单胎妊娠的妊娠糖尿病会增加胎龄婴儿的风险,妊娠高血压疾病,和新生儿发病率。与单胎妊娠相比,双胎妊娠会增加胎儿生长异常的风险,高血压疾病,和新生儿发病率。妊娠糖尿病是否会进一步增加这些结局的风险尚不清楚。
我们试图确定妊娠期糖尿病与先兆子痫风险之间的关系。胎儿生长异常,和新生儿重症监护病房住院的一大群双胎妊娠妇女。
我们使用了1998年至2013年在我们机构分娩的所有双胎妊娠的回顾性队列。我们排除了妊娠24周前分娩的妊娠,单绒毛膜-单羊膜双胞胎,和先前存在糖尿病的患者进行2573例双胎分娩的最后队列。妊娠期糖尿病被定义为100克的2个异常值,由Carpenter-Coustan标准定义的3小时葡萄糖激发试验或50g葡萄糖试验后的1小时值200mg/dL。多变量泊松回归模型用于估计妊娠期糖尿病和先兆子痫之间的关联。小于胎龄婴儿,大的胎龄婴儿,调整孕前体重指数后进入新生儿重症监护病房,母性种族,产妇年龄,奇偶校验,使用体外受精,孕前吸烟状况,和慢性高血压是混杂因素。
妊娠期糖尿病的未调整发生率为6.5%(n=167)。患有妊娠期糖尿病的女性更有可能年龄在35岁或以上,患有肥胖症,并且通过体外受精怀孕的妇女比没有妊娠期糖尿病的妇女。先兆子痫在双胎妊娠合并妊娠糖尿病的妇女中(31%)比在双胎妊娠无妊娠糖尿病的妇女中(18%)更常见(调整后的风险比,1.5;95%置信区间,1.1-2.1)。与没有妊娠糖尿病的妇女(24%)相比,妊娠糖尿病妇女(17%)的胎龄小于婴儿的诊断较少。尽管结果不精确(调整后的风险比,0.8;95%置信区间,0.5-1.1)。妊娠糖尿病与胎龄新生儿或新生儿重症监护病房入院的发生率之间没有关联。在妊娠35周的妊娠糖尿病妇女中,62%(n=60)需要医疗管理。
妊娠糖尿病是双胎妊娠妇女先兆子痫的危险因素。密切的血压监测和患者教育对于这一高危人群至关重要。妊娠糖尿病与双胎妊娠妇女的新生儿结局之间的关系不太精确,虽然它可以减少小于胎龄儿的发生率。需要进行前瞻性研究,以确定血糖控制是否可以降低患有妊娠糖尿病的双胎妊娠先兆子痫的风险。
Gestational diabetes in singleton pregnancies increases the risk for large for gestational age infants, hypertensive disorders of pregnancy, and neonatal morbidity. Compared with singleton gestations, twin gestations are at increased risk for fetal growth abnormalities, hypertensive disorders, and neonatal morbidity. Whether gestational diabetes further increases the risk for these outcomes is unclear.
We sought to determine the relationship between gestational diabetes and the risk for preeclampsia, fetal growth abnormalities, and neonatal intensive care unit admissions in a large cohort of women with twin pregnancies.
We used a retrospective cohort of all twin gestations that were delivered at our institution from 1998 to 2013. We excluded pregnancies delivered before 24 weeks\' gestation, monochorionic-monoamniotic twins, and patients with preexisting diabetes for a final cohort of 2573 twin deliveries. Gestational diabetes was defined as 2 abnormal values on a 100 g, 3-hour glucose challenge test as defined by the Carpenter-Coustan criteria or a 1-hour value of 200 mg/dL after a 50 g glucose test. Multivariable Poisson regression models were used to estimate the associations between gestational diabetes and preeclampsia, small for gestational age infants, large for gestational age infants, and admission to the neonatal intensive care unit after adjusting for prepregnancy body mass index, maternal race, maternal age, parity, use of in vitro fertilization, prepregnancy smoking status, and chronic hypertension as confounders.
The unadjusted incidence of gestational diabetes was 6.5% (n=167). Women with gestational diabetes were more likely to be aged 35 years or older, living with obesity, and have conceived via in vitro fertilization than women without gestational diabetes. Preeclampsia was more common among women with twin pregnancies complicated by gestational diabetes (31%) than among women with twin pregnancies without gestational diabetes (18%) (adjusted risk ratio, 1.5; 95% confidence interval, 1.1-2.1). A diagnosis of small for gestational age infant was less common among women with gestational diabetes (17%) than among women without gestational diabetes (24%), although the results were imprecise (adjusted risk ratio, 0.8; 95% confidence interval, 0.5-1.1). There was no association between gestational diabetes and the incidence of large for gestational age neonates or neonatal intensive care unit admissions. Among women with gestational diabetes who reached 35 weeks\' gestation, 62% (n=60) required medical management.
Gestational diabetes is a risk factor for preeclampsia among women with twin pregnancies. Close blood pressure monitoring and patient education are critical for this high-risk group. The association between gestational diabetes and neonatal outcomes among women with twin pregnancies is less precise, although it may reduce the incidence of small for gestational age infants. Prospective studies to determine if glycemic control decreases the risk for preeclampsia in twin pregnancies with gestational diabetes are needed.