Influence of gestational diabetes mellitus on neonatal weight outcome in twin pregnancies

• Published in: Diabetic medicine Vol. 31; no. 12; pp. 1651 - 1656
• Main Authors: Guillén, M. A., Herranz, L., Barquiel, B., Hillman, N., Burgos, M. A., Pallardo, L. F.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01-12-2014; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Biological and medical sciences; Birth Weight; Body Mass Index; Case-Control Studies; Delivery, Obstetric; Diabetes; Diabetes, Gestational - drug therapy; Diabetes, Gestational - epidemiology; Endocrinopathies; Feeding. Feeding behavior; Female; Fetal Macrosomia - epidemiology; Fundamental and applied biological sciences. Psychology; Gestational Age; Humans; Hypertension, Pregnancy-Induced - epidemiology; Hypoglycemic Agents - therapeutic use; Infant, Newborn; Insulin - therapeutic use; Male; Medical sciences; Overweight - epidemiology; Pre-Eclampsia - epidemiology; Pregnancy; Pregnancy, Twin; Reproductive Techniques, Assisted - statistics & numerical data; Retrospective Studies; Risk Factors; Smoking - epidemiology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Spain; Human; Obesity; Neonatal; Prognosis; Nutrition; Body weight; Nutrition disorder; Metabolic diseases; Corporal biometry; Maternal diseases; Newborn; Multiple pregnancy; Evolution; Gestational diabetes; Twin pregnancy; Endocrinology; Nutritional status
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12523

Aims
To evaluate the influence of gestational diabetes mellitus on neonatal birthweight, macrosomia and weight discrepancy in twin neonates.
Methods
An observational retrospective study was performed. One hundred and six women with gestational diabetes and twin pregnancy and 166 twin controls who delivered viable fetuses > 24 weeks were included. Impact of maternal pre‐pregnancy BMI, smoking habit, method of conception, chorionicity, gestational age at delivery, mode of delivery and hypertensive complications were also analysed. The effect of maternal hyperglycaemia and metabolic control in gestational diabetes pregnancies was assessed.
Results
Gestational hypertension and pre‐eclampsia were significantly higher in the group with gestational diabetes (21.5% vs. 6.3%, P = 0.007 and 6.2% vs. 0%, P = 0.025). There were no differences in the incidence of macrosomia (5.7% vs. 7.2%, P = 0.803), large for gestational age (10.3% vs. 13.2%, P = 0.570), small for gestational age (10.3% vs. 12.0%, P = 0.701), severely small for gestational age (6.6% vs. 7.8%, P = 0.814) or weight discrepancy (20.6% vs. 15.2%, P = 0.320) in the group with gestational diabetes compared with twin pregnancies without diabetes. There were no differences when comparing insulin‐requiring gestational diabetes pregnancies and twins without diabetes for any of the neonatal weight outcomes. There was no relationship between third trimester HbA1c and neonatal birthweight or infant birthweight ratio.
Conclusion
Gestational diabetes did not increase the risk of macrosomia or weight discrepancy of twin newborns. Furthermore, glycaemic control did not influence the rate of any of the weight outcomes in our study population. In twin pregnancies, gestational diabetes was associated with a higher risk of gestational hypertension and pre‐eclampsia.
What's new?
Although gestational diabetes mellitus is clearly associated with macrosomia, its influence on weight outcome (including macrosomia, growth restriction and growth discrepancy) in twin pregnancies remains controversial.
In our study population, there were no differences in the incidence of macrosomia, large for gestational age, small for gestational age; severely small for gestational age or weight discrepancy between twin pregnancies complicated by gestational diabetes and controls. Neither were there differences when comparing insulin‐requiring gestational diabetes pregnancies and the control group for any of the neonatal weight outcomes. There was no relationship between third trimester HbA1c and neonatal birthweight or infant birthweight ratio.
Maternal mild hyperglycaemia may be physiological or ‘beneficial’ on twin pregnancies as a response for an increased demand of energy and nutrients, counterbalancing other known factors responsible for growth restriction in these pregnancies.