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Incidence and risk factors for gestational diabetes mellitus in twin versus singleton pregnancies

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To compare the incidence and risk factors for gestational diabetes mellitus (GDM) between women with twin and singleton pregnancies.

Methods

Retrospective study of all women who had a twin or singleton birth in Ontario (2012–2016). Risk ratios (RR) and 95% CIs for GDM (stratified by type of treatment) were adjusted for relevant confounding variables. Multivariable Poisson regression analysis was used to identify risk factors for GDM in twin and singleton gestations.

Results

Of 270,843 women who met inclusion criteria, 266,942 (98.6%) and 3901 (1.4%) had a singleton and a twin pregnancy, respectively. Women with twins had a significantly higher risk for overall GDM (aRR = 1.13, 95% CI 1.01–1.28) and diet-treated GDM (aRR = 1.20, 95% CI 1.01–1.42) while the association with insulin-treated GDM was not significant (aRR = 1.07, 95% CI 0.89–1.28). Maternal age ≥ 35 years, non-Caucasian ethnicity and BMI > 30 kg/m2 were independent risk factors for GDM among women with twins and singletons, and the magnitude of the association of these factors with GDM was similar.

Conclusions

Women with twins are at increased risk of GDM, mainly due to a higher rate of diet-treated GDM. Despite higher baseline risk of GDM in women with twins, the effect of known risk factors for GDM is similar to that observed in singletons.

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References

  1. Chauhan SP, Scardo JA, Hayes E, Abuhamad AZ, Berghella V (2010) Twins: prevalence, problems, and preterm births. Am J Obstet Gynecol 203:305–315

    Article  PubMed  Google Scholar 

  2. Rauh-Hain JA, Rana S, Tamez H, Wang A, Cohen B, Cohen A, Brown F, Ecker JL, Karumanchi SA, Thadhani R (2009) Risk for developing gestational diabetes in women with twin pregnancies. J Matern Fetal Neonatal Med 22:293–299

    Article  PubMed  Google Scholar 

  3. Lai FY, Johnson JA, Dover D, Kaul P (2016) Outcomes of singleton and twin pregnancies complicated by pre-existing diabetes and gestational diabetes: a population-based study in Alberta, Canada, 2005–11. J Diabetes 8:45–55

    Article  PubMed  Google Scholar 

  4. Wang YA, Nikravan R, Smith HC, Sullivan EA (2013) Higher prevalence of gestational diabetes mellitus following assisted reproduction technology treatment. Hum Reprod 28:2554–2561

    Article  PubMed  CAS  Google Scholar 

  5. Retnakaran R, Shah BR (2016) Impact of twin gestation and fetal sex on maternal risk of diabetes during and after pregnancy. Diabetes Care 39:e110–e111

    Article  PubMed  CAS  Google Scholar 

  6. Yogev Y, Eisner M, Hiersch L, Hod M, Wiznitzer A, Melamed N (2014) The performance of the screening test for gestational diabetes in twin versus singleton pregnancies. J Matern Fetal Neonatal Med 27:57–61

    Article  PubMed  Google Scholar 

  7. Spellacy WN, Handler A, Ferre CD (1990) A case-control study of 1253 twin pregnancies from a 1982–1987 perinatal data base. Obstet Gynecol 75:168–171

    PubMed  CAS  Google Scholar 

  8. Buhling KJ, Henrich W, Starr E, Lubke M, Bertram S, Siebert G, Dudenhausen JW (2003) Risk for gestational diabetes and hypertension for women with twin pregnancy compared to singleton pregnancy. Arch Gynecol Obstet 269:33–36

    Article  PubMed  Google Scholar 

  9. Henderson CE, Scarpelli S, LaRosa D, Divon MY (1995) Assessing the risk of gestational diabetes in twin gestation. J Natl Med Assoc 87:757–758

    PubMed  PubMed Central  CAS  Google Scholar 

  10. Simoes T, Queiros A, Correia L, Rocha T, Dias E, Blickstein I (2011) Gestational diabetes mellitus complicating twin pregnancies. J Perinat Med 39:437–440

    PubMed  Google Scholar 

  11. Committee Canadian Diabetes Association Clinical Practice Guidelines Expert (2008) Canadian diabetes association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 32(Suppl 1):S1–S201

    Google Scholar 

  12. Shinagawa S, Suzuki S, Chihara H, Otsubo Y, Takeshita T, Araki T (2005) Maternal basal metabolic rate in twin pregnancy. Gynecol Obstet Invest 60:145–148

    Article  PubMed  Google Scholar 

  13. Marconi AM, Davoli E, Cetin I, Lanfranchi A, Zerbe G, Fanelli R, Fennessey PV, Pardi G, Battaglia FC (1993) Impact of conceptus mass on glucose disposal rate in pregnant women. Am J Physiol 264:E514–E518

