Abstract
Objective Existing data suggest that obstetric outcomes for individuals with twin gestations,
who have gestational diabetes mellitus (GDM), may be comparable to those who do not
have GDM, yet studies are limited by small sample sizes. The aim of this study was
to examine differences in maternal and neonatal outcomes of individuals with twin
gestations based on presence of GDM.
Methods This was a population-based retrospective cohort study of individuals giving birth
to twins in the United States between 2012 and 2014. Inclusion criteria were live
births (≥24 weeks) and available information on GDM status; individuals with pregestational
diabetes were excluded. Participants were categorized as either having had or not
had GDM. Multivariable logistic regression was utilized to assess the independent
association of GDM with adverse maternal outcomes, whereas generalized estimating
equation models were used to estimate associations with neonatal outcomes to account
for clustering.
Results Of 173,196 individuals meeting inclusion criteria, 13,194 (7.6%) had GDM. Individuals
with GDM were more likely to be older, identify as Hispanic or Asian race and ethnicity,
married, college educated, privately insured, and obese than those without GDM. After
adjusting for potential confounding variables, those with GDM were more likely to
have hypertensive disorders (18.0 vs. 10.2%) and undergo cesarean delivery (51.2 vs.
47.3%). Neonates born to individuals with GDM were more likely to require mechanical
ventilation for greater than 6 hours (6.5 vs. 5.6%) and experience neonatal intensive
care unit (NICU) admission (41.1 vs. 36.2%), but were less likely to be low birth
weight or have small for gestational age status (16.2 vs. 19.5%). Findings were confirmed
in a sensitivity analysis of neonates born at 32 weeks of gestation or greater.
Conclusion Odds of poor obstetric and neonatal outcomes are increased for individuals with twin
gestations complicated by GDM.
Key Points
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Individuals with GDM and twin gestation have higher odds of developing hypertensive
disorders during pregnancy and of undergoing cesarean delivery.
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Neonates of such pregnancies are less likely to be low birth weight or small for gestational
age.
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Neonates of pregnancies complicated by GDM and twin gestation are more likely to require
mechanical ventilation and experience NICU admission.
Keywords
gestational diabetes - twin pregnancy - pregnancy outcomes - cohort studies
