A Retrospective Study Of Twin Pregnancy With Gestational Diabetes Mellitus

Background and Objective: By studying the maternal and infant clinical data of twins with gestational diabetes mellitus,the influence of GDM on maternal and fetal outcomes of twins,the risk factors of twins with GDM and the correlation between twins with GDM and chorion were discussed,so as to provide theoretical basis for further understanding of twins with GDM.Materials and methods: 54139 cases of pregnant women who met the criteria were collected from January 1,2018 to January 1,2020 in Northwest Women’s And Children’s Hospital hospital obstetrics and delivery,including 52,478 singleton pregnant women,10,813 singleton pregnant women with combined GDM,and 1,661 twin pregnant women,and finally 1,619 twin pregnant women were included as study subjects,and maternal and infant clinical data were collected retrospectively.Study grouping and content: 1.According to the 75 g OGTT results,the subjects were divided into 400 cases of twin GDM group and1,219 cases of twin non-GDM group.The basic data,pregnancy complications,pregnancy outcomes and neonatal outcomes of the two groups were compared,and whether GDM would increase the occurrence of adverse maternal and fetal outcomes of twin pregnancy was analyzed.Through binary logistic regression analysis,the risk factors of twin GDM were screened out.2.Based on chorionicity,the twin GDM groups were divided into 65 cases in the single chorionic bilamellar group and 335 cases in the double chorionic bilamellar group,and the clinical data of the two groups were compared to analyze the correlation between combined twin GDM and chorionicity.The statistical software SPSS26.0 was used to analyze the collected clinical data.Results:1.The incidence of GDM in twins was 24.7% higher than that in singletons(20.6%).The prevalence of GDM in DCDA twins group was(25.7%)higher than that in MCDA twins group(20.3%),and the difference between the two groups was statistically significant(P<0.05).2.In the twin GDM group,primiparity,advanced age,high pre-pregnancy BMI,IVF-ET conception,DCDA twin,a medical history of PCOS,family history of diabetes,and combined ICP were higher than in the twin non-GDM group,and the difference between the two groups was statistically significant(P<0.05).3.The OGTT value,Hb A1 c value,positive rate of urine glucose,positive rate of urine protein,D-Dimer and FIB were all higher in the twin GDM group than in the twin nonGDM group,and the rate of placental infarction or calcification was lower than in the twin non-GDM group,and the difference between the two groups was statistically significant(P<0.05).4.The spontaneous delivery rate,delivery week,newborn birth weight,the incidence of neonatal hospitalization and incidence of neonatal hypoglycemia were higher in the twin GDM group than in the twin non-GDM group,and the incidence of neonatal anemia were lower than in the twin non-GDM group,and the differences between the two groups were statistically significant(P<0.05).5.Age > 35 years old,pre-pregnancy BMI ≥ 25 Kg/m 2,IVF-ET conception,PCOS medical history,multiparae,family history of diabetes and ICP were risk factors for twin GDM.6.The percentage of first pregnancy,first birth,IVF-ET and age at conception were all higher in the GDM pregnant women in the DCDA twin group than in the MCDA twin group,and the difference between the two groups was statistically significant(P<0.05).7.The positive rate of urine ketone body and urine sugar of GDM pregnant women in the DCDA twin group were higher than those in the MCDA twin group,and the differences between the two groups were statistically significant(P<0.001),while the differences in other laboratory indicators,pregnancy complications and placental diseases between the two groups were not statistically significant(P>0.05).8.The gestational weeks and birth weight of newborns in the DCDA twin group were higher than those in the MCDA twin group,while the delivery rate≤34 weeks,the hospitalization days of newborns,the incidence of neonatal hospitalization,the incidence of neonatal anemia and hypoglycemia were lower than those in the MCDA twin group,and the differences between the two groups were statistically significant(P<0.05).Conclusions:1.The incidence of GDM in twin pregnancy is higher than that in single pregnancy,and the incidence of GDM in DCDA twin is higher than that in MCDA twin.2.GDM increased the incidence of ICP in twin pregnancy,but did not increase the incidence of pregnancy complications such as HDP,anemia during pregnancy and premature rupture of membranes.3.GDM can increase he birth weight of twin and the incidence of neonatal hospitalization.In addition to neonatal hypoglycemia,GDM does not increase the occurrence of other complications of twin pregnancy newborns4.Risk factors for gestational diabetes in twin pregnancies were age>35 years old,prepregnancy BMI≤25 Kg/m2,IVF-ET conception,PCOS medical history,multiparae,family history of diabetes and ICP.5.There was no significant relationship between chorionic and pregnancy complications in twins with GDM,but there was a correlation between chorionic and neonatal outcomes.The incidence of adverse pregnancy outcomes in twins with MCDA was high.