    PubMed  CAS  Google Scholar 

  14. Schwartz DB, Daoud Y, Zazula P, Goyert G, Bronsteen R, Wright D, Copes J (1999) Gestational diabetes mellitus: metabolic and blood glucose parameters in singleton versus twin pregnancies. Am J Obstet Gynecol 181:912–914

    Article  PubMed  CAS  Google Scholar 

  15. Luo ZC, Simonet F, Wei SQ, Xu H, Rey E, Fraser WD (2011) Diabetes in pregnancy may differentially affect neonatal outcomes for twins and singletons. Diabet Med 28:1068–1073

    Article  PubMed  CAS  Google Scholar 

  16. Foeller ME, Zhao S, Szabo A, Cruz MO (2015) Neonatal outcomes in twin pregnancies complicated by gestational diabetes compared with non-diabetic twins. J Perinatol 35:1043–1047

    Article  PubMed  CAS  Google Scholar 

  17. Guillen MA, Herranz L, Barquiel B, Hillman N, Burgos MA, Pallardo LF (2014) Influence of gestational diabetes mellitus on neonatal weight outcome in twin pregnancies. Diabet Med 31:1651–1656

    Article  PubMed  CAS  Google Scholar 

  18. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee (2013) Canadian diabetes association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 37(Suppl 1):S1–S212

    Google Scholar 

  19. Tward C, Barrett J, Berger H, Kibel M, Pittini A, Halperin I, Cohen H, Melamed N (2016) Does gestational diabetes affect fetal growth and pregnancy outcome in twin pregnancies? Am J Obstet Gynecol 214(653):e651–e658

    Google Scholar 

  20. Okby R, Weintraub AY, Sergienko R, Eyal S (2014) Gestational diabetes mellitus in twin pregnancies is not associated with adverse perinatal outcomes. Arch Gynecol Obstet 290:649–654

    Article  PubMed  Google Scholar 

  21. Moses RG, Webb AJ, Lucas EM, Davis WS (2003) Twin pregnancy outcomes for women with gestational diabetes mellitus compared with glucose tolerant women. Aust N Z J Obstet Gynaecol 43:38–40

    Article  PubMed  Google Scholar 

  22. Fox NS, Gerber RS, Saltzman DH, Gupta S, Fishman AY, Klauser CK, Rebarber A (2016) Glycemic control in twin pregnancies with gestational diabetes: are we improving or worsening outcomes? J Matern Fetal Neonatal Med 29:1041–1045

    Article  PubMed  Google Scholar 

  23. Morikawa M, Yamada T, Akaishi R, Kojima T, Nishida R, Koyama T, Cho K, Minakami H (2015) Prevalence of hyperglycaemia in singleton versus twin pregnancy. Diabetes Metab Res Rev 31:198–203

    Article  PubMed  CAS  Google Scholar 

  24. Wein P, Warwick MM, Beischer NA (1992) Gestational diabetes in twin pregnancy: prevalence and long-term implications. Aust N Z J Obstet Gynaecol 32:325–327

    Article  PubMed  CAS  Google Scholar 

  25. Wegrzyn P, Fabio C, Peralta A, Faro C, Borenstein M, Nicolaides KH (2006) Placental volume in twin and triplet pregnancies measured by three-dimensional ultrasound at 11 + 0 to 13 + 6 weeks of gestation. Ultrasound Obstet Gynecol 27:647–651

    Article  PubMed  CAS  Google Scholar 

  26. Almog B, Shehata F, Aljabri S, Levin I, Shalom-Paz E, Shrim A (2011) Placenta weight percentile curves for singleton and twins deliveries. Placenta 32:58–62

    Article  PubMed  CAS  Google Scholar 

  27. Taricco E, Radaelli T, Nobile de Santis MS, Cetin I (2003) Foetal and placental weights in relation to maternal characteristics in gestational diabetes. Placenta 24:343–347

    Article  PubMed  CAS  Google Scholar 

  28. Daskalakis G, Marinopoulos S, Krielesi V, Papapanagiotou A, Papantoniou N, Mesogitis S, Antsaklis A (2008) Placental pathology in women with gestational diabetes. Acta Obstet Gynecol Scand 87:403–407

    Article  PubMed  Google Scholar 

  29. Kazer RR, Cheng ER, Unterman TG, Glick RP (1991) Maternal plasma concentrations of insulin-like growth factor-I (IGF-I) and human placental lactogen (hPL) in twin pregnancies. Acta Genet Med Gemellol 40:383–387

    Article  PubMed  CAS  Google Scholar 

  30. Thiery M, Dhont M, Vandekerckhove D (1977) Serum HCG and HPL in twin pregnancies. Acta Obstet Gynecol Scand 56:495–497

