Diabetes Res Clin Pract. 2026 Aug 22:113517. doi: 10.1016/j.diabres.2026.113517. Online ahead of print.
ABSTRACT
AIMS: To evaluate the independent and combined associations of gestational diabetes mellitus (GDM) and multifetal gestation with maternal morbidity, particularly hypertensive disorders of pregnancy (HDP).
METHODS: We conducted a national multicenter retrospective cohort study from six university-affiliated medical centers (2010-2024) mapped to the OMOP Common Data Model. Pregnancies were categorized as singleton without GDM, singleton with GDM, multifetal without GDM, and multifetal with GDM. Outcomes included HDP, ICP, cesarean delivery, and placental abruption. Multivariable Firth logistic regression adjusted for maternal age, body mass index, parity, and fertility treatment.
RESULTS: Among 134,517 pregnancies, HDP rates increased from 4.5% in singleton pregnancies without GDM to 10.2% in singleton pregnancies with GDM, 11.0% in multifetal pregnancies without GDM, and 16.4% in multifetal pregnancies with GDM. GDM was independently associated with HDP (aOR 1.7, 95% CI 1.6-1.8). Multifetal gestation showed stronger associations with HDP (aOR 2.2-2.5) and severe preeclampsia (aOR 3.6). ICP was most frequent in multifetal pregnancies with GDM (aOR 6.5,95% CI 3.5-10.9). No statistically significant interaction between GDM and multifetal gestation was detected for HDP(q = 0.088).
CONCLUSION: Both GDM and multifetal gestation were independently associated with maternal morbidity. Multifetal gestation showed stronger associations with hypertensive outcomes, without evidence of interaction between the two exposures.
PMID:42632456 | DOI:10.1016/j.diabres.2026.113517
