Impact of fetal reduction on the incidence of gestational diabetes.
OBJECTIVE
To estimate the rate of gestational diabetes in triplet pregnancies and to assess the impact of fetal reduction on the incidence of this complication.


METHODS
One hundred eighty-eight consecutive triplet pregnancies referred to the Sheba Medical Center between 1994 and 1998 were included. One hundred three of these pregnancies continued as triplets, whereas 85 women elected to undergo fetal reduction to twins. The incidence of gestational diabetes (based on the criteria of Carpenter and Coustan) and other outcome variables were compared between the two groups. Student t-tests and chi(2) analysis were used as appropriate.


RESULTS
Mean (+/-SD) maternal age was 29.2 +/- 4.8 in the triplet group and 29.3 +/- 4.1 in the reduction group. The groups had similar median parity (1.6 +/- 1.1 in the triplet group and 1.5 +/- 0.7 in the reduction group). The rate of gestational diabetes was significantly higher in the triplet group than in the reduction group (22.3% vs 5.8%). A lower birth weight (1764 +/- 448 g vs 2208 +/- 526 g) and an earlier gestational age at delivery (33.4 +/- 2.8 weeks vs 36.0 +/- 2.8 weeks) were observed in the triplet group compared with the reduction group.


CONCLUSIONS
The number of fetuses in multifetal pregnancies influences the incidence of gestational diabetes. These findings support the hypothesis that an increase in placental mass and, thus, an increase in diabetogenic hormones play a role in the etiology of gestational diabetes.
Sivan
Eyal
E
Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel. sivane@zahav.net.il
Maman
Eti
E
Homko
Carol J
CJ
Lipitz
Shlomo
S
Cohen
Shlomi
S
Schiff
Eyal
E
D000328:Adult; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal; D011272:Pregnancy, Multiple; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D012494:Sampling Studies; D016896:Treatment Outcome; D014310:Triplets; D014427:Twins