Glycemic Status and Fetal Growth in Twin Gestations

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

The prevalence of gestational diabetes mellitus (GDM) in twin pregnancies is higher than in singleton pregnancies, and there is currently a knowledge gap regarding fetal growth patterns in twin pregnancies affected by GDM.

This was a secondary analysis of a retrospective cohort of 944 dichorionic twin pregnancies from 17 U.S. centers between December 20, 2011 and August 10, 2020. The primary exposure studied was GDM documented in the medical record. The primary outcome studied was longitudinal estimated fetal weight. We also secondarily examined longitudinal growth of individual fetal biometric indices, including head circumference, abdominal circumference, femur length, and the HC/AC ratio as a measure of asymmetric fetal growth, as well as birthweight including birthweight discordance and small- and large-for-gestational-age, and incidence of preterm birth. Trajectories of log-transformed EFW, FL, AC, HC, HC/AC ratio were modeled using linear mixed models, estimated using a restricted maximum likelihood approach. Fixed effects of the linear, quadratic, and cubic terms, and cubic spline terms of gestational age (three knots at 25th, 50th, 75th percentiles), as well as a random intercept and random effect.

GDM was not associated with differences in EFW (global P=0.703) or individual biometric indices (all global P>0.05) across gestation. Mean birthweight was 2437.64 grams +/- 603.33 grams in the normoglycemic group and 2388.07 grams +/- 536.19 grams in the GDM group (P>0.05).

Given our observation that GDM was not associated with differences in EFW, and that, unlike in singletons, maternal hyperglycemia did not seem to significantly alter fetal growth trajectories in twins, it is clinically relevant to address the appropriateness of current GDM classification and diagnostic criteria in this population.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2097

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