Maternal diabetes following gestational diabetes: Does multiple gestation multiply the risk?

Area of Science:

• Reproductive Endocrinology
• Maternal-Fetal Medicine
• Diabetes Research

Background:

• Gestational diabetes (GD) is a significant risk factor for future type 2 diabetes in mothers.
• Understanding the long-term implications of GD based on gestation type is crucial for risk stratification and management.

Purpose of the Study:

• To compare the risk of future diabetes development in women diagnosed with GD during twin gestations versus singleton gestations.
• To identify potential differences in diabetes incidence based on the multiplicity of pregnancy.

Main Methods:

• Retrospective cohort study of women with at least one GD diagnosis between 1991-2021.
• Comparison of GD diagnosis in twin versus singleton gestations, with follow-up up to 30 years.
• Analysis of first postpartum and highest follow-up hemoglobin A1C (HbA1C) levels, using multivariable logistic and Cox proportional analyses.

Main Results:

• Included 13,770 mothers; 3.3% had GD during twin gestations, 96.7% during singleton gestations.
• Diabetes incidence was lower in the twin gestation group (15.5% vs 22.1% postpartum; 31.8% vs 40.7% long-term).
• Results remained significant after adjusting for age, ethnicity, and fertility treatments.

Conclusions:

• Gestational diabetes diagnosis during multiple gestations is associated with a reduced risk of future diabetes.
• Women with GD during twin pregnancies demonstrate a lower incidence of postpartum and long-term diabetes.
• This suggests a potentially different metabolic trajectory following GD in multifetal gestations.