Department of Public Health, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Int J Gynaecol Obstet. 2024 Mar;164(3):1047-1052. doi: 10.1002/ijgo.15090. Epub 2023 Sep 12.
To assess whether the risk for future diabetes is higher among women diagnosed with gestational diabetes (GD) during twin versus singleton gestations.
A retrospective cohort study was performed including all women who delivered at a tertiary medical center between the years 1991 and 2021 and had at least one GD diagnosis. The first GD diagnosis per women was defined as the index pregnancy. Women diagnosed with GD during multiple gestations were compared with women diagnosed with GD during singleton gestations. The outcomes included first hemoglobin A1C (Hba1C) level > 6.4 mg/dL post partum, and the highest level measured during the follow-up period of up to 30 years. Multivariable logistic and Cox proportional analysis were used to compare the risk between the two groups while adjusting for confounding variables.
The current study included 13 770 mothers, with 458 patients (3.3%) diagnosed with GD during twin gestations and 13 312 (96.7%) during singleton gestations. The mean follow-up was 12.25 ± 9.3 years. Mothers of both groups did not differ in age at index pregnancy; however, mothers of twins were more likely to conceive following fertility treatments. Incidence of diabetes and prediabetes (defined as Hba1C > 6.4 and >5.7, respectively) were lower among the twin-gestation group, both during the 6-month postpartum period (for diabetes: 15.5% vs 22.1%; odds ratio [OR], 0.65 [95% confidence interval (CI), 0.46-0.91]) and during the long-term follow-up (for diabetes: 31.8% vs 40.7%; OR, 0.68 [95% CI, 0.52-0.88]). These results remained significant in the multivariable analysis, while accounting for age, ethnicity, and fertility treatments.
GD diagnosis during multiple versus singleton gestations is associated with a lower risk for future diabetes.
评估在双胎妊娠和单胎妊娠中诊断为妊娠期糖尿病（GDM）的女性未来发生糖尿病的风险是否更高。
本研究为回顾性队列研究，纳入了 1991 年至 2021 年在一家三级医疗中心分娩的至少有一次 GDM 诊断的所有女性。每位女性的首次 GDM 诊断定义为指数妊娠。将多胎妊娠中诊断为 GDM 的女性与单胎妊娠中诊断为 GDM 的女性进行比较。主要结局为产后首次血红蛋白 A1C（HbA1C）水平＞6.4mg/dL，以及在长达 30 年的随访期间测量的最高水平。使用多变量逻辑和 Cox 比例风险分析比较两组之间的风险，同时调整混杂变量。
本研究共纳入了 13770 名母亲，其中 458 名（3.3%）在双胎妊娠中诊断为 GDM，13312 名（96.7%）在单胎妊娠中诊断为 GDM。平均随访时间为 12.25±9.3 年。两组母亲的指数妊娠年龄无差异；然而，双胎妊娠的母亲更有可能在接受生育治疗后怀孕。在产后 6 个月内（糖尿病：15.5%比 22.1%；比值比 [OR]，0.65[95%置信区间（CI），0.46-0.91]）和长期随访期间（糖尿病：31.8%比 40.7%；OR，0.68[95%CI，0.52-0.88]），双胎妊娠组的糖尿病和糖尿病前期（定义为 HbA1C＞6.4 和＞5.7）的发生率均较低。这些结果在多变量分析中仍然显著，同时考虑了年龄、种族和生育治疗。
与单胎妊娠相比，多胎妊娠中诊断为 GDM 与未来发生糖尿病的风险较低相关。
