Chorionicity and gestational diabetes mellitus in twin pregnancies in relation to placental weight.

BACKGROUND: Gestational diabetes mellitus (GDM) is glucose intolerance first detected during pregnancy. Twin pregnancies have a higher risk of GDM, likely due to increased placental mass and elevated placental lactogen levels. OBJECTIVE: The aims of this study were 1) to assess the impact of chorionicity on the development of GDM in twin pregnancies and 2) to assess a possible association between placenta weight and the development of GDM. METHODS: We conducted a prospective cohort study of all women with twin pregnancies (N = 819) at the department of Obstetrics and Gynecology, Lillebaelt University Hospital, Kolding, Denmark, between January 1, 2007 and April 30, 2019. Information on chronicity was determined at the first visit with ultrasonic imaging, during weeks' gestation 11-13. Oral glucose-tolerance test was performed to diagnose gestational diabetes mellitus. RESULTS: Among 819 twins, 17.8 % were monochorionic twins and 82.2 % were dichorionic twins. There were no statistically significant difference of GDM prevalence between monochorionic twins group 7.4 % and dichorionic twins group 9.8 % (P = 0.42). Placenta's weight in dichorionic twins was larger compared with monochorionic twins. No association was found between the weight of placenta and the prevalence of GDM (P = 0.21), even after adjustment for body mass index, gestational age, and fertility treatment (P = 0.87). CONCLUSIONS: Our study could not find an association between chorionicity, placental weight, and GDM. It is, therefore, possible that twin pregnancies, regardless of chorionicity and placental weight, have the same risk for GDM.

Neonatal and maternal outcomes with elective cesarean section compared to induction of labor in twin pregnancies: A prospective cohort study.

OBJECTIVES: The aim of this study was to compare neonatal and maternal outcomes in twin pregnancies with elective cesarean section (ECS) and induction of labor (IOL) to better inform women during the counselling process. MATERIALS AND METHODS: We conducted a cohort study including all twin pregnancies referred to the Department of Obstetrics at Kolding University Hospital, Denmark between January 2007 to April 2019 (n = 819). The primary analysis compared maternal and neonatal outcomes in pregnancies planned for IOL with those planned for ECS after week 34. A secondary analysis compared maternal and neonatal outcomes in pregnancies who underwent IOL followed by successful vaginal delivery with outcomes in those who underwent ECS. RESULTS: Among 587 eligible twin pregnancies, the rates of unplanned CS did not differ between those planned for ECS compared to those planned for IOL (38% vs. 33%; p = 0.27). IOL resulted in successful vaginal delivery in 67% (155/231) of those planned for IOL. Maternal outcomes did not differ between women who were planned for, or received, delivery with either IOL or ECS. Regarding neonatal outcomes, significantly more neonates required treatment with C-PAP in ECS group, than in the IOL group, and a higher median number of maturity days among mothers planned for ECS. However, no other significant difference in neonatal outcomes was observed when comparing successful IOL with successful ECS. CONCLUSION: Induction of labor was not associated with worse outcomes compared to elective caesarean section in this large cohort of routinely handled twin pregnancies. In women with twin pregnancies indicated for delivery, who does not go into spontaneous labor, induction of labor is a safe option for both the mothers and their neonates.

[Obese pregnant women have complicated deliveries]. / Overvaegtige kvinder har komplicerede fødselsforløb.

INTRODUCTION: On the background of the increasing prevalence of overweight and obesity, we wanted to describe the deliveries among this group of women. MATERIAL AND METHODS: A prospective study of 798 pregnant women during 1 1/2 year. According to Body-Mass-Index (BMI) all referred women were divided into three groups considering their age and parity. A) 270 pregnant women with BMI 26-30. B) 132 pregnant women with BMI > 30. C) 320 pregnant women with BMI 20-25, the control group. RESULTS: The deliveries were induced at 9% and 11% in group A and group B, making a significant difference to the induction of 5% among the controls (p < 0.05). The most frequent reason for induction was graviditas prolongata. This was the case for 5% in group A and 6% in group B compared to 3% in group C. This was not significant (p = 0.24). The rates of cesarean section were 19% and 24% in group A and B, making a significant difference to the rate of 9% among the controls (p < 0.01). Disproportio foetopelvina and late decelerations were the most frequent reason for cesarean section during delivery. Disproportio foetopelvina discovered during delivery was the case for 5% in group A and 8% in group B compared to 1% in group C. This difference is significant with p < 0.05. DISCUSSION: Our study shows that obese and pregnant women have a high rate of induction and postdatism. They have a higher rate of cesarean section compared to normal weight women and get more frequently cesarean section during delivery because of disproportio foetopelvina. Health service professionals working with pregnant women should be aware of the overweight problems.