Gestational Diabetes Mellitus and the Longitudinal Fetal Growth Trajectories in Twin Pregnancies.

Abstract

Although it is well established that gestational diabetes mellitus (GDM) is associated with fetal overgrowth in singleton pregnancies, little is known about its role in twins. We aimed to explore the relationship between GDM and the longitudinal fetal growth in twin pregnancies. This was a retrospective matched cohort study of GDM and non-GDM twin pregnancies delivered ≥36 weeks without other complications. All the women performed ≥3 ultrasounds after 22 weeks. Linear mixed models (LMMs) were used to explore the relationships between longitudinal fetal growth trajectories and GDM. Group-based trajectory modeling (GBTM) and generalized estimating equation (GEE) were applied to identify the latent growth patterns and investigate their relationships with GDM. In total, 215 GDM and 645 non-GDM twins were included, the majority of the patients did not require medication therapy (n = 202, GDMA1). LMM revealed that, compared with non-GDM, GDM was associated with an average increase in fetal weight of 4.36 g (95% CI [1.25, 7.48]) per week. GBTM and GEE further revealed that GDM increased the odds of fetal weight trajectory to nearly 40% of the total fetal weight trajectory, classified into the high-speed group (aOR = 1.39, 95% CI [1.03, 1.88]), associating with a 49.44 g (95% CI [11.41, 87.48]) increase in birth weight. Subgroup analysis revealed that all these differences were only significant among the GDMA1 pregnancies (p < .05). GDM (GDMA1) is significantly associated with an increase in fetal weight during gestation in twin pregnancies. However, this acceleration is mild, and its significance requires further exploration.