Abstract:
BACKGROUND:Our aim was to evaluate the difference in pregnancy outcomes and characteristics between insulin- and diet-treated women with gestational diabetes (GDM). METHODS:Retrospective analysis of the medical files from 2010-2013 of women with GDM diagnosed with the Carpenter & Coustan criteria attending two clinics, one in a university and another in a non-university hospital. Characteristics associated with insulin use were analyzed. Multivariable logistic regression was used to adjust for confounders. For women attending the university hospital, indices of insulin sensitivity such as the reciprocal of the homeostasis model assessment of insulin resistance (1/HOMA-IR) and an index of beta-cell function, the Insulin Secretion-Sensitivity Index-2 (ISSI-2) were calculated. RESULTS:Over a 4 year period, 601 women were identified with GDM of whom 22.9% were obese at first prenatal visit. 24.2% needed insulin. Insulin did not prevent adverse outcomes, as women on insulin had higher rates of large-for-gestational age infants (LGA) (28.5% vs. 13.1 %, p < 0.0001) and more cesarean sections (44.1% vs. 27.0%, p = 0.001), remaining significant after adjustment for confounders. Compared to diet-treated women, women on insulin more often had an ethnic minority background (33.3 % vs. 21.6%, p = 0.004), more often had a history of GDM (21.5% vs. 10.4%, p = 0.002), were more often multiparous (59.3% vs. 47.6%, p = 0.044) and were diagnosed with GDM earlier in pregnancy (weeks 25.3 ± 4.9 vs. 27.1 ± 3.7, p < 0.0001). When undergoing an oral glucose tolerance test, women treated with insulin had a higher fasting glycaemia (97.6 ± 18.8 vs.87.7 ± 10.3, p < 0.0001), a higher 1-hour glycaemia (197.7 ± 30.1 vs.184.5 ± 25.8, p < 0.0001), a higher 2-hour glycaemia (185.2 ± 28.5 vs. 175.0 ± 22.8, p < 0.0001), more often 3 and 4 abnormal values (58