Maternal and Neonatal Outcomes in Twin Pregnancies Complicated With Gestational Diabetes Mellitus Compared to Twin Pregnancies Without Gestational Diabetes Mellitus: A Population-based Retrospective Cohort Study of Nova Scotia Births
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Background: Gestational diabetes mellitus (GDM) is broadly defined as diabetes that is first diagnosed during pregnancy. It can lead to complications in singleton pregnancies for both mother and baby, such as excessively high birthweight and consequentially the need for Caesarean section, shoulder dystocia, birth trauma, gestational hypertension, and neonatal hypoglycemia. Women carrying twins have increased risk of adverse maternal and fetal outcomes such as growth restriction, discordant growth, pre-eclampsia and preterm delivery, but few studies have examined the outcomes of GDM among twin pregnancies. Objectives: This study investigated twin pregnancies, comparing women affected by GDM to those unaffected with respect to: (1) maternal outcomes including hypertensive disorders of pregnancy, placental abruption, preterm delivery, mode of delivery and antepartum length of stay and (2) neonatal outcomes of perinatal death, hypoglycemia, birthweight discordance, small for gestational age (SGA), large for gestational age (LGA), neonatal intensive care unit (NICU) admission, neonatal length of stay, respiratory distress and low Apgar score. Methods: The retrospective cohort study was carried out using provincial data from the Nova Scotia Atlee Perinatal Database (NSAPD) between 1988 and 2013. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) for the association between GDM and each outcome were estimated from logistic regression models with generalized estimating equations to account for nonindependence between twins. Results: 2374 women who delivered twins were included, 109 (4.6%) of whom had GDM. Outcomes with estimated aORs > 1.30 included hypertensive disorders of pregnancy (aOR 1.44, 95% CI 0.88-2.38), an antepartum length of stay > 48 hours (aOR 1.55, 95% CI 0.97-2.50) and Caesarean section (aOR 1.34, 95% CI 0.87-2.07). Neonates born to mothers with GDM had estimated aORs > 1.30 for the outcomes of hypoglycemia (aOR 3.07, 95% CI 1.82-5.19) and small for gestational age (aOR 1.46, 95% CI 0.99-2.15), while aORs < 0.77 were calculated for respiratory distress (aOR 0.70, 95% CI 0.41-1.22), and low Apgar score (aOR 0.53, 95% CI 0.23-1.23). Conclusions: The results of this study confirmed some associations previously noted in the literature while finding differing results of other associations. The study suggested an association between GDM and a longer antepartum length of stay in women pregnant with twins, an outcome not previously examined. Further research is warranted, ideally with larger study numbers and information on maternal glucose control during pregnancy.