Perinatal Outcomes of Subgroups of Gestational Diabetes Mellitus Among Twin Pregnancies: A Retrospective Cohort Study

Abstract Objective: To evaluate perinatal outcomes in twin pregnancies, comparing different gestational diabetes mellitus (GDM) subgroups with pregnancies without GDM. Methods: A retrospective cohort study of twin pregnancies was performed from January 2014 to December 2022. GDM was diagnosed based on the International Association of Diabetes and Pregnancy Study Groups criteria for the 2-h 75-g oral glucose tolerance test. Women with twin pregnancies were divided into four groups: healthy control, impaired fasting glucose (IFG), gestational impaired glucose tolerance (GIGT), and IFG + GIGT. Poisson regression models were performed to compare perinatal outcomes between these groups, including large for gestational age, small for gestational age, gestational hypertension, preeclampsia, hypertensive disorders of pregnancy, neonatal unit admission, neonatal jaundice, and neonatal respiratory distress syndrome. Generalized estimation equation models were utilized to address intertwin correlation. Results: A total of 2162 women with twin pregnancies were eligible for analysis. IFG was associated with an increased risk of having large for gestational age infants (adjusted risk ratio (a RR ): 2.62, 95% confidence interval ( CI ): 1.31–5.24 in the IFG; and a RR : 2.09, 95% CI : 1.19–3.66 in the IFG + GIGT group, respectively). An increased risk of preeclampsia (a RR : 1.78, 95% CI : 1.05–3.03) and hypertensive disorders of pregnancy (adjusted odds ratio: 1.85, 95% CI : 1.05–3.27) was observed in the IFG + GIGT group. Conversely, GIGT was not associated with any adverse perinatal outcomes. Conclusion: The present findings revealed differences in perinatal outcomes between women with twin pregnancies with subgroups of GDM and without GDM. Classification of GDM by fasting glucose and post-load glucose may benefit risk stratification in the perinatal management of twin pregnancies.