Risk Factors for Insulin Therapy in Gestational Diabetes Mellitus
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Abstract
Objectives: To determine the factors associated with insulin requirement in patients with gestational diabetes mellitus (GDM) and compare the obstetrics outcomes between those who required insulin therapy and who did not.
Materials and Methods: A case-control study was conducted, including 100 GDM women who required insulin therapy as cases and 400 GDM women who did not require insulin therapy as controls. Data on baseline and obstetric characteristics, antenatal care, GDM risks, screening and diagnostic test results, labor and delivery, and obstetrics outcomes were reviewed from the medical records.
Results: Cases were significantly more likely to be nulliparous, overweight or obese, have DM in family, have had prior GDM, had higher number of GDM risks than controls. Compared with controls, cases had significantly higher plasma glucose level at fasting, 1, and 2 hours, but not at 3 hours after glucose loading and higher rate of abnormal fasting plasma glucose values and higher number of abnormal OGTT values. Logistic regression analysis showed that independent associated factors for insulin requirement were fasting plasma glucose (FPG) at OGTT > 95 mg/dL (adjusted odds ratio (OR) 20.8, 95% confidence interval (CI) 11.4-37.9), overweight or obesity (adjusted OR 1.9, 95%CI 1.1-3.5) and family history of DM (adjusted OR 2.2, 95%CI 1.2-3.9). While other pregnancy outcomes were comparable between the 2 groups, infants of cases were significantly more likely to have neonatal hypoglycemia and need for phototherapy.
Conclusion: Independent associated risks for insulin therapy in GDM women included FPG of > 95 mg/dL at OGTT, overweight or obesity, and family history of DM.
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