Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
J Matern Fetal Neonatal Med. 2021 Aug;34(16):2677-2681. doi: 10.1080/14767058.2019.1670805. Epub 2019 Oct 3.
Gestational diabetes mellitus (GDM) results in an increased risk for maternal and neonatal complications in singletons. In twin pregnancies, however, scarce data exist regarding its implications.
To investigate whether a diagnosis of GDM in twin gestation poses a risk for subsequent maternal long-term cardiovascular morbidity.
A population-based cohort study was conducted, comparing the incidence of cardiovascular morbidity within a group of women with and without a diagnosis of GDM who delivered twins in a tertiary medical center, between the years 1991 and 2014. Mothers with pregestational diabetes mellitus, triplet or higher-order multiples, patients lacking prenatal care, patients with known cardiovascular morbidities prior to or during the current pregnancy and fetal malformations or/and chromosomal abnormalities were excluded. Kaplan-Meier's survival curve was used to estimate the cumulative incidence of cardiovascular-related hospitalizations, and a Cox proportional hazards model was used to estimate the adjusted HRs for cardiovascular morbidity.
Of 4256 twin deliveries that met the inclusion criteria, 336 (7.9%) occurred in patients that were diagnosed with GDM. During a follow-up period of more than 10 years, with a median of 3431 (0-9172) days in total, patients with GDM had higher rates of simple cardiovascular events as compared to women without diagnosis of GDM (incidence = 7, 2.1%. OR = 2.7, 95% confidence interval (CI) 1.17-6.12, = .03). Total cardiovascular hospitalizations were comparable between the groups. There was no difference between the two groups in the rate of complex cardiovascular events, noninvasive or invasive cardiac diagnostic procedures. In a Cox proportional hazards model, which is adjusted for maternal age, ethnicity, hypertensive disorders, and fertility treatments, GDM in twin pregnancies was not found to be associated with long-term cardiovascular morbidity (adjusted HR 1.41, 95% CI 0.77-2.58, = .26).
While GDM during twin pregnancy might be associated with long-term maternal simple cardiovascular events, the complex, as well as the total morbidities, are comparable to patients without GDM.
妊娠糖尿病（GDM）会增加单胎产妇和新生儿并发症的风险。然而，在双胎妊娠中，关于其影响的相关数据很少。
研究双胎妊娠中 GDM 的诊断是否会增加随后的母体长期心血管发病率。
进行了一项基于人群的队列研究，比较了在 1991 年至 2014 年期间，在一家三级医疗中心分娩的 GDM 组和非 GDM 组妇女的心血管发病率。排除了孕前糖尿病、三胞胎或更高多胎、缺乏产前护理、当前妊娠期间或之前已知心血管疾病的患者以及胎儿畸形或/和染色体异常的患者。Kaplan-Meier 生存曲线用于估计心血管相关住院的累积发病率，Cox 比例风险模型用于估计心血管发病率的调整 HR。
在符合纳入标准的 4256 例双胎分娩中，336 例（7.9%）发生在 GDM 患者中。在超过 10 年的随访期间，中位随访时间为 3431 天（0-9172 天），GDM 患者的单纯心血管事件发生率高于未诊断为 GDM 的患者（发生率=7，2.1%；OR=2.7，95%CI 1.17-6.12， = .03）。两组之间的总心血管住院率无差异。两组之间的复杂心血管事件、非侵入性或侵入性心脏诊断程序的发生率也无差异。在调整了母亲年龄、种族、高血压疾病和生育治疗的 Cox 比例风险模型中，GDM 与双胎妊娠的长期心血管发病率无关（调整 HR 1.41，95%CI 0.77-2.58， = .26）。
虽然双胎妊娠期间的 GDM 可能与长期母体单纯心血管事件有关，但复杂事件以及总发病率与没有 GDM 的患者相当。
