Higher odds of gestational diabetes among women with multiple pregnancies: a nationwide register-based cohort study in Finland

The association between interpregnancy interval and gestational diabetes mellitus: A nationwide register-based study in Finland

OBJECTIVE

Previous results on the association between interpregnancy interval (IPI) and gestational diabetes mellitus (GDM) have been contradictory. Hence, the aim of this study was to examine the association between IPI and GDM using high-quality nationwide register data.

METHODS

All women with first and second pregnancies during our study period from the National Medical Birth Register during 2004-2018 were considered. A logistic regression model was used to assess the association between the length of the IPI and development of the GDM in the second pregnancy. Women were divided into three groups based on the length of the IPI: short IPI (0-11 months), normal IPI (12-47 months), and long IPI (48+ months). Adjusted odds ratios (aOR) with 95% CI were compared between the groups.

RESULTS

A total of 47 078 women were included in the study. We found no evidence of difference when women with short IPI were compared with women with normal IPI (aOR 0.99, 95% CI 0.93-1.05). Women with long IPI had increased odds for the development of GDM when compared with women with normal IPI (aOR 1.28, 95% CI 1.19-1.38). In the logistic regression model for continuous IPI, the total odds for the development of GDM increased as the IPI increased (aOR 1.05 per year, 95% CI 1.03-1.06).

CONCLUSION

The odds for the development of GDM increased as the IPI increased. This study's results serve as a clarion call for proactive measures in GDM prevention. Moreover, they advocate for intensified investigation into the underlying factors contributing to GDM among women with extended IPI. It is imperative that these insights inform both clinical practice and further research agendas, as we strive to safeguard maternal health and well-being.

The association between maternal obesity and fetomaternal outcomes in twin pregnancies

The prevalence of overweight and obese people worldwide has dramatically increased in the last decades and is yet to peak. At the same time and partly due to obesity and associated assisted reproduction, twinning rates showed a clear rise in the last years. Adverse fetomaternal outcomes are known to occur in singleton and twin pregnancies in overweight and obese women. However, the impact of the obesity levels as defined by the World Health Organization on the outcomes of twin pregnancies has not been thoroughly studied. Therefore, the purpose of this study is to examine how maternal overweight, and the level of obesity affect fetomaternal outcomes in twin pregnancies, hypothesizing a higher likelihood for adverse outcomes with overweight and each obesity level. This is a retrospective cohort study with 2,349 twin pregnancies that delivered at the Buergerhospital Frankfurt, Germany between 2005 and 2020. The mothers were divided into exposure groups depending on their pre-gestational body mass index; these were normal weight (reference group), overweight and obesity levels I, II, and III. A multivariate logistic regression analysis was performed to assess the influence of overweight and obesity on gestational diabetes mellitus, preeclampsia, postpartum hemorrhage, intrauterine fetal death, and a five-minutes Apgar score below seven. The adjusted odds ratio for gestational diabetes compared to normal weight mothers were 1.47, 2.79, 4.05, and 6.40 for overweight and obesity levels I, II and III respectively (p = 0.015 for overweight and p < 0.001 for each obesity level). Maternal BMI had a significant association with the risk of preeclampsia (OR 1.04, p = 0.028). Overweight and obesity did not affect the odds of postpartum hemorrhage, fetal demise, or a low Apgar score. While maternal overweight and obesity did not influence the fetal outcomes in twin pregnancies, they significantly increased the risk of gestational diabetes and preeclampsia, and that risk is incremental with increasing level of obesity.

Trends in the use for labor analgesia in twin pregnancies: A nationwide register-based analysis in Finland

Objectives

The aim of this study is to calculate the trends in the use of labor analgesia in vaginal twin pregnancies at or after 37+0 weeks of gestation and evaluate the use of different labor analgesia in vaginal twin deliveries when compared to vaginal singleton pregnancies.

Study design

Data from the National Medical Birth Register during the years 2004-2018 was used to evaluate the usage of labor analgesia in vaginal twin deliveries at or after 37+0 weeks of gestation when compared to a comparison group consisting of singleton deliveries at or after 37+0 weeks of gestation. These results are presented as adjusted risk ratios (aORs) with 95% confidence intervals (Cis). The model was adjusted by maternal age and gestational diabetes, year of the pregnancy, and labor induction.

