Gestational diabetes in dichorionic-diamniotic twin pregnancies: associations with delivery and neonatal outcomes

Abstract Purpose To evaluate whether gestational diabetes mellitus (GDM) is independently associated with delivery and neonatal outcomes in dichorionic-diamniotic (DCDA) twin pregnancies. Methods Retrospective cohort of DCDA twin pregnancies delivered at a single academic center. Patients were stratified by GDM status using the two-step Carpenter–Coustan diagnostic criteria. Maternal, intrapartum, and neonatal outcomes were compared between GDM and non-GDM pregnancies. Prespecified pregnancy-level multivariable models evaluated independent associations with urgent intrapartum cesarean delivery of the presenting twin, neonatal hypoglycemia in either twin, NICU admission in either twin, and mean pair birthweight. A secondary analysis within GDM compared insulin-dependent GDM (IDGDM) versus non-insulin-dependent GDM (NIDGDM). Results Among 1,196 DCDA twin pregnancies, 213 (17.8%) had GDM. Women with GDM were older and more frequently nulliparous, with higher rates of BMI >30 kg/m 2 and IVF conception. Intrapartum and neonatal outcomes were largely comparable between groups. In pregnancy-level adjusted models, GDM was not independently associated with urgent cesarean delivery of the leading twin, neonatal hypoglycemia in either twin, NICU admission in either twin, or mean pair birthweight. NICU admission was independently associated with earlier gestational age at delivery, urgent cesarean delivery of the leading twin, and BMI >30 kg/m 2 . In the GDM-restricted model, treatment category was not associated with NICU admission. Conclusion In DCDA twin pregnancies, GDM clustered with maternal metabolic risk factors but was not independently associated with delivery or neonatal outcomes, after adjustment for confounders. These findings support further evaluation of whether singleton-derived GDM diagnostic and management frameworks optimally reflect risk in twin pregnancies.