling for maternal factors. Data analyses were performed using logistic regression in SAS 9.2.

RESULTS: Gestational diabetes mellitus twins compared with nondiabetic twins demonstrated a 50% decrease in neonatal death (adjusted OR 0.54, 95% confidence interval [CI] 0.44-0.69), decreased low 5-minute Apgar scores (adjusted OR 0.63, 95% CI 0.44-0.68), and small-for-gestational age (adjusted OR 0.90, 95% CI 0.85-0.96). Decreases in adverse neonatal outcomes were not demonstrated in pregestational diabetic twins compared with nondiabetic twins.

CONCLUSION: Gestational diabetes mellitus in twins may exert a protective effect on important neonatal outcomes suggesting that GDM in twins may be more a compensatory physiologic state; differential management may be indicated for these pregnancies such as mild hyperglycemia or modifying criteria for the diagnosis of GDM in twins.

Author List

Cruz M, Foeller M, Zhao S, Szabo A

Author

Aniko Szabo PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin




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