Results

A total of 3060 twin deliveries and 669 718 singleton deliveries (comparison group) were included in our study. The use of spinal analgesia in vaginal twin deliveries has shown a steadily growing trend increasing from 7.8% (95% Ci 4.8, 12.0) in 2004-24.8% (95% Ci 16.0, 33.0) in 2018. When compared to singleton deliveries, there was increased use of epidural analgesia (57.3% vs 46.1%, aOR 1.41; 95% Ci 1.31, 1.51), but lower use of spinal analgesia (12.3% vs 16.7%, aOR 0.66; 95% Ci 0.59, 0.73), another medical (7.9% vs 12.5%, aOR 0.55; 95% Ci 0.48, 0.63), and nonmedical analgesia (21.8% vs 30.2%, aOR 0.69, 95% Ci 0.63, 0.76) observed among women with twin pregnancies.

Conclusions

The main finding of this study was that women with twin pregnancies had a higher rate of epidural analgesia than women with singleton pregnancies. The results of this study should be acknowledged by midwives, obstetricians, and anesthesiologists to provide optimal pain relief for mothers with twin pregnancies and encourage researchers to further research on this topic.

Characteristics of the oral glucose tolerance test in women with different pre-pregnancy body mass index and the effect of gestational diabetes mellitus on twin pregnancy outcomes

OBJECTIVE

This study aimed to investigate the mid-pregnancy blood glucose levels of women with singleton or twin pregnancies.

METHOD

The relationship between blood glucose levels and Gestational Diabetes Mellitus (GDM) was studied in women with different pre-pregnancy Body Mass Index (BMI), and the effect of GDM on twin pregnancy outcomes was analyzed. Women with twin (n = 1,985) and singleton (n = 1,985) pregnancies were categorized into underweight (BMI < 18.5 kg/m2, n = 597), normal weight (BMI: 18.5-23.9 kg/m2, n = 2,575), and overweight/obese (BMI ≥ 24 kg/m2, n = 798) groups.

RESULTS

The incidence of GDM was 21.01% in women with twin pregnancies. Among the women with GDM in twin pregnancies, 38.37% had at least two abnormal blood glucose levels. The incidence of these parameters increased with preconception BMI, and the incidence of twin pregnancies was higher than that of singleton pregnancies (p < 0.001). In the normal weight and overweight/obese group, the oral glucose tolerance test glucose level and incidence of GDM were higher in women with twin than singleton pregnancies (p < 0.05). For twin pregnancies, the prevalence of selective fetal growth restriction was higher and anemia was lower in the GDM group than in the non-GDM group (all p < 0.05).

CONCLUSION

Therefore, a greater emphasis should be placed on BMI before conception, and well-controlled GDM does not increase adverse pregnancy outcomes for twin pregnancies.

Previous induced abortion or miscarriage is associated with increased odds for gestational diabetes: a nationwide register-based cohort study in Finland

AIMS

The aim of this study was to investigate the association between previous induced abortion or miscarriage and the development of gestational diabetes mellitus (GDM) using high-quality register data.

METHODS

In this retrospective nationwide register-based cohort study, data from the national medical birth register (MBR) were used to evaluate the association between a history of miscarriage or induced abortion and GDM. We included all first pregnancies ending in delivery in which the oral glucose tolerance test was performed between 2004 and 2018. A logistic regression model was used to assess the development of GDM in the first pregnancy ending in delivery. Adjusted odds ratios (aOR) with 95% confidence intervals (Cis) were compared between groups.

RESULTS

In total, 15,873 nulliparous women with a history of induced abortions, 22,337 with a history of miscarriages and 3594 with a history of both were found. The reference group consisted of 138,869 women without a history of induced abortions or miscarriages. Women with a history of induced abortions (24.7%, aOR 1.15 [CI 1.11-1.20]), a history of miscarriages (24.8%, aOR 1.14 [CI 1.10-1.18]) and a history of both (27.7% aOR 1.18 [CI 1.09-1.28]) had higher odds for the development of GDM when compared to the reference group (20.8%). The odds for GDM increased along with the increasing number of previous induced abortions and miscarriages.

CONCLUSION

Women with a history of induced abortions or miscarriages had higher odds for GDM in their first pregnancy leading to birth. Knowledge of this association will be helpful in the prevention and screening of GDM.