Background: Twin pregnancies occurred in 1.4% of NSW births [2014-2019]1. The Institute of Medicine [IOM 2009] has maximum weight gain recommendations for twin pregnancies2: Healthy weight 25kg; Overweight 23kg; Obese 19kg respectively.
Aim: To assess maternal characteristics, management and outcomes of twin versus singleton GDM pregnancies.
Methods: We assessed prospectively collected data for all pregnancies with GDM diagnosed by WHO 2013 criteria 1/3/2016-1/3/2021. Data analysed were: maternal age, gravida/parity, pre-gestational BMI, gestation at GDM diagnosis and delivery, OGTT results, HbA1c at GDM diagnosis, insulin therapy, caesarean birth, total maternal weight gain, neonatal hypoglycaemia and jaundice. We compared data from twin versus singleton births using t-tests and Chi-square analyses (SPSS version 24). Significance p<0.05.
Results: There were 36 twin births amongst 1932 GDM women [1.9%]. Mean total weight gained: Healthy weight(n=16) 18.0kg, Overweight(n=6) 14.8kg and Obese(n=14) 12.3kg respectively. Data in the Table are Mean+SD [Range] or percent.
|
|
Twins[n=36] |
Singleton[n=1896] |
p= |
|
Maternal Age [years] |
31.1+5.7 |
31.3+5.4 |
0.83 |
|
Gravida |
2.9+1.8[1-7] |
2.9+1.9[1-22] |
0.89 |
|
Parity |
1.3+1.3[0-4] |
1.4+1.4[0-10] |
0.89 |
|
Pre-gestational BMI [kg/m2] |
28.4+6.9 |
27.0+6.2 |
0.18 |
|
Gestation [GDM diagnosis-weeks] |
22.5+5.8[10-32] |
23.6+5.8[3-36] |
0.25 |
|
FBGL [mmol/L] |
5.4+0.7 |
5.1+0.7 |
0.73 |
|
1HourBGL [mmol/L] |
10.2+2.1 |
9.7+1.9 |
0.59 |
|
2HourBGL [mmol/L] |
8.2+1.7 |
7.7+1.9 |
0.75 |
|
HbA1c [GDM diagnosis-%] |
5.2+0.4[4.6-7.0] |
5.2+0.4[4.1-8.7] |
0.59 |
|
Insulin Rx |
44.4% |
43.9% |
1.0 |
|
Gestation [Delivery-weeks] |
36.0+1.9[28-38] |
38.7+1.3[28-42] |
<0.0001 |
|
Exceeded IOM Weight Gain Guidelines |
11.1% |
38.9% |
<0.001 |
|
%Caesarean |
72.2% |
35.0% |
<0.0001 |
|
Birthweight |
4748+776 2392+414 2356+426 |
3294+513 |
- |
|
Hypoglycaemia [<2.6mmol/L] |
22.2% |
10.0% |
<0.05 |
|
Jaundice [Phototherapy] |
19.4% |
4.9% |
<0.01 |
Conclusions: Twin pregnancies occurred more commonly in GDM pregnancies than the NSW average. GDM women with twins delivered earlier and were more likely to have a caesarean delivery, neonatal hypoglycaemia and jaundice than singleton pregnancy GDM women, but far fewer exceeded IOM total pregnancy weight gain recommendations.
(1) Centre for Epidemiology and Evidence. New South Wales Mothers and Babies 2019. Sydney: NSW Ministry of Health, 2021.
(2) Institute of Medicine. Weight gain during pregnancy: re-examining the guidelines. Washington, DC: National Academies Press; 2009.