{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T12:46:20Z","timestamp":1785761180371,"version":"3.56.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gestational diabetes mellitus (GDM) poses distinct challenges across different pregnancy types, yet whether the roles of early metabolic markers and conventional risk factors vary between singleton and twin pregnancies remains unclear. This study sought to clarify the associations of early pregnancy fasting plasma glucose (FPG) and established risk factors with GDM and adverse perinatal outcomes in both pregnancy settings, with a particular focus on heterogeneity across the two groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study enrolled 5,532 singleton and 175 twin pregnancies from Ningjin County Hospital, Hebei Province, between January 1, 2019, and December 31, 2024. Data collected encompassed maternal baseline characteristics, early pregnancy FPG, GDM diagnosis (based on IADPSG criteria), and perinatal outcomes. Analytical approaches comprised multivariate logistic regression, interaction analysis, SHAP (Shapley additive explanations) analysis, and receiver operating characteristic (ROC) curve evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      GDM incidence was significantly higher in twin than singleton pregnancies (30.29% vs. 21.98%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), as were adverse perinatal outcomes (preeclampsia, preterm birth, cesarean section; all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). In singletons, early pregnancy FPG and all traditional risk factors correlated with GDM (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05); in twins, GDM history and PCOS associations with GDM were attenuated (not significant). Interaction analysis showed pre-pregnancy BMI and PCOS had stronger GDM predictive effects in singletons (\n                      <jats:italic>p<\/jats:italic>\n                      -interaction &amp;lt; 0.05). SHAP analysis confirmed lower contributions of GDM history and PCOS in twins, while early pregnancy FPG was the top predictor in both. Individual predictors had limited GDM predictive value (AUCs &amp;lt; 0.6), but combining early pregnancy FPG with all risk factors improved performance (AUCs: 0.783 for singletons, 0.784 for twins). Early pregnancy FPG and risk factors correlated with adverse outcomes, with more pronounced effects in twins.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Twin pregnancy is a high-risk condition for GDM and adverse outcomes. Pre-pregnancy BMI and PCOS are more strongly predictive of GDM in singleton pregnancies, while early pregnancy FPG serves as a universal predictor in both types. Individualized management strategies based on pregnancy type are warranted, with enhanced monitoring for twin pregnancies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1851313","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T11:51:00Z","timestamp":1785757860000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early pregnancy fasting plasma glucose and risk factors: impact on gestational diabetes mellitus and other adverse perinatal outcomes in singleton and twin pregnancies"],"prefix":"10.3389","volume":"13","author":[{"given":"Ran","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ningjin County Hospital","place":["Xingtai, Hebei, China"]},{"name":"Department of Central Laboratory, The Third Affiliated Hospital of Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Central Laboratory, The Third Affiliated Hospital of Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1007\/s13300-022-01210-6","article-title":"Overt diabetes in pregnancy","volume":"13","author":"Goyal","year":"2022","journal-title":"Diabetes Ther"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1097\/AOG.0000000000006090","article-title":"Gestational and Pregestational diabetes screening changes in early pregnancy and perinatal outcomes","volume":"147","author":"Greenberg","year":"2026","journal-title":"Obstet Gynecol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"111890","DOI":"10.1016\/j.diabres.2024.111890","article-title":"Early screening and diagnosis of gestational diabetes mellitus (GDM) and its impact on perinatal outcomes","volume":"217","author":"Bastian","year":"2024","journal-title":"Diabetes Res Clin Pract"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"839882","DOI":"10.3389\/fped.2022.839882","article-title":"Hypertensive disorders of pregnancy and neonatal outcomes in twin vs. singleton pregnancies after assisted reproductive technology","volume":"10","author":"Liu","year":"2022","journal-title":"Front Pediatr"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1097\/AOG.0000000000005912","article-title":"Factors and perinatal outcomes associated with intrapartum cesarean delivery in twin gestations","volume":"146","author":"Lin","year":"2025","journal-title":"Obstet Gynecol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1007\/s00404-025-08266-2","article-title":"Abnormal fasting glucose levels in the diagnosis of GDM may be associated with adverse pregnancy outcomes","volume":"313","author":"Wang","year":"2026","journal-title":"Arch Gynecol Obstet"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"4953","DOI":"10.3390\/jcm11174953","article-title":"Screening of gestational diabetes and its risk factors: pregnancy outcome of women with gestational diabetes risk factors according to glycose tolerance test results","volume":"11","author":"Hanson","year":"2022","journal-title":"J Clin Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.ejogrb.2022.06.009","article-title":"Excessive gestational weight gain is an independent risk factor for gestational diabetes mellitus in singleton pregnancies: results from a French cohort 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