title: Outcomes of twin pregnancies complicated by gestational diabetes: a meta-analysis of observational studies.
abstract: Gestational diabetes mellitus (GDM) in singleton pregnancy is associated with large for gestational age neonates and adverse perinatal outcomes; however, the impact of GDM in twin pregnancy is unclear. Thus, the aim of this study is to assess the perinatal outcomes of twin pregnancies complicated by GDM by performing a meta-analysis of observational studies.
  
  
  
  Studies investigating GDM in twin pregnancy were identified through an online search of three databases: Medline, Embase and Web of Science. Selection criteria comprised full paper observational studies (retrospective or prospective) published in English that examined GDM in twin pregnancy compared with non-GDM twin pregnancy and reported on birth weight and/or adverse perinatal outcomes. Random-effects models with inverse-variance weighting were used to calculate standardized mean differences and unadjusted odds ratios. Sensitivity analyses were carried out to determine the impact of possible maternal confounders (body mass index and age) and GDM diagnostic criteria on perinatal outcomes.
  
  
  
  Thirteen observational studies were included. GDM twins were born at the same gestation as non-GDM twins, with marginally lower birth weight. There was no difference in the incidence of large or small for gestational age neonates. Although there was no correlation between GDM in twin pregnancy and respiratory distress, neonatal hypoglycemic or low Apgar score, GDM twins had a higher rate of neonatal intensive care unit admission (OR 1.49; 95% confidence interval: 1.10, 2.02; P<0.01).
  
  
  
  Identification and subsequent treatment of GDM in twin pregnancy demonstrates a similar risk of adverse perinatal outcomes compared with non-GDM twin pregnancies.
authors.affiliation: Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, NSW 2065, Australia.|University of Sydney, Northern Clinical School, Royal North Shore Hospital, Sydney, NSW 2065, Australia.
authors.forename: R T
authors.initials: RT
authors.lastname: McGrath
authors.affiliation: Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, NSW 2065, Australia.|University of Sydney, Northern Clinical School, Royal North Shore Hospital, Sydney, NSW 2065, Australia.
authors.forename: S L
authors.initials: SL
authors.lastname: Hocking
authors.affiliation: Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, NSW 2065, Australia.
authors.forename: E S
authors.initials: ES
authors.lastname: Scott
authors.affiliation: University of Sydney, Northern Clinical School, Royal North Shore Hospital, Sydney, NSW 2065, Australia.|Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia.
authors.forename: S K
authors.initials: SK
authors.lastname: Seeho
authors.affiliation: Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, NSW 2065, Australia.|University of Sydney, Northern Clinical School, Royal North Shore Hospital, Sydney, NSW 2065, Australia.
authors.forename: G R
authors.initials: GR
authors.lastname: Fulcher
authors.affiliation: Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, NSW 2065, Australia.|Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, Sydney, NSW 2065, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Glastras
mesh_terms: D000328:Adult; D001724:Birth Weight; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D064887:Observational Studies as Topic; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D059285:Pregnancy, Twin