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Pregestational diabetes is associated with adverse outcomes in twin pregnancies: a regional register-based study

Lookup NU author(s): Dr Jo Darke, Dr Svetlana Glinianaia, Dr Philippa Marsden, Dr Ruth Bell

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Abstract

IntroductionThe incidence of pregnancies complicated by twinning and diabetes is increasing in the UK. This is a worrying trend as both diabetes and twin gestations are associated with a high risk of adverse pregnancy outcomes. The few studies that have specifically addressed how twinning and pregestational diabetes in the same pregnancy may affect outcome have reported conflicting results.Material and methodsWe analyzed data on 27 women with a twin pregnancy and pregestational diabetes (54 babies) and 6407 women with a twin pregnancy without diabetes (12 814 babies) from the Northern Survey of Twin and Multiple Pregnancy during 1998-2010. A composite adverse pregnancy outcome (comprising fetal loss before 24 weeks, termination of pregnancy, stillbirth, infant death or any major congenital anomaly), extended perinatal mortality (stillbirths and neonatal deaths) and major congenital anomaly were the main outcome measures. Adjusted rate ratios were estimated using generalized estimating equations for Poisson regression controlling for potential confounders.ResultsMothers with twin pregnancies with diabetes were older (p = 0.001) and had higher body mass indices (p < 0.0001) than those without diabetes. Their twins were more likely to be delivered earlier (p = 0.026), be delivered by cesarean section (80.4% vs. 49.7%; p < 0.0001), be large-for-gestational-age (p < 0.0001) and require admission to a special care baby unit (p < 0.0001). Pregestational diabetes was associated with significantly increased rates of the composite adverse outcome and major congenital anomalies in twins (adjusted rate ratios 2.66, 95% confidence interval 1.14-6.20 and adjusted rate ratios 3.51, 95% confidence interval 1.31-9.40, respectively).ConclusionMaternal pregestational diabetes in twin pregnancies is associated with a significantly increased risk of an adverse pregnancy outcome.

Publication metadata

Author(s): Darke J, Glinianaia SV, Marsden P, Bell R

Publication type: Article

Publication status: Published

Journal: Acta Obstetricia et Gynecologica Scaninavica

Year: 2016

Volume: 95

Issue: 3

Pages: 339-346

Print publication date: 01/03/2016

Online publication date: 09/01/2016

Acceptance date: 03/11/2015

ISSN (print): 0001-6349

ISSN (electronic): 1600-0412

Publisher: Wiley-Blackwell Publishing Ltd.

URL: http://dx.doi.org/10.1111/aogs.12825

DOI: 10.1111/aogs.12825

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