---
title: "Gestational Diabetes in Multifetal vs Singleton Pregnancies: Neonatal and Long-Term Outcomes"
id: "pubmed-42683762"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42683762"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42683762/"
doi: "10.1111/aogs.70326"
published_at: "2026-09-02T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Gestational Diabetes in Multifetal vs Singleton Pregnancies: Neonatal and Long-Term Outcomes
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42683762
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42683762/)
- **DOI:** [10.1111/aogs.70326](https://doi.org/10.1111%2Faogs.70326)
- **Published At:** 2026-09-02T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This multicenter retrospective cohort assessed how **gestational diabetes mellitus (GDM)** affects neonatal complications and long-term offspring healthcare utilization in **multifetal pregnancies** compared with **singleton pregnancies** using electronic records from six Israeli university-affiliated centers (1/1/2010–6/30/2024). - The cohort comprised 134,517 pregnancies (136,579 live-born offspring) to 104,023 mothers. GDM complicated 10,605 singleton pregnancies (7.9%) and 256 multifetal pregnancies (0.2%). - Exposure groups: singleton without GDM, singleton with GDM, multifetal without GDM, and multifetal with GDM (GDM identified by ICD-9 648.8x). - Short-term neonatal outcomes evaluated included **neonatal hypoglycemia**, NICU admission, respiratory distress, intraventricular hemorrhage, and growth abnormalities. Long-term offspring outcomes were proxied by hospital-based specialty healthcare utilization (e.g., neurology, ophthalmology, cardiology). - Multivariable Firth logistic and OLS regression models adjusted for maternal age, BMI, parity, and fertility treatment; additional models adjusted for gestational age. False discovery rate correction and GDM-by-plurality interaction terms were applied. - Key finding: in **multifetal pregnancies**, GDM was not associated with increased short-term neonatal complications and was linked to lower adjusted odds of neonatal hypoglycemia (aOR 0.30; 95% CI 0.18–0.49) and reduced neurologic (aOR 0.37; 95% CI 0.24–0.59) and ophthalmologic (aOR 0.49; 95% CI 0.31–0.77) healthcare utilization. - Adjustment for gestational age reduced the association with NICU admission but did not fully explain the interactions observed for hypoglycemia and certain long-term outcomes. - Conversely, in **singleton pregnancies**, GDM was associated with increased neonatal morbidity. - The authors conclude that relationships between GDM and neonatal/offspring outcomes differ by plurality and that risk stratification derived from singleton data may not accurately represent risk in multifetal pregnancies.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Gestational diabetes in multifetal versus singleton pregnancies: A multicenter cohort study [Rinat Gabbay-Benziv](https://pubmed.ncbi.nlm.nih.gov/?term=Gabbay-Benziv+R&cauthor_id=42683762)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-1 "Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-2 "The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel."), [Esther Maor-Sagie](https://pubmed.ncbi.nlm.nih.gov/?term=Maor-Sagie+E&cauthor_id=42683762)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-1 "Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-2 "The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel."), [Amos Stern](https://pubmed.ncbi.nlm.nih.gov/?term=Stern+A&cauthor_id=42683762)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-3 "The Rachel and Selim Benin School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-4 "Efi Arazi School of Computer Science, Reichman University, Herzliya, Israel."), [Inna Bleicher](https://pubmed.ncbi.nlm.nih.gov/?term=Bleicher+I&cauthor_id=42683762)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-2 "The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-5 "Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel."), [Simon Shenhav](https://pubmed.ncbi.nlm.nih.gov/?term=Shenhav+S&cauthor_id=42683762)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-6 "Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-7 "Ben-Gurion University of the Negev, Beer-Sheva, Israel."), [Enav Yefet](https://pubmed.ncbi.nlm.nih.gov/?term=Yefet+E&cauthor_id=42683762)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-8 "Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya, Israel.")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-9 "The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel."), [Yifat Wiener](https://pubmed.ncbi.nlm.nih.gov/?term=Wiener+Y&cauthor_id=42683762)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-10 "Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Israel.")[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-11 "The Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel."), [Michal Kovo](https://pubmed.ncbi.nlm.nih.gov/?term=Kovo+M&cauthor_id=42683762)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-10 "Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Israel.")[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-11 "The Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel."), [Maya Frank Wolf](https://pubmed.ncbi.nlm.nih.gov/?term=Frank+Wolf+M&cauthor_id=42683762)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-9 "The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.")[ 12 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#full-view-affiliation-12 "Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.") Affiliations Expand ### Affiliations * 1 Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel. * 2 The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. * 3 The Rachel and Selim Benin School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel. * 4 Efi Arazi School of Computer Science, Reichman University, Herzliya, Israel. * 5 Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel. * 6 Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel. * 7 Ben-Gurion University of the Negev, Beer-Sheva, Israel. * 8 Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya, Israel. * 9 The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel. * 10 Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Israel. * 11 The Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel. * 12 Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel. * PMID: **42683762** * DOI: [ 10.1111/aogs.70326 ](https://doi.org/10.1111/aogs.70326) Item in Clipboard # Gestational diabetes in multifetal versus singleton pregnancies: A multicenter cohort study Rinat Gabbay-Benziv et al. Acta Obstet Gynecol Scand. 2026. Show details Display options Display options Format Abstract PubMed PMID Acta Obstet Gynecol Scand Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Acta+Obstet+Gynecol+Scand%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Acta+Obstet+Gynecol+Scand%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42683762/) . 