Gestational Diabetes Mellitus Screening In Twin Pregnancies

Akin Usta 1, Mehmet Kanter 2, Meryem Hocaoğlu 3, Ceyda Sancakli Usta 4, Aydin Savkli 4, Eylem Sen Dalkiran 5, Selin Demirer 6, Betul Kanter 7
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1 Balıkesir Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum AD, Balıkesir
2 İstanbul Medeniyet Üniversitesi Tıp Fakültesi, Histoloji ve Embriyoloji AD, İstanbul
3 İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği, İstanbul
4 Balıkesir Atatürk Hastanesi Kadın Hastalıkları ve Doğum Kliniği, Balık
5 Balıkesir Atatürk Hastanesi, Çocuk Hastalıkları Kliniği, Balıkesir
6 Namık Kemal Üniversitesi Tıp Fakültesi, Histoloji ve Embriyoloji AD, Tekirdağ
7 Medikal Üniversitesi Tıp Fakültesi, Sofya, Bulgaristan
EUR J BASIC MED SCI, Volume 5, Issue 3, pp. 39-44.
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The purpose of this study was to ideal cutoff in plasma glucose levels in screening for gestational diabetes mellitus (GDM) in twin pregnancies. A total 311 twin pregnancies were identified from hospital data base from 2007 to 2015. A 50 gram oral glucose challenge test (GCT) was performed at 24–28 weeks’ gestation. In those with a GCT of≥130 mg/dL underwent a 100-gram threehour oral glucose tolerance test (OGTT). The diagnosis of GDM was made if two of the four values on the oral glucose tolerance test were abnormal (The Carpenterand Coustanvalues). The screening results of the GCT was evaluated with ROC curve analysis to obtain a complete sensitivity/specificity at different cut-off points. We excluded all patients with pre-gestational diabetes and GDM diagnosed before 24 weeks of gestation. The positive screen rate was 32.5%. The incidence of GDM was 7.1%. The ROC analysis showed that a GCT cutoff of >135 mg/dL maintained 100% sensitivity, with a specificity of 78.2%. The positive predictive value was 22.9% and the negative predictive value was 100%. Area under ROC curve (AUC) was 0.948. Compared to a cutoff of ≥130 mg/dL, a cutoff of >135 mg/dL resulted in 5.1% less patients testing positive while maintaining the same 100% sensitivity. In twin pregnancy screening, a 50 gram GCT cutoff appears to be 135 mg/dL.


Usta A, Kanter M, Hocaoğlu M, Sancakli Usta C, Savkli A, Sen Dalkiran E, et al. Gestational Diabetes Mellitus Screening In Twin Pregnancies. Eur J Basic Med Sci. 2015;5(3):39-44.


  • Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care 1998;21 Suppl 2:B161–7.
  • Committee on Practice Bulletins: Obstetrics. Practice Bulletin No. 137: gestational diabetes mellitus. Obstet Gynecol 2013;122(2 Pt 1):406-16.
  • Hartling L, Dryden DM, Guthrie A, et al. Screening and Diagnosing Gestational Diabetes Mellitus. Evid Rep Technol Assess 2012;210:1-327.
  • Moyer VA, U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014;160:414.
  • Mazze RS, Krogh CL. Gestational diabetes mellitus: now is the time for detection and treatment. Mayo Clin Proc 1992;67(10):995–1002.
  • Harris SB, Caulfield LE, Sugamori ME, Whalen EA, Henning B. The epidemiology of diabetes in pregnant Native Canadians. A risk profile. Diabetes Care 1997;20(9):1422–5.
  • Landon MB, Gabbe SG. Gestational diabetes mellitus. Obstet Gynecol 2011;118(6):1379–93.
  • HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, DyerAR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse preg-nancy outcomes. N Engl J Med 2008;358(19):1991–2002.
  • Yogev Y, Xenakis EMJ, Langer O. The association between preeclampsia and the severity of gestational diabetes: the impact of glycemic control. Am J Obstet Gynecol 2004;191(5):1655–60.
  • Horvath K, Koch K, Jeitler K, et al. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ 2010;340:c1395.
  • Jacqueminet S, Jannot-Lamotte M-F. Therapeutic management of gesta-tional diabetes. Diabetes Metab 2010;36(6 Pt 2):658–71.
  • Kühl C. Etiology and pathogenesis of gestational diabetes. Diabetes Care 1998;21 Suppl 2:B19–26.
  • Norwitz ER, Edusa V, Park JS. Maternal physiology and complications of multiple pregnancy. Semin Perinatol 2005;29:338-48.
  • Spellacy WN, Buhi WC, Birk SA. Human placental lactogen levels in multiple pregnancies. Obstet Gynecol 1978;52:210-2.
  • Yun Ji Jung, Ja Young Kwon, Hee Young Cho, Yong-Won Park, Young-Han Kim. Comparison of the performance of screening test for gestational diabetes in singleton versus twin pregnancies. Obstet Gynecol Sci 2015;58(6):439-445.
  • Buhling KJ, Henrich W, Starr E, Lubke M, Bertram S,Siebert G, et al. Risk for gestational diabetes and hypertension for women with twin pregnancy compared to singleton pregnancy. Arch Gynecol Obstet 2003;269:33- 6.
  • Rauh-Hain JA, Rana S, Tamez H, Wang A, Cohen B, Cohen A, et al. Risk for developing gestational diabetes in women with twin pregnancies. J Matern Fetal Neonatal Med 2009;22:293-9.
  • Simmons D, Yapa M. Association between twin pregnancy and hyperglycemia in a multiethnic community in New Zealand. Diabetes Care 2002;25:934-5.
  • Wein P, Warwick MM, Beischer NA. Gestational diabetes in twin pregnancy: prevalence and long-term implications. Aust N Z J Obstet Gynaecol 1992;32:325-7.
  • Van Leeuwen M, Louwerse MD, Opmeer BC, Limpens J, Serlie MJ, Reitsma JB, et al. Glucose challenge test for detecting gestational diabetes mellitus: a systematic review. BJOG 2012;119:393-401.
  • Donovan L, Hartling L, Muise M, Guthrie A, Vandermeer B, Dryden DM. Screening tests for gestational diabetes: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2013;159(2):115–22.
  • Rebarber A, Dolin C, Fields JC, Saltzman DH, Klauser CK, Gupta S, vd. Screening approach for gestational diabetes in twin pregnancies. Am J Obstet Gynecol 2014;211(6):639. e1–5.