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Outcomes of twin pregnancies complicated by gestational diabetes: a meta-analysis of observational studies

Journal of Perinatology volume 37, pages 360–368 (2017)Cite this article

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Abstract

Objective:

Gestational diabetes mellitus (GDM) in singleton pregnancy is associated with large for gestational age neonates and adverse perinatal outcomes; however, the impact of GDM in twin pregnancy is unclear. Thus, the aim of this study is to assess the perinatal outcomes of twin pregnancies complicated by GDM by performing a meta-analysis of observational studies.

Study Design:

Studies investigating GDM in twin pregnancy were identified through an online search of three databases: Medline, Embase and Web of Science. Selection criteria comprised full paper observational studies (retrospective or prospective) published in English that examined GDM in twin pregnancy compared with non-GDM twin pregnancy and reported on birth weight and/or adverse perinatal outcomes. Random-effects models with inverse-variance weighting were used to calculate standardized mean differences and unadjusted odds ratios. Sensitivity analyses were carried out to determine the impact of possible maternal confounders (body mass index and age) and GDM diagnostic criteria on perinatal outcomes.

Results:

Thirteen observational studies were included. GDM twins were born at the same gestation as non-GDM twins, with marginally lower birth weight. There was no difference in the incidence of large or small for gestational age neonates. Although there was no correlation between GDM in twin pregnancy and respiratory distress, neonatal hypoglycemic or low Apgar score, GDM twins had a higher rate of neonatal intensive care unit admission (OR 1.49; 95% confidence interval: 1.10, 2.02; P<0.01).

Conclusion:

Identification and subsequent treatment of GDM in twin pregnancy demonstrates a similar risk of adverse perinatal outcomes compared with non-GDM twin pregnancies.

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Acknowledgements

We thank Dr Megan Foeller and Dr María Guillén for providing additional unpublished data for inclusion in the present analysis.

Author contributions

RTM identified studies of interest, extracted data, analyzed data and wrote the first draft of the manuscript. SLH extracted and interpreted data and contributed to the discussion. ESS identified studies of interest and extracted data. SKS interpreted data and provided methodological guidance. GRF interpreted data and contributed to the discussion. SJG designed the study, interpreted data and contributed to the discussion. All authors reviewed and edited the manuscript and approved the final version before submission.

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Authors and Affiliations

  1. Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, 2065, NSW, Australia

    R T McGrath, S L Hocking, E S Scott, G R Fulcher & S J Glastras

  2. University of Sydney, Northern Clinical School, Royal North Shore Hospital, Sydney, 2065, NSW, Australia

    R T McGrath, S L Hocking, S K Seeho & G R Fulcher

  3. Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, Northern Sydney Local Health District, Sydney, 2065, NSW, Australia

    S K Seeho

  4. Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, Sydney, 2065, NSW, Australia

    S J Glastras

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  1. R T McGrath
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Correspondence to R T McGrath.

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McGrath, R., Hocking, S., Scott, E. et al. Outcomes of twin pregnancies complicated by gestational diabetes: a meta-analysis of observational studies. J Perinatol 37, 360–368 (2017). https://doi.org/10.1038/jp.2016.254

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