RESUMEN
OBJECTIVE: To assess the impact of twin versus singleton pregnancy on obstetric and perinatal outcomes among women with pregestational diabetes mellitus (DM). METHODS: Multicenter retrospective cohort study of women with pregestational DM and twin or singleton pregnancy, conducted in Spain during 2005-2010. Each group included 63 women (type 1 DM, n=39; type 2 DM, n=24). RESULTS: Of 269 565 deliveries, 68 (0.025%) were twins of mothers with pregestational DM, with 28/63 (44.4%) conceptions achieved with assisted reproduction technology. Among women with type 1 DM, hypertensive complications were more common among those with twins than among controls (13% versus 3%, P=0.02); the rate of preterm birth was higher (69% versus 15%, P<0.001); and the rate of admission to the neonatal intensive care unit was higher (51% versus 21%, P=0.005). Twin pregnancy was an independent risk factor for adverse perinatal outcomes regardless of the type of diabetes. CONCLUSION: Twin pregnancy in women with either type of DM dramatically increased the risk of perinatal morbidity. In mothers with type 1 DM, twin pregnancy was more often associated with hypertensive complications than singleton pregnancy. Transfer of more than one embryo should be avoided if ART is needed in a woman with DM.
Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Hipertensión Inducida en el Embarazo/etiología , Embarazo en Diabéticas , Embarazo Gemelar , Adulto , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Resultado del Embarazo , Técnicas Reproductivas Asistidas , Estudios RetrospectivosRESUMEN
Desde la publicación del primer caso de una gestación a término conseguida en trasplante simultáneo renopancreático, todos los esfuerzos han sido dirigidos a conocer y prevenir 2 riesgos que conlleva esta situación para la madre, el feto y el injerto. Esto supone un reto multidisciplinar encaminado a elaborar unas guías internacionales para el seguimiento en estas gestaciones de alto riesgo. Presentamos 2 casos de gestantes, con trasplante simultáneo reno-pancreático previo, que evolucionaron favorablemente y culminaron con el nacimiento de 2 niños sanos. La gestación no afectó a la funcionalidad de los injertos, ni a corto ni a largo plazo (AU)
Since the publication of the first case of a term pregnanc achieved in simultaneous kidney-pancreas transplantation, efforts have been directed to understanding the impact, risks and benefits on the mother, fetus, and the graft. The development of multidisciplinary international guidelines for the monitoring of these high-risk pregnancies is a challenge. We report two cases of pregnant women with simultaneous kidney-pancreas transplants, which progressed favorably and culminated with the birth of two healthy newborns. Pregnancy did not affect the functionality of the grafts in the short or long term (AU)