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Gestational diabetes in twin pregnancies-a pathology requiring treatment or a benign physiological adaptation?
Melamed, Nir; Avnon, Tomer; Barrett, Jon; Fox, Nathan; Rebarber, Andrei; Shah, Baiju R; Halperin, Ilana; Retnakaran, Ravi; Berger, Howard; Kingdom, John; Hiersch, Liran.
Affiliation
  • Melamed N; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Ontario, Canada. Electronic address: nir.melamed@sunnybrook.ca
  • Avnon T; Lis Maternity Hospital, Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Barrett J; Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
  • Fox N; Icahn School of Medicine at Mount Sinai, New York, NY; Maternal Fetal Medicine Associates, PLLC, New York, NY.
  • Rebarber A; Icahn School of Medicine at Mount Sinai, New York, NY; Maternal Fetal Medicine Associates, PLLC, New York, NY.
  • Shah BR; Institute for Clinical Evaluative Sciences, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Ca
  • Halperin I; Division of Endocrinology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
  • Retnakaran R; Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada; Division of Endocrinology, University of Toronto, Toronto, ON, Canada.
  • Berger H; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada.
  • Kingdom J; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
  • Hiersch L; Lis Maternity Hospital, Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Obstet Gynecol ; 231(1): 92-104.e4, 2024 07.
Article in En | MEDLINE | ID: mdl-38218511
ABSTRACT
There is level-1 evidence that screening for and treating gestational diabetes in singleton pregnancies reduce maternal and neonatal morbidity. However, similar data for gestational diabetes in twin pregnancies are currently lacking. Consequently, the current approach for the diagnosis and management of gestational diabetes in twin pregnancies is based on the same diagnostic criteria and glycemic targets used in singleton pregnancies. However, twin pregnancies have unique physiological characteristics, and many of the typical gestational diabetes-related complications are less relevant for twin pregnancies. These differences raise the question of whether the greater increase in insulin resistance observed in twin pregnancies (which is often diagnosed as diet-treated gestational diabetes) should be considered physiological and potentially beneficial in which case alternative criteria should be used for the diagnosis of gestational diabetes in twin pregnancies. In this review, we summarize the most up-to-date evidence on the epidemiology, pathophysiology, and clinical consequences of gestational diabetes in twin pregnancies and review the available data on twin-specific screening and diagnostic criteria for gestational diabetes. Although twin pregnancies are associated with a higher incidence of diet-treated gestational diabetes, diet-treated gestational diabetes in twin pregnancies is less likely to be associated with adverse outcomes and accelerated fetal growth than in singleton pregnancies and may reduce the risk for intrauterine growth restriction. In addition, there is currently no evidence that treatment of diet-treated gestational diabetes in twin pregnancies improves outcomes, whereas preliminary data suggest that strict glycemic control in such cases might increase the risk for intrauterine growth restriction. Overall, these findings provide support to the hypothesis that the greater transient increase in insulin resistance observed in twin pregnancies is merely a physiological exaggeration of the normal increase in insulin resistance observed in singleton pregnancies (that is meant to support 2 fetuses) rather than a pathology that requires treatment. These data illustrate the need to develop twin-specific screening and diagnostic criteria for gestational diabetes to avoid overdiagnosis of gestational diabetes and to reduce the risks associated with overtreatment of diet-treated gestational diabetes in twin pregnancies. Although data on twin-specific screening and diagnostic criteria are presently scarce, preliminary data suggest that the optimal screening and diagnostic criteria in twin pregnancies are higher than those currently used in singleton pregnancies.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Diabetes, Gestational / Pregnancy, Twin Limits: Female / Humans / Pregnancy Language: En Journal: Am J Obstet Gynecol Year: 2024 Document type: Article Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Diabetes, Gestational / Pregnancy, Twin Limits: Female / Humans / Pregnancy Language: En Journal: Am J Obstet Gynecol Year: 2024 Document type: Article Country of publication: United States