2026 Sep 2. doi: 10.1111/aogs.70326. Online ahead of print. ### Authors [Rinat Gabbay-Benziv](https://pubmed.ncbi.nlm.nih.gov/?term=Gabbay-Benziv+R&cauthor_id=42683762)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-1 "Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-2 "The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel."), [Esther Maor-Sagie](https://pubmed.ncbi.nlm.nih.gov/?term=Maor-Sagie+E&cauthor_id=42683762)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-1 "Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-2 "The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel."), [Amos Stern](https://pubmed.ncbi.nlm.nih.gov/?term=Stern+A&cauthor_id=42683762)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-3 "The Rachel and Selim Benin School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-4 "Efi Arazi School of Computer Science, Reichman University, Herzliya, Israel."), [Inna Bleicher](https://pubmed.ncbi.nlm.nih.gov/?term=Bleicher+I&cauthor_id=42683762)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-2 "The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-5 "Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel."), [Simon Shenhav](https://pubmed.ncbi.nlm.nih.gov/?term=Shenhav+S&cauthor_id=42683762)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-6 "Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-7 "Ben-Gurion University of the Negev, Beer-Sheva, Israel."), [Enav Yefet](https://pubmed.ncbi.nlm.nih.gov/?term=Yefet+E&cauthor_id=42683762)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-8 "Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya, Israel.")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-9 "The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel."), [Yifat Wiener](https://pubmed.ncbi.nlm.nih.gov/?term=Wiener+Y&cauthor_id=42683762)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-10 "Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Israel.")[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-11 "The Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel."), [Michal Kovo](https://pubmed.ncbi.nlm.nih.gov/?term=Kovo+M&cauthor_id=42683762)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-10 "Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Israel.")[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-11 "The Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel."), [Maya Frank Wolf](https://pubmed.ncbi.nlm.nih.gov/?term=Frank+Wolf+M&cauthor_id=42683762)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-9 "The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.")[ 12 ](https://pubmed.ncbi.nlm.nih.gov/42683762/#short-view-affiliation-12 "Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.") ### Affiliations * 1 Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel. * 2 The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. * 3 The Rachel and Selim Benin School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel. * 4 Efi Arazi School of Computer Science, Reichman University, Herzliya, Israel. * 5 Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel. * 6 Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel. * 7 Ben-Gurion University of the Negev, Beer-Sheva, Israel. * 8 Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya, Israel. * 9 The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel. * 10 Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Israel. * 11 The Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel. * 12 Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel. * PMID: **42683762** * DOI: [ 10.1111/aogs.70326 ](https://doi.org/10.1111/aogs.70326) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Introduction:** Gestational diabetes mellitus (GDM) is associated with increased neonatal morbidity in singleton pregnancies, but evidence in multifetal pregnancies is limited. Current diagnostic thresholds are largely extrapolated from singleton data; It remains unclear whether plurality modifies GDM-associated neonatal and long-term offspring outcomes. We wanted to evaluate neonatal complications and long-term offspring healthcare utilization associated with GDM in multifetal versus singleton pregnancies, and to assess effect modification by plurality and the impact of gestational age at delivery. **Material and methods:** This multicenter retrospective cohort study utilized electronic medical records across six university-affiliated medical centers in Israel (1/1/2010-6/30/2024). All live births at 22 weeks' gestation or later or with birthweight of >500 g were included. Four exposure groups were defined by plurality and GDM status (ICD-9 code 648.8x): singleton without GDM, singleton with GDM, multifetal without GDM, and multifetal with GDM. Short-term neonatal complications (neonatal hypoglycemia, neonatal ICU admission, respiratory distress, intraventricular hemorrhage, and growth abnormalities) and long-term offspring outcomes were assessed by hospital-based health-care utilization (e.g., neurology, ophthalmology, cardiology). Multivariable Firth logistic and ordinary least squares regression models were adjusted for maternal age, body mass index, parity, and fertility treatment. Additional models adjusted for gestational age were performed. False discovery rate correction and GDM-by-plurality interaction terms were applied. **Results:** Of 134 517 pregnancies (136 579 live-born offspring) to 104 023 mothers, 10 605 singleton (7.9%) and 256 multifetal (0.2%) pregnancies were complicated by GDM. In multifetal pregnancies, GDM was not associated with increased short-term neonatal complications nor with lower adjusted odds of neonatal hypoglycemia (adjusted odds ratio [aOR], 0.30; 95% CI: 0.18-0.49), neurologic (aOR, 0.37; 95% CI: 0.24-0.59), or ophthalmologic (aOR, 0.49; 95% CI: 0.31-0.77) health-care utilization. Adjustment for gestational age attenuated associations for neonatal intensive care unit admission but did not fully explain interactions for hypoglycemia or selected long-term outcomes. Conversely, GDM in singleton pregnancies was associated with increased neonatal morbidity. **Conclusions:** Associations between GDM and neonatal and offspring outcomes differ by plurality. Risk stratification strategies derived from singleton pregnancies may not fully capture risk profiles in multifetal pregnancies. **Keywords:** gestational diabetes mellitus; long‐term neurodevelopment; maternal morbidity; multifetal pregnancies; neonatal outcomes. © 2026 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## References 1. 1. American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: standards of care in diabetes–2025. Diabetes Care. 2025;48(1Suppl 1):S27‐S49. doi:10.2337/dc25-S002 2. 1. ACOG Practice Bulletin No. 190: Gestational diabetes mellitus. Obstet Gynecol. 2018;131(2):e49‐e64. doi:10.1097/AOG.0000000000002501 3. 1. Savoia F, Muscettola G, Iliodromiti S, Greco E. Open questions on gestational diabete
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