AI Article Synopsis
- The study explores the impact of diabetes on perinatal death rates (including stillbirths and neonatal deaths) specifically in twin pregnancies, using a large dataset of twin births from 1995-2000.
- Findings indicate that diabetic twin pregnancies showed a lower overall perinatal mortality rate compared to non-diabetic pregnancies, particularly in cases of very preterm births (before 32 weeks) or very low birth weight infants (<1500 g).
- However, diabetes was linked to a higher risk of perinatal death for twins born between 32 to 36 weeks and for those with a birth weight of 2500 g or more, suggesting a complex relationship that requires further studies to understand.
Article Abstract
Background: Diabetes in pregnancy has been associated with a paradoxically reduced risk of neonatal death in twin pregnancies. Risk "shift" may be a concern in that the reduction in neonatal deaths may be due to an increase in fetal deaths (stillbirths). This study aimed to clarify the impact of diabetes on the risk of perinatal death (neonatal death plus stillbirth) in twin pregnancies.
Methods: This was a retrospective cohort study of twin births using the largest available dataset on twin births (the U.S. matched multiple birth data 1995-2000; 19,676 neonates from diabetic pregnancies, 541,481 from non-diabetic pregnancies). Cox proportional hazard models were applied to estimate the adjusted hazard ratios (aHR) of perinatal death accounting for twin cluster-level dependence.
Results: Comparing diabetic versus non-diabetic twin pregnancies, overall perinatal mortality rate was counterintuitively lower [2.1% versus 3.3%, aHR 0.70 (95% confidence intervals 0.63-0.78)]. Individually, both stillbirth and neonatal mortality rates were lower in diabetic pregnancies, but we identified significant differences by gestational age and birth weight. Diabetes was associated with a survival benefit in pregnancies completed before 32 weeks [aHR 0.55 (0.48-0.63)] or with birth weight <1500 g [aHR 0.61 (0.53-0.69)]. In contrast, diabetes was associated with an elevated risk of perinatal death in pregnancies delivered between 32 and 36 weeks [aHR 1.38 (1.10-1.72)] or with birth weight >=2500 g [aHR 2.20 (1.55-3.13)].
Conclusions: Diabetes in pregnancy appears to be "protective" against perinatal death in twin pregnancies ending in very preterm or very low birth weight births. Prospective studies are required to clarify whether these patterns of risk are real, or they are artifacts of unmeasured confounders. Additional data correlating these outcomes with the types of diabetes in pregnancy are also needed to distinguish the effects of pre-gestational vs. gestational diabetes.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776783 | PMC |
| http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0075354 | PLOS |
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