Fetal malformations in twin pregnancies of type I diabetic women

Gestational diabetes mellitus complicating twin pregnancies

OBJECTIVE

To compare outcomes of twin pregnancies with and without gestational diabetes mellitus (GDM).

STUDY DESIGN

We compared 105 twin pregnancies with GDM (7.8% of all twin pregnancies) to 315 controls without GDM, matched for gestational age, chorionicity and year of birth.

RESULTS

Pre-gravid obesity appears to predispose women to GDM during twin pregnancy [odds ratio (OR) 3.5; 95% confidence interval (CI) 1.7, 7.0]. Overweight and obese women that subsequently developed GDM during their twin gestation were less likely to conceive spontaneously (OR 0.4; 95% CI 0.3, 0.7). Twins from the GDM group had more respiratory distress syndrome (RDS, OR 2.2; 95% CI 1.3, 3.7) and had a three-fold, but not significantly increased perinatal mortality rate. Birth weight characteristics were similar in both groups.

CONCLUSION

Twin pregnancies complicated by GDM might be associated with pre-pregnancy maternal obesity and are at increased risk of RDS and non-significant increased risk of perinatal death.

Determinants and consequences of discrepancies in menstrual and ultrasonographic gestational age estimates

OBJECTIVES

To assess the association between maternal and fetal characteristics and discrepancy between last normal menstrual period and early (<20 weeks) ultrasound-based gestational age and the association between discrepancies and pregnancy outcomes.

DESIGN

Hospital-based cohort study.

SETTING

Montreal, Canada.

SAMPLE

A total of 46,514 women with both menstrual- and early ultrasound-based gestational age estimates.

MAIN OUTCOME MEASURES

Positive (last normal menstrual period > early ultrasound, i.e. menstrual-based gestational age is higher than early ultrasound-based gestational age, so that the expected date of delivery is earlier with the menstrual-based gestational age) discrepancies > or =+7 days, mean birthweight, low birthweight, stillbirth and in-hospital neonatal death.

RESULTS

Multiparous mothers and those with diabetes, small stature or high pre-pregnancy body mass index were more likely to have positive discrepancies. The proportion of women with discrepancies > or =+7 days was significantly higher among chromosomally malformed and female fetuses. The mean birthweight declined with increasingly positive differences. The risk of low birthweight was significantly higher for positive differences. Associations with fetal growth measures were more plausible with early ultrasound estimates.

CONCLUSIONS

Although most discrepancies between last normal menstrual period- and early ultrasound-based gestational age are attributable to errors in menstrual dating, our results suggest that some positive differences reflect early growth restriction.