What Is The Risk Of Gestational Diabetes With Twins

Pregnancy causes a large number of changes throughout the body. For the most part, women’s bodies can meet the added demands of pregnancy. Despite this, some can experience health issues during their pregnancy. 

One such health issue is gestational diabetes mellitus (GDM), a form of diabetes that occurs during pregnancy. Gestational diabetes affects nearly 10%¹ of pregnancies in the U.S. 

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What is gestational diabetes?

Gestational diabetes is a condition characterized by high blood sugar. It develops during pregnancy and typically disappears after delivery.

Gestational diabetes develops due to two main factors:

  1. Hormones from the placenta interfere with the action of insulin, causing a condition called insulin resistance, and

  2. Insulin-producing cells in the pancreas don’t seem to function well enough to keep blood glucose (sugar) levels in the normal range. 

If left untreated, gestational diabetes can increase the risk of pregnancy-related complications for both mother and baby. However, it’s important to remember that with the help of their healthcare team, most women with gestational diabetes will have healthy pregnancies and babies.

Gestational diabetes with twins

Twin pregnancies tend to put a lot more demands on women than singleton pregnancies. Carrying two babies results in higher levels of pregnancy hormones and a higher risk for pregnancy-related complications. 

This means that gestational diabetes is slightly more common in twin pregnancies. The exact figure varies by source, but one study shows that it is probably about 9%.² Most researchers agree that gestational diabetes is more common in twin pregnancies.  

The risk of complications from gestational diabetes is also a little higher if you carry twins.

Symptoms of gestational diabetes with twins

Gestational diabetes usually has no symptoms. When symptoms do occur, they are typically thirst and more frequent urination. Frequent urination is seen as normal during pregnancy and can make recognizing the symptoms of gestational diabetes (and possibly urinary tract infections) a little more difficult. 

Because most women with gestational diabetes experience no symptoms, the U.S. Preventive Services Task Force recommends screening for GDM at 24 weeks of gestation.³ Whether or not you have twins, you should be checked for GDM at 24 weeks.

Causes of gestational diabetes with twins

Some insulin resistance is standard during pregnancy and typically goes away after birth. This is related to hormones made by the placenta.

There are, however, some known risk factors for GDM, including:

  • Obesity and overweight

  • Sedentary lifestyle

  • Pre-diabetes

  • Advanced maternal age, meaning 35 years or over

  • Family history of diabetes

  • Being of a certain race or ethnicity, such as Black, Hispanic, American Indian, Asian, or Pacific Islander

  • Having given birth previously to a baby weighing over 9 pounds (4.1kg)

  • Having had gestational diabetes in a previous pregnancy (Different studies suggest a recurrence rate⁴ of 30% to 84% across groups of women)

  • Polycystic ovary syndrome

  • Certain medications, e.g., corticosteroids and anti-psychotics

How does gestational diabetes affect twin pregnancy?

Gestational diabetes can affect the mother’s health and the development of the fetus. In singleton pregnancies, GDM tends to result in accelerated fetal growth⁵ and higher birth weight, resulting in complications during labor, including the need for a C-section. It is also common for the children of such pregnancies to experience childhood obesity.

Twin pregnancies, however, are different. Twins tend to be born earlier and at lower birth weights. The reasons for this are poorly understood, but the environment inside the womb during early pregnancy may play an essential part in fetal growth. 

Complications of gestational diabetes

Gestational diabetes with twins can cause a variety of potential complications, including:

  • Increased risk for hypertensive (high blood pressure) disorders of pregnancy, including gestational hypertension and preeclampsia

  • Higher risk for polyhydramnios⁶ (too much amniotic fluid in the womb)

  • Higher risk of premature (early) birth

  • Higher risk of emergency C-section

  • Higher risk of the babies needing neonatal intensive care (NICU) support

  • Increased risk for infant respiratory distress syndrome⁷

  • Neonatal hypoglycemia⁸ (low blood glucose levels in one or both babies)

  • Neonatal jaundice⁹ requiring phototherapy

Gestational diabetes will go away entirely for most women once the pregnancy ends. However, for a small number of women, diabetes persists after pregnancy. These women will then be diagnosed with diabetes outside pregnancy (non-gestational diabetes such as type 1 or 2). 

