Abstract
Introduction
The aim is to investigate the proportion of multiple pregnancies with gestational diabetes mellitus (GDM) diagnosed using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and to identify the impact of age, body mass index (BMI), and mode of conception on incidence of GDM.
Materials and methods
This is a single center, retrospective cohort study on 656 multiple pregnancies screened for GDM with 75-g, 2-h oral glucose tolerance test at 24–28 weeks of gestation, between January 2010 and January 2016. The diagnosis of gestational diabetes mellitus (GDM) was reached through the IADPSG.
Results
The incidence of GDM in our population was 15.1%. When patients who conceived through heterologous assisted reproduction technology were compared with those who conceived spontaneously, there was a significant difference for GDM (31.1 vs 13.6%, p < 0.001, OR 2.86). A similar finding was also observed comparing egg donation IVF/ICSI patients with homologous IVF/ICSI patients (31.1 vs 14.8%, p = 0.006, OR 2.59). Incidence of GDM was significantly higher in obese than in non-obese patients (42.5 vs 14.8%, p < 0.001, OR 4.88) and in women over 35 compared to younger patients (18.4 vs 11.1%, p = 0.01, OR 1.81). Logistic regression comparing the diabetes onset with conception mode gave a p = 0.07. The calculation of the Chi-square and odds ratio for single mode of conception showed that homologous vs conceived spontaneously p = 0.90, OR 0.97, heterologous vs homologous p = 0.01 with OR 2.46, and heterologous vs conceived spontaneously p = 0.01 with OR 2.39. Logistic regression showed that age and BMI are risk factors for develo** GDM, respectively, p = 0.03 with OR 1.4 and p < 0.01 and OR 1.09.
Discussion
The contribution our study can make is improved counseling about GDM risks for couples with multiple pregnancies. Our data support the role of age, BMI, and mode of conception as risk factors for GDM in multiple pregnancies.
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References
Rossi AC, D’Addario V (2011) Neonatal outcomes of assisted and naturally conceived twins: systematic review and meta-analysis. J Perinat Med 39(5):489–493
Campbell DM, MacGillivray I (1999) Preeclampsia in twin pregnancies: incidence and outcome. Hypertens Pregnancy 18:197–207
Wein P, Warwick MM, Beischer NA (1992) Gestational diabetes in twin pregnancy: prevalence and long term complications. Aust NZ J Obstet Gynaecol 32:325–327
Dwyer PL, Oats JN, Walstab JE (1982) Glucose intolerancein twin pregnancy. Aust NZ J Obstet Gynaecol 22:131–135
Naicker RS, Subrayen KT, Jialal I (1983) Carbohydrate metabolism in twin pregnancy. S Afr Med J 63:538–544
Buhling KJ, Henrich W, Starr E, Lubke M, Bertram S, Siebert G, Dudenhausen JW (2003) Risk for gestational diabetes and hypertension for women with twin pregnancy compared to singleton pregnancy. Arch Gynecol Obstet 269(1):33
Schwartz DB, Daoud Y, Zazula P, Goyert G, Bronsteen R, Wright D, Copes J (1999) Gestational diabetes mellitus: metabolic and blood glucose parameters in singleton vs twin pregnancies. Am J Obstet Gynecol 181(4):912–914
Bishop KC, Goetzinger KR, Tuuli MG, Cahill AG (2015) The impact of chorionicity on maternal pregnancy outcomes. Am J Obstet Ginaecol 213(3):390.e1-7
Hedderson MM, Ferrara A (2008) High blood pressure before and during early pregnancy is associated with an increased risk of gestational diabete mellitus. Diabetes Care 31:2362–2367
.Alshami HA, Kadasne AR, Khalfan M, Iqbal SZ, Mirghani HM (2011) Pregnancy outcome in late maternal age in a high-income develo** country. Arch Gynecol Obstet 284(5):1113–1116
Baci Y, Üstüner I, Keskin HL, Ersoy R, Avşar F (2013) Effect of maternal obesity and weight gain on gestational diabetes mellitus. Gynecol Endocrinol 29(2):133–136
Jones BJ, Zollner J, Haynes S, Cheng F, Dornhorst A (2013) In vitro fertilization treatment influences glucose tolerance in multiple pregnancy. Diabet Med 30:252–254
