Fox Nathan S, Gerber Rachel S, Saltzman Daniel H, Gupta Simi, Fishman Ariel Y, Klauser Chad K, Rebarber Andrei
a Maternal Fetal Medicine Associates , PLLC, New York , NY , USA .
b The Department of Obstetrics, Gynecology, and Reproductive Science , Icahn School of Medicine at Mount Sinai , New York , NY , USA .
J Matern Fetal Neonatal Med. 2016;29(7):1041-5. doi: 10.3109/14767058.2015.1038517. Epub 2015 May 4.
To estimate the association between glycemic control and adverse outcomes in twin pregnancies with gestational diabetes (GDM).
A cohort of patients with twin pregnancies and GDM were identified from one maternal-fetal medicine practice from 2005 to 2014. Patients with prepregnancy diabetes were excluded. First, outcomes were compared between patients with GDMA1 and GDMA2 (gestational age at delivery, birthweight, small for gestational age (SGA, birthweight <10th percentile), preeclampsia, and cesarean delivery). Then, finger stick glucose logs were reviewed and correlated with the risk of SGA and preeclampsia. Abnormal finger stick values were defined as: fasting ≥ 90 mg/dL, 1-h postprandial ≥ 140 mg/dL, 2-h postprandial ≥ 120 mg/dL.
Sixty-six patients with twin pregnancies and GDM were identified (incidence 9.1%). Comparing the 43 patients with GDMA1 to the 23 patients with GDMA2, outcomes were similar, aside from patients with GDMA1 having lower birthweight of the smaller twin (2184 ± 519 g versus 2438 ± 428 g, p = 0.040). The risk of preeclampsia was not associated with glycemic control. Patients with SGA had lower mean fasting values (83.3 ± 5.5 versus 87.2 ± 7.7 mg/dL, p = 0.033), and a lower percentage of abnormal fasting values (24.0% versus 36.9%, p = 0.040), abnormal post-breakfast values (9.9% versus 27.1%, p = 0.003), and total abnormal values (20.1% versus 27.7%, p = 0.055).
In twin pregnancies with GDM, improved glycemic control is not associated with improved outcomes, and is associated with a higher risk of SGA. Prospective trials in twin pregnancies should be performed to establish goals for glycemic control in twin pregnancies.
评估妊娠糖尿病（GDM）双胎妊娠患者血糖控制与不良结局之间的关联。
从一家母胎医学诊所中确定了一组2005年至2014年期间患有双胎妊娠和GDM的患者。排除孕前糖尿病患者。首先，比较了A1级GDM患者和A2级GDM患者的结局（分娩孕周、出生体重、小于胎龄儿（SGA，出生体重<第10百分位数）、子痫前期和剖宫产）。然后，回顾手指血糖记录，并将其与SGA和子痫前期的风险相关联。异常手指血糖值定义为：空腹≥90mg/dL，餐后1小时≥140mg/dL，餐后2小时≥120mg/dL。
确定了66例双胎妊娠合并GDM的患者（发病率9.1%）。将43例A1级GDM患者与23例A2级GDM患者进行比较，除A1级GDM患者较小胎儿的出生体重较低外（2184±519g对2438±428g，p=0.040），其他结局相似。子痫前期的风险与血糖控制无关。SGA患者的平均空腹血糖值较低（83.3±5.5对87.2±7.7mg/dL，p=0.033），空腹血糖异常值的百分比更低（24.0%对36.9%，p=0.040），早餐后血糖异常值的百分比更低（9.9%对27.1%，p=0.003），以及总异常值的百分比更低（20.1%对27.7%，p=0.055）。
在GDM双胎妊娠中，改善血糖控制与改善结局无关，且与SGA风险较高相关。应进行双胎妊娠的前瞻性试验，以确定双胎妊娠血糖控制的目标。
