Department of Obstetrics and Gynecology, Universita' degli Studi della Campania, Luigi Vanvitelli, Naples, Italy.
The Royal London Hospital, Barts Health NHS Trust, London UK.
Curr Diabetes Rev. 2023;19(2):e260422204032. doi: 10.2174/1573399818666220426085843.
The concurrent, recent increase in prevalence of Gestational Diabetes Mellitus (GDM) and twin pregnancy, in combination with the shared risk factors, has led to speculation that multiples are a risk factor for GDM and, GDM may contribute to twin complications. Twin pregnancies have different physiology and greater obstetric risks compared to singletons, including prematurity and growth restriction. However, in twins methods of GDM screening, thresholds for diagnosis and treatment, as well as glycaemic control targets, have been predominantly extrapolated from singletons. Studies investigating the impact of GDM on pregnancy outcomes in twin pregnancies are conflicting.
To provide a comprehensive, critical overview of evidence on GDM in twin pregnancies with an emphasis on prevalence, methods of screening, thresholds for diagnosis, risk of pregnancy complications and the impact of treatment on perinatal outcomes.
Review of retrospective and prospective cohort, case-control, and case-series studies on twin pregnancies with GDM published between 1980 and 2021.
Glucose tolerance in twin pregnancies is poorly studied. Specific guidance for screening, diagnosis, and treatment of GDM in twins is lacking. Studies evaluating pregnancy outcomes in twins with GDM are few and heterogeneous. The absolute risk of maternal complications is greater in twins with GDM compared to singletons; conversely, differences in risks between twins with and without GDM may be due to maternal confounders rather than to GDM. Most studies agree on a positive effect of GDM on neonatal outcomes in twins, likely mediated by the hyperglycaemia improving fetal growth. The impact of lifestyle-measures versus medical management on pregnancy outcomes in twins with GDM is unknown.
Larger longitudinal studies evaluating glucose tolerance, pregnancy outcomes and the impact of treatment both in mono and di-chorionic twins with GDM are warranted to gain further insight into the pathophysiology of this condition and guide optimal management.
妊娠糖尿病（GDM）和双胞胎妊娠的患病率最近同时增加，再加上两者有共同的风险因素，因此人们推测多胎妊娠是 GDM 的一个风险因素，而 GDM 可能会导致双胞胎妊娠并发症。与单胎妊娠相比，双胎妊娠的生理学和产科风险更大，包括早产和生长受限。然而，在双胎妊娠中，GDM 的筛查方法、诊断和治疗阈值以及血糖控制目标主要是从单胎妊娠中推断出来的。研究表明 GDM 对双胎妊娠的妊娠结局有影响，但结果相互矛盾。
全面、批判性地综述 GDM 在双胎妊娠中的证据，重点关注 GDM 的患病率、筛查方法、诊断阈值、妊娠并发症风险以及治疗对围产儿结局的影响。
回顾了 1980 年至 2021 年间发表的关于 GDM 双胎妊娠的回顾性和前瞻性队列研究、病例对照研究和病例系列研究。
双胎妊娠中的葡萄糖耐量研究较少。缺乏针对双胎妊娠 GDM 的筛查、诊断和治疗的具体指导。评估 GDM 双胎妊娠结局的研究较少且存在异质性。与单胎妊娠相比，患有 GDM 的双胎妊娠的母亲并发症风险更大；相反，患有 GDM 的双胎妊娠与无 GDM 的双胎妊娠之间的风险差异可能是由于母亲混杂因素而不是 GDM 导致的。大多数研究都认为 GDM 对双胎新生儿结局有积极影响，这可能是由于高血糖改善了胎儿生长。在 GDM 双胎妊娠中，生活方式干预与药物治疗对妊娠结局的影响尚不清楚。
需要更大规模的纵向研究来评估 GDM 双胎妊娠的葡萄糖耐量、妊娠结局以及治疗的影响，以便更深入地了解这种疾病的病理生理学，并指导最佳管理。