Grady R, Alavi N, Vale R, Khandwala M, McDonald SD (2012) Elective single embryo transfer and perinatal outcomes: a systematic review and meta-analysis. Fertil Steril 97:324–331
Ashrafi M, Gosili R, Hosseini R, Arabipoor A, Ahmadi J, Chehrazi M (2014) Risk of gestational diabetes mellitus in patients undergoing assisted reproductive techniques. Eur J Obstet Gynecol Reprod Biol 176:149–152
Wang YA, Nikravan R, Smith HC, Sullivan EA (2013) Higher prevalence of gestational diabetes mellitus following assisted reproduction technology treatment. Hum Reprod 28(9):2554–2561
International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva Ad, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682
BMI Classification (2006) Global database on body mass index. World Health Organization, Geneva
Levorato S, Bocci G, Troiano G, Messina G, Nante N (2017) Health status of homeless persons: a pilot study in the Padua municipal dorm. Ann Ig 29(1):54–62
Rauh-Hain JA, Rana S, Tamez H, Wang A, Cohen B, Cohen A, Brown F, Ecker JL, Karumanchi SA, Thadhani R (2009) Risk for develo** gestational diabetes in women with twin pregnancies. J Matern Fetal Neonatal Med 22(4):293–299
Yogev Y, Eisner M, Hiersch L, Hod M, Wiznitzer A, Melamed N (2014) The performance of the screening test for gestational diabetes in twin versus singleton pregnancies. J Matern Fetal Neonatal Med 27(1):57–61
Beemsterboer SN, Homburg R, Gorter NA, Schats R, Hompes PG, Lambalk CB (2006) The paradox of declining fertility but increasing twinning rates with advancing maternal age. Hum Reprod 21(6):1531–1532
Carolan M, Frankowska D (2011) Advanced maternal age and adverse perinatal outcome: a review of the evidence. Midwifery 27(6):793–801
Chan BC, Lao TT (2008) Effect of parity and advanced maternal age on obstetric outcome. Int J Gynaecol Obstet 102(3):237–241
Kazer RR, Cheng ER, Unterman TG, Glick RP (1991) Maternal plasma concentrations of insulin-like growth factor-I (IGF-I) and human placental lactogen (hPL) in twin pregnancies. Acta Genet Med Gemellol 40(3–4):383–387
Alptekin H, Çizmecioğlu A, Işık H, Cengiz T, Yildiz M, Iyisoy MS (2016) Predicting gestational diabetes mellitus during the first trimester using anthropometric measurements and HOMA-IR. J Endocrinol Invest 39:577–583
HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358(19):1991–2002
Dinham GK, Henry A, Lowe SA, Nassar N, Lui K, Spear V, Shand AW (2016) Twin pregnancies complicated by gestational diabetes mellitus: a single centre cohort study. Diabet Med 33(12):1659–1667
Liu X, Chen Y, Zhou Q, Shi H, Cheng WW (2015) Utilization of International Association of Diabetes and Pregnancy Study Groups criteria vs a two-step approach to screening for gestational diabetes mellitus in Chinese women with twin pregnancies. Diabet Med 32(3):367–373
Jackson RA, Gibson KA, Wu YW, Croughan MS (2004) Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol 103:551–563
Szymanska M, Horosz E, Szymusik I, Bomba-Opon D, Wielgos M (2011) Gestational diabetes in IVF and spontaneous pregnancies. Neuroendocrinol Lett 32:885–888
Pandey S, Shetty A, Hamilton M, Bhattacharya S, Maheshwari A (2012) Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Hum Reprod Update 18(5):485–503
Holst S, Kjær SK, Jørgensen ME, Damm P, Jensen A (2016) Fertility problems and risk of gestational diabetes mellitus: a nationwide cohort study. Fertil Steril 106(2):427–434.e1
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Cozzolino, M., Serena, C., Maggio, L. et al. Analysis of the main risk factors for gestational diabetes diagnosed with International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria in multiple pregnancies. J Endocrinol Invest 40, 937–943 (2017). https://doi.org/10.1007/s40618-017-0646-6
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DOI: https://doi.org/10.1007/s40618-017-0646-6