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Gestational Diabetes and Related Outcomes in Singleton and Twin Pregnancies

Jan 16, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Sandra Zaki, PharmD Candidate, Florida A&M University

Does gestational diabetes pose the same risks in twin pregnancies? 

There is an increase in cases of gestational diabetes mellitus, which can be linked to unhealthy lifestyle factors such as obesity in maternal women. This study looked at differences in the occurrence of gestational diabetes mellitus between singleton and twin pregnancies. Gestational diabetes mellitus for singleton pregnancies is associated with neonatal and maternal complications, but this association may be weaker in twin pregnancies due to higher baseline risk of prematurity and some other complications in twin pregnancies. The study indicates that limited literature exists concerning gestational diabetes mellitus. Also, there is conflicting information about existing literature that facilitates the need to establish the truth about gestational diabetes mellitus. In this sense, some scholars argue that gestational diabetes mellitus has no relation to twin pregnancy complications. On the contrary, some scholars say that gestational diabetes mellitus is associated with increased fetal growth, hypersensitive disorders, and other complications such as neonatal respiratory issues. This study’s other drive is to overcome the possibility of errors in previous studies that used limited samples and control groups.  

 

The aim of the study is to establish a comparison between adverse pregnancy outcomes and gestational diabetes mellitus in singleton and twin pregnancies. The study tests the hypothesis that gestational diabetes mellitus is less likely to be related to adverse pregnancy outcomes in twin pregnancies than it is in singleton gestations. The population used in this study includes women who had either twin or singleton pregnancies resulting in live or stillbirth between April 2012 and March 2016 in Ontario, Canada. The data about these women was obtained from the Better Outcomes Registry and Network database of Ontario. The registry was the best option for the study because it provides detailed information, including maternal demographics, reproductive history, health behaviors, and information relating to pregnancies such as neonatal and fetal outcomes. The registry offered necessary information for comparing pregnancy outcomes between women with singleton and twin pregnancies. However, women with gestational age at birth of <280/7 or >420/7 weeks were excluded. Other exclusions include pregnant women under the age of 19 years, individuals with pre-existing diabetes, and individuals with pregnancies with complicated genetic anomalies. Two critical tests were included in the study, a 50g glucose challenge test, and a 75g glucose tolerance test. The data analysis was achieved by comparing pregnancy outcomes of women with singleton and twin pregnancies. The researchers also used standardized differences rather than P values because it is more informative and less sensitive to large samples. The study also involved Modified Poisson Regression analysis in calculating adjusted risk ratio for women with gestational diabetes mellitus experiencing adverse pregnancy outcomes. Data were analyzed by use of SAS statistical software.  

Analysis of study data shows that pregnant women with gestational diabetes mellitus were more likely to be of Asian ethnicity and had a higher body mass index. The study also indicates that women with gestational diabetes mellitus were likely to experience birth problems leading to cesarean delivery. However, women with gestational diabetes mellitus giving birth to twins are less likely to risk hypertension. The current study shows significant findings concerning women with singleton and twin pregnancies. The study establishes that gestational diabetes mellitus is associated with increased fetal growth among both twin and singleton pregnancies. However, it is essential to note that gestational diabetes mellitus may have a protective role because of fewer neonatal complications, including birth trauma and shoulder dystocia. The study also indicates that gestational diabetes mellitus leads to jaundice requiring phototherapy both in singleton and twin pregnancies. However, singleton pregnancies are associated with higher neonatal respiratory and hypoglycemia risks among women with gestational diabetes mellitus. Notably, the study indicates a similarity between neonatal hypoglycemia rates between singleton and twins without or with gestational diabetes mellitus. However, the condition is likely to be higher among singleton pregnancies without gestational diabetes mellitus.  

In conclusion, the researchers found that, in contrast to singleton pregnancies, gestational diabetes mellitus in twins was not associated with hypertensive complications and certain neonatal morbidities. However, gestational diabetes in twin pregnancies is still associated with some adverse pregnancy outcomes, including accelerated fetal growth. The researchers report both strengths and limitations in conducting their research. A larger sample size, including singleton and twin pregnant women and data availability, forms the study’s power.  

 

Practice Pearls: 

  • Gestational diabetes mellitus among women is linked to the healthy lifestyle of maternal women.  
  • Gestational diabetes mellitus leads to jaundice, requiring phototherapy both in singleton and twin pregnancies.  
  • Gestational diabetes mellitus is associated with increased fetal growth, hypersensitive disorders, and other complications such as neonatal respiratory issues. 

 

Hiersch, Liran, et al. “Gestational diabetes mellitus is associated with adverse outcomes in twin pregnancies.” American journal of obstetrics and gynecology 220.1 (2019): 102-e1.  

 

Sandra Zaki, PharmD Candidate, Florida A&M University