997: Is Gestational Diabetes Associated with Adverse Pregnancy Outcome in Women with Twin Pregnancies?

Abstract

Gestational diabetes mellitus (GDM) is associated with adverse outcomes in singleton pregnancies. However, in twin pregnancies, some of these complications may be either less clinically relevant (e.g., macrosomia, shoulder dystocia) or may be common irrespective of GDM (e.g., preeclampsia, CS, hypoglycemia). We aimed to assess the association between GDM and pregnancy complications in twin gestations, and to compare it to that observed among singletons using a large population-based cohort. The study group included all women with a twin pregnancy who gave birth in Ontario, Canada between 2012-2016. Data were obtained from the Better Outcomes Registry & Network (BORN) Ontario database (N=3,964). Pregnancy outcomes were compared between women with and without GDM. Similar analysis was performed for women with singleton pregnancies (N=267,503). Risk ratios (RR) and 95% CIs were adjusted for maternal age, parity, pre-pregnancy BMI, fertility treatments, and gestational weight gain. 1) The rate of GDM was higher in twins compared to singletons (8.3% vs. 6.3%, p<0.001). 2) With respect to maternal complications, GDM was associated with an increased risk (aRR, 95%CI) for gestational hypertension (1.66, 1.55-1.77), preeclampsia (1.29, 1.09-1.53) and induction of labor (1.68, 1.65-1.72) in singletons but not in twin pregnancies (Table 1). GDM was associated with an increased risk for preterm delivery and Cesarean delivery in both singleton and twin groups (Table 1). 3) With respect to neonatal outcome, GDM was associated with an increased risk of birthweight >90th% in both twins and singletons, but the risk was about 2-fold higher in twins (Table 2). While GDM was associated with a similar increase in the risk of jaundice in both twins and singletons, GDM was associated with NICU admission and neonatal hypoglycemia only in singletons (Table 2). The association of GDM with pregnancy complications differs between singleton and twin pregnancies, possibly due to the higher baseline risk of prematurity and hypertensive complications in twin pregnancies. Still, the current study highlights that GDM is also associated with certain adverse maternal and neonatal outcomes in twin pregnancies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)