Abstracts

Abstract

INTRODUCTION: Existing data suggest obstetric outcomes for women with twin gestations who have gestational diabetes mellitus (GDM) may be comparable to those who do not have GDM, yet studies are limited by small sample sizes. The aim of this study was to utilize a large populationbased cohort to examine differences in maternal and neonatal outcomes of twin gestations based on presence of GDM. METHODS: This was a population-based retrospective cohort study of women giving birth to twin gestations in the United States between 2012 and 2014. Inclusion criteria were live births (>23 weeks) and available information on GDM status; women with pregestational diabetes were excluded. Women were categorized as either having had or not had GDM, and maternal and neonatal outcomes were assessed using bivariable and multivariable analyses. Multivariable logistic regression was utilized to assess the independent association of GDM with adverse maternal outcomes, whereas generalized estimating equation models were used to estimate associations with neonatal outcomes to account for clustering. Significance was set at p<0.001. RESULTS: Of 173,196 women meeting inclusion criteria, 13,194 (7.6%) had GDM. Women with GDM were more likely to be older, of Hispanic or Asian race/ethnicity, married, college educated, privately insured, and obese than women without GDM. Women with GDM also were more likely to have had a prior cesarean delivery (CD) and to have conceived via assisted reproductive technology. After adjusting for potential confounders, women with GDM were more likely to have hypertensive disorders (18.0% vs. 10.2%; aOR 1.72, 95% CI 1.63-1.81) and to be delivered by CD (79.2% vs. 73.7%; aOR 1.17, 95% CI 1.10-1.25). In contrast, twins born to mothers with GDM had greater birthweights, lower odds of being very low birthweight, and lower odds of extreme prematurity. However, neonates born to mothers with GDM were more likely to receive ventilation >6 hours, NICU admission, and antibiotics. CONCLUSIONS: Odds of maternal hypertension and CD are increased in twin gestations complicated by GDM. Although some neonatal outcomes are actually improved in the presence of GDM, this finding is balanced by the increased odds of adverse events such as NICU admission and ventilator support.