Perinatal adverse outcomes in twin pregnancies with preeclampsia complicated by distinct gestational diabetes subtypes.

Abstract

Background: The impact of gestational diabetes mellitus (GDM) complicated with preeclampsia (PE) on perinatal outcomes in twin pregnancies, particularly across different GDM subtypes, remains unclear.

Methods: This case-control study included 1,263 twin pregnancies with GDM and categorized participants as follows: (i) GDM without PE and GDM with PE groups, and (ii) GDM subgroups based on oral glucose tolerance test (OGTT) values at different time points, including GDM-IFH, GDM-IPH, and GDM-CH. Initially, the study investigated risk factors for PE occurrence in women with GDM. Subsequently, univariate and multivariate logistic regression analyses were conducted to explore the impact of GDM with PE on perinatal outcomes in twin pregnancies compared to GDM without PE. Stratified analyses and interaction effects were also examined to assess the risk of adverse perinatal outcomes in GDM twin pregnancies with various maternal characteristics combined with PE. Additionally, the study assessed the influence of aspirin on the GDM with PE group. Based on OGTT values, the study further investigated their impact on perinatal outcomes in the GDM with PE group and examined the influence of different GDM subtypes on perinatal outcomes in twin pregnancies with GDM and PE.

Results: Baseline characteristics of twin pregnancies with GDM indicated that pre-pregnancy BMI (PBMI) (p < 0.001), weight gain during pregnancy (p < 0.001), nulliparity (p = 0.029), and the use of IVF (p = 0.023) may be risk factors for the occurrence of PE in GDM. Additionally, GDM with PE increased the risk of Intrahepatic Cholestasis of Pregnancy (ICP) (OR 2.00), hypoproteinemia during pregnancy (OR 4.18), anemia during pregnancy (OR 2.34), and MICU admission (OR 5.43) compared to GDM without PE. Regarding neonatal outcomes, the GDM with PE group had significantly higher risks of neonatal hyperbilirubinemia (OR 1.97), preterm labor (OR 1.58), and NICU admission (OR 2.32). In the GDM with PE group, aspirin significantly reduced the risk of preterm labor. Further research indicated that glucose values significantly affected the occurrence of ICP, hypoproteinemia during pregnancy, and anemia during pregnancy in the GDM with PE group. Subgroup analysis based on OGTT glucose values classified GDM subtypes showed that different GDM subtypes are closely related to the risk of hypoproteinemia during pregnancy, neonatal hyperbilirubinemia, and preterm labor in both GDM without PE group and GDM with PE groups. Particularly in GDM-IPH and GDM-CH subtypes, PE combined with GDM significantly increased the risks associated with ICP, hypoproteinemia during pregnancy, and MICU admission. Moreover, GDM-IPH combined with PE significantly increased the risks of anemia during pregnancy, NICU admission, and neonatal hyperbilirubinemia, while GDM-CH combined with PE also significantly increased the risk of preterm birth.

Conclusion: Twin pregnancies with GDM complicated by PE are associated with an increased risk of adverse perinatal outcomes, closely related to the subtypes of GDM. However, the use of aspirin has been shown to significantly reduce the risk of preterm birth in twin pregnancies with GDM and PE.