Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.
Am J Perinatol. 2024 Apr;41(5):628-634. doi: 10.1055/s-0042-1743184. Epub 2022 Feb 21.
Existing data suggest that obstetric outcomes for individuals with twin gestations, who have gestational diabetes mellitus (GDM), may be comparable to those who do not have GDM, yet studies are limited by small sample sizes. The aim of this study was to examine differences in maternal and neonatal outcomes of individuals with twin gestations based on presence of GDM.
This was a population-based retrospective cohort study of individuals giving birth to twins in the United States between 2012 and 2014. Inclusion criteria were live births (≥24 weeks) and available information on GDM status; individuals with pregestational diabetes were excluded. Participants were categorized as either having had or not had GDM. Multivariable logistic regression was utilized to assess the independent association of GDM with adverse maternal outcomes, whereas generalized estimating equation models were used to estimate associations with neonatal outcomes to account for clustering.
Of 173,196 individuals meeting inclusion criteria, 13,194 (7.6%) had GDM. Individuals with GDM were more likely to be older, identify as Hispanic or Asian race and ethnicity, married, college educated, privately insured, and obese than those without GDM. After adjusting for potential confounding variables, those with GDM were more likely to have hypertensive disorders (18.0 vs. 10.2%) and undergo cesarean delivery (51.2 vs. 47.3%). Neonates born to individuals with GDM were more likely to require mechanical ventilation for greater than 6 hours (6.5 vs. 5.6%) and experience neonatal intensive care unit (NICU) admission (41.1 vs. 36.2%), but were less likely to be low birth weight or have small for gestational age status (16.2 vs. 19.5%). Findings were confirmed in a sensitivity analysis of neonates born at 32 weeks of gestation or greater.
Odds of poor obstetric and neonatal outcomes are increased for individuals with twin gestations complicated by GDM.
· Individuals with GDM and twin gestation have higher odds of developing hypertensive disorders during pregnancy and of undergoing cesarean delivery.. · Neonates of such pregnancies are less likely to be low birth weight or small for gestational age.. · Neonates of pregnancies complicated by GDM and twin gestation are more likely to require mechanical ventilation and experience NICU admission..
现有数据表明，患有妊娠期糖尿病（GDM）的双胎妊娠个体的产科结局可能与未患 GDM 的个体相当，但这些研究受到样本量小的限制。本研究的目的是基于 GDM 的存在，检查双胎妊娠个体的母婴结局差异。
这是一项基于人群的回顾性队列研究，纳入了 2012 年至 2014 年期间在美国分娩的双胎妊娠个体。纳入标准为活产（≥24 周）和 GDM 状态的可用信息；排除了孕前糖尿病患者。参与者分为患有或未患有 GDM。多变量逻辑回归用于评估 GDM 与不良母婴结局的独立关联，而广义估计方程模型用于估计与新生儿结局的关联，以考虑聚类。
在符合纳入标准的 173196 名个体中，有 13194 名（7.6%）患有 GDM。患有 GDM 的个体比未患有 GDM 的个体更年长、更可能是西班牙裔或亚洲种族和民族、已婚、受过大学教育、私人保险和肥胖。在调整了潜在混杂变量后，患有 GDM 的个体更有可能患有高血压疾病（18.0% vs. 10.2%）和接受剖宫产（51.2% vs. 47.3%）。患有 GDM 的个体的新生儿更有可能需要机械通气超过 6 小时（6.5% vs. 5.6%）和入住新生儿重症监护病房（NICU）（41.1% vs. 36.2%），但更不可能为低出生体重或小于胎龄（16.2% vs. 19.5%）。在对 32 周或以上分娩的新生儿进行的敏感性分析中，也证实了这些发现。
患有 GDM 和双胎妊娠的个体发生不良产科和新生儿结局的几率增加。
·患有 GDM 和双胎妊娠的个体在怀孕期间出现高血压疾病和接受剖宫产的几率更高。·此类妊娠的新生儿体重较低或小于胎龄的可能性较小。·患有 GDM 和双胎妊娠的孕妇的新生儿更有可能需要机械通气和入住新生儿重症监护病房。
