Association between gestational diabetes mellitus and adverse perinatal outcome of dichorionic diamniotic sac twins

Objective To explore the influence of gestational diabetes mellitus (GDM) on perinatal adverse pregnancy outcomes of dichorionic diamniotic twins, so as to provide evidence for clinical standardized management and targeted treatment and reduce the occurrence of adverse perinatal pregnancy outcomes.

Methods  Clinical data of 516 pregnant women with dichorionic diamniotic twin pregnancies from January 2018 to October 2022 who delivered babies at Shenzhen Baoan Women’s and Children’s Hospital of Guangdong were collected retrospectively. Among them, 258 pregnant women with diabetes were case group, and 258 pregnant women with normal glucose metabolism were control group. The pregnancy complications, the perinatal maternal and fetal outcomes were compared between 2 groups, and the impact of gestational blood glucose intervention on pregnancy outcomes of some women in case group were compared pre and post invention.

Results  The incidence of severe preeclampsia, premature birth, and small for gestational age in the case group was much higher than that in the control group (all P < 0.05). The other aspects of maternal complications and perinatal maternal and fetal outcomes were not different between 2 groups (all P > 0.05). The incidence of anemia in case group was lower than that in control group (P < 0.05), but there was no statistically significant difference in the proportion of cases requiring blood transfusion for severe anemia between 2 groups (P > 0.05). Further intervention on twin pregnant women with diabetes was carried out. In the case group, 140 cases received blood glucose intervention, and 118 cases did not. Compared with those who did not receive intervention, the incidence of severe preeclampsia, premature rupture of membranes, intrauterine infections, and premature birth was lower among those who did it (all P < 0.05).

Conclusion GDM does not increase the risk of other pregnancy complications, perinatal maternal and infant except for severe preeclampsia, preterm birth, and small for gestational age in dichorionic diamniotic twins. Blood glucose intervention among twin pregnant women with diabetes can reduce the incidence of severe preeclampsia, premature rupture of membranes, intrauterine infection and premature delivery.