Trends in Prevalence of Diabetes among Twin Pregnancies and Perinatal Outcomes in Catalonia between 2006 and 2015: The DIAGESTCAT Study.

Lucia Gortazar,Juana Antonia Flores-Le Roux,Juan Pedro-Botet,Albert Goday,Eugènia Sarsanedas,Antonio Payà,Humberto Navarro,Laura Mañé,David Benaiges

doi:10.3390/jcm10091937

Abstract

The aims of our study were to evaluate the trends in the prevalence of diabetes among twin pregnancies in Catalonia, Spain between 2006 and 2015, to assess the influence of diabetes on perinatal outcomes of twin gestations and to ascertain the interaction between twin pregnancies and glycaemic status. A population-based study was conducted using the Spanish Minimum Basic Data Set. Cases of gestational diabetes mellitus (GDM) and pre-existing diabetes were identified using ICD-9-CM codes. Data from 743,762 singleton and 15,956 twin deliveries between 2006 and 2015 in Catalonia was analysed. Among twin pregnancies, 1088 (6.82%) were diagnosed with GDM and 83 (0.52%) had pre-existing diabetes. The prevalence of GDM among twin pregnancies increased from 6.01% in 2006 to 8.48% in 2015 (p < 0.001) and the prevalence of pre-existing diabetes remained stable (from 0.46% to 0.27%, p = 0.416). The risk of pre-eclampsia was higher in pre-existing diabetes (15.66%, p = 0.015) and GDM (11.39%, p < 0.001) than in normoglycaemic twin pregnancies (7.55%). Pre-existing diabetes increased the risk of prematurity (69.62% vs. 51.84%, p = 0.002) and large-for-gestational-age (LGA) infants (20.9% vs. 11.6%, p = 0.001) in twin gestations. An attenuating effect on several adverse perinatal outcomes was found between twin pregnancies and the presence of GDM and pre-existing diabetes. As a result, unlike in singleton pregnancies, diabetes did not increase the risk of all perinatal outcomes in twins and the effect of pre-existing diabetes on pre-eclampsia and LGA appeared to be attenuated. In conclusion, prevalence of GDM among twin pregnancies increased over the study period. Diabetes was associated with a higher risk of pre-eclampsia, prematurity and LGA in twin gestations. However, the impact of both, pre-existing diabetes and GDM, on twin pregnancy outcomes was attenuated when compared with its impact on singleton gestations.

Highlights

Diabetes mellitus (DM) is the most frequent metabolic complication of pregnancy.Pre-existing diabetes and gestational diabetes mellitus (GDM) affect around 0.3–0.6%and 2–10% of pregnancies, respectively, in Europe [1,2,3,4,5], and there is evidence that the prevalence of diabetes in pregnancy is rising worldwide [6,7,8]
Regarding obstetric and perinatal outcomes in twin pregnancies, diabetes, both pre-existing and GDM, were associated with an increased risk of pre-eclampsia compared to normoglycaemic women
Prematurity and LGA were more frequent in women with pre-existing diabetes than in non-diabetic mothers

Summary

Introduction

Diabetes mellitus (DM) is the most frequent metabolic complication of pregnancy. 2–10% of pregnancies, respectively, in Europe [1,2,3,4,5], and there is evidence that the prevalence of diabetes in pregnancy is rising worldwide [6,7,8]. The risk of perinatal complications appears to be greater in pre-existing diabetes than in GDM [11]. Evidence of the effect of diabetes on maternal and perinatal outcomes in twin pregnancies is conflicting. In this respect, population-based studies evaluating epidemiological data in twin pregnancies complicated by diabetes in Southern Europe are scant and few have focused on pre-existing diabetes

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