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The Incidence of Gestational Diabetes in Multiple Pregnancy

The aetiology of glucose intolerance in pregnancy remains unknown. Pregnancy induces metabolic changes in all women that are probably adaptive in nature and optimize the supply of fuel to the fetus. Insulin resistance in pregnancy is probably a result of a postreceptor defect with the addition of mediating effects from increased circulating hormones. A likely candidate is human placental lactogen (HPL), a 26 amino acid polypeptide, produced by the syncytiotrophoblast and demonstrable in the maternal serum from the fifth week of gestation. A recognized insulin-antagonist, HPL is thought to mediate the diabetogenic effects of pregnancy either directly or by its influence on other hormones such as insulin-like growth factors. The level of HPL has been demonstrated to be significantly higher in twin than in singleton pregnancy (1). Previous studies (2-5) have reported conflicting results regarding the incidence of gestational diabetes in twin pregnancy. To our knowledge, the comparative incidence in triplet pregnancy has not been reported. The aim of this study was to compare the incidence of gestational diabetes, using uniform criteria, between singleton, twin and triplet pregnancies.