    Article  PubMed  CAS  Google Scholar 

  31. Norwitz ER, Edusa V, Park JS (2005) Maternal physiology and complications of multiple pregnancy. Semin Perinatol 29:338–348

    Article  PubMed  Google Scholar 

  32. Rebarber A, Dolin C, Fields JC, Saltzman DH, Klauser CK, Gupta S, Fox NS (2014) Screening approach for gestational diabetes in twin pregnancies. Am J Obstet Gynecol 211(639):e631–e635

    Google Scholar 

  33. Lucovnik M, Blickstein I, Verdenik I, Steblovnik L, Trojner Bregar A, Tul N (2014) Impact of pre-gravid body mass index and body mass index change on preeclampsia and gestational diabetes in singleton and twin pregnancies. J Matern Fetal Neonatal Med 27:1901–1904

    Article  PubMed  CAS  Google Scholar 

  34. de Wilde MA, Veltman-Verhulst SM, Goverde AJ, Lambalk CB, Laven JS, Franx A, Koster MP, Eijkemans MJ, Fauser BC (2014) Preconception predictors of gestational diabetes: a multicentre prospective cohort study on the predominant complication of pregnancy in polycystic ovary syndrome. Hum Reprod 29:1327–1336

    Article  PubMed  CAS  Google Scholar 

  35. Kim C, Berger DK, Chamany S (2007) Recurrence of gestational diabetes mellitus: a systematic review. Diabetes Care 30:1314–1319

    Article  PubMed  Google Scholar 

  36. Kruse AR, Darling MS, Hansen MK, Markman MJ, Lauszus FF, Wielandt HB (2015) Recurrence of gestational diabetes in primiparous women. Acta Obstet Gynecol Scand 94:1367–1372

    Article  PubMed  Google Scholar 

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Funding

This study was funded by Canadian Institute of Health Research (CIHR) (Grant# 146442; Non-communicable Diseases in Obstetrics: Improving Quality of Care and Maternal-infant Outcomes Through an Obstetrical Research Network). Dr. Sarah D. McDonald is supported by a Tier II Canada Research Chair. Dr. Beth Murray-Davis is supported by a Hamilton Health Sciences Early Career Award. None of the funding agencies had any role in the idea, design, analyses, interpretation of data, writing of the manuscript or decision to submit the manuscript.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Liran Hiersch

  2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada

    Howard Berger & Michael Geary

  3. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Rania Okby, Jon Barrett & Nir Melamed

  4. Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada

    Joel G. Ray

  5. Department of Obstetrics, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada

    Joel G. Ray

  6. Department of Gynaecology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada

    Joel G. Ray

  7. Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada

    Sarah D. Mcdonald & Beth Murry-Davis

  8. Department of Radiology, McMaster University, Hamilton, ON, Canada

    Sarah D. Mcdonald & Beth Murry-Davis

  9. Department of Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Sarah D. Mcdonald & Beth Murry-Davis

  10. Better Outcomes Registry and Network (BORN) Ontario, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada

    Catherine Riddell & Haroon Hasan

  11. Department of Endocrinology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Ilana Halperin

Authors
  1. Liran Hiersch
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  2. Howard Berger
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  3. Rania Okby
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  4. Joel G. Ray
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  5. Michael Geary
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  6. Sarah D. Mcdonald
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  7. Beth Murry-Davis
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  8. Catherine Riddell
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  9. Ilana Halperin
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  10. Haroon Hasan
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  11. Jon Barrett
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  12. Nir Melamed
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Consortia

for DOH-NET (Diabetes, Obesity and Hypertension in Pregnancy Research Network) and SOON (Southern Ontario Obstetrical Network) Investigators™

Contributions

LH researched data, wrote the manuscript and reviewed/edited the manuscript. HB reviewed the protocol involved in study design, reviewed and edited the manuscript. RO involved in the study design, protocol development, literature search. JGR reviewed and edited the manuscript. MG reviewed and edited the manuscript. SDM reviewed and edited the manuscript. BMD reviewed and edited the manuscript. RC data extraction, data analysis. IH involved in the conception of the study, writing of the protocol. HH data extraction, data analysis. JB assisted with the conception of the study, design, manuscript writing. NM researched data, wrote the manuscript and reviewed/edited the manuscript.

Corresponding author

Correspondence to Liran Hiersch.

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The authors declare that they have no conflict of interest.

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Hiersch, L., Berger, H., Okby, R. et al. Incidence and risk factors for gestational diabetes mellitus in twin versus singleton pregnancies. Arch Gynecol Obstet 298, 579–587 (2018). https://doi.org/10.1007/s00404-018-4847-9

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  • DOI: https://doi.org/10.1007/s00404-018-4847-9

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