It’s important to know that women with gestational diabetes have a ten-fold risk of developing type 2 diabetes¹⁰ later in life. Women who have had GDM require regular, lifelong screening for type 2 diabetes.

The American Association of Family Practitioners recommends diabetes screening ¹¹at 6 to 12 weeks postpartum (after delivery) and every three years after that, regardless of age.

Some children born to mothers with GDM also have a higher risk of developing pre-diabetes,¹² type 2 diabetes, overweight, obesity, and developmental issues. Children whose mothers had GDM must be taught from a young age about healthy lifestyle choices and the need for regular check-ups with their healthcare professionals.

Treating gestational diabetes—and keeping blood glucose levels within the range recommended by your healthcare team—can significantly reduce the risk of complications for both mother and babies.

Can gestational diabetes with twins be treated?

Gestational diabetes can be treated. The goal is to keep blood glucose at the same levels as pregnant women who don’t have GDM. 

The primary approach to treatment is lifestyle modification, such as improving diet and increasing physical activity. Blood glucose monitoring is also critical. This means working with one or more healthcare professionals specializing in these areas, including an endocrinologist or specialist physician, nutritionist or dietician, credentialed diabetes educator, physiotherapist, or exercise physiologist. 

In some cases, insulin injections or other medications may be added. 

How to prevent gestational diabetes with twins

The best way to prevent GDM¹³ is a topic of ongoing research. However, many studies suggest that healthy eating, an active lifestyle, younger age (below 35), and healthy body size and shape may help decrease the risk of gestational diabetes. 

Keeping your weight down will also increase your chances of conceiving. Obese women are at higher risk of miscarriage and various maternal and fetal complications. Being fit and healthy¹⁴ before pregnancy will help ensure that you stay that way and give birth to a healthy child or children. 

However, it’s typical to gain weight during pregnancy, so you should not try to lose weight once pregnant. Your doctor will guide you about how much weight gain to expect. If you are carrying twins, you are likely to gain more weight than with a singleton.

When to visit a doctor

Prenatal (pregnancy) care appointments are extremely important for your health and your babies. Pregnant women should be screened for gestational diabetes using an oral glucose challenge test and/or an oral glucose tolerance test between 24 and 28 weeks of gestation. 

If you are diagnosed with gestational diabetes, you will need to visit your doctor and the other members of your healthcare team regularly. This will help ensure your and your babies’ health throughout your pregnancy. 

The lowdown

Gestational diabetes is one of the most typical medical conditions in pregnancy. The good news is that the complications associated with gestational diabetes can be decreased or prevented with diagnosis and treatment. For most women, gestational diabetes goes away soon after delivery. 

It’s important to remember that all women diagnosed with gestational diabetes are advised to maintain a healthy lifestyle and to have regular, lifelong screening for type 2 diabetes. Their children and other family members will benefit from their knowledge and living example of a healthy lifestyle.

  1. Gestational diabetes and a healthy baby? Yes. | American Diabetes Association

  2. Obstetric and neonatal outcomes of gestational diabetes mellitus in twin pregnancies according to changes in its diagnostic criteria from national diabetes data group criteria to carpenter and coustan criteria: a retrospective cohort study (2022)

  3. Screening for gestational diabetes US preventive services task force recommendation statement (2021)

  4. Frequency and risk factors for recurrent gestational diabetes mellitus in primiparous women: a case control study (2019)

  5. Gestational diabetes and ultrasound-assessed fetal growth in South Asian and White European women: findings from a prospective pregnancy cohort (2018)

  6. Polyhydramnios (too much amniotic fluid) | NHS

  7. Newborn respiratory distress syndrome | NHS

  8. Neonatal hypoglycemia (2022)

  9. Jaundice in newborns | Johns Hopkins Medicine

  10. Persistence of risk for type 2 diabetes after gestational diabetes mellitus | American Diabetes Association

  11. Screening, diagnosis, and management of gestational diabetes mellitus (2015)

  12. Gestational diabetes mellitus: Long-term consequences for the mother and child grand challenge: How to move on towards secondary prevention? (2020)

  13. Gestational diabetes mellitus—Innovative approach to prediction, diagnosis, management, and prevention of future NCD—mother and offspring (2020)

  14. Gestational diabetes | Centers for Disease Control and Prevention

Other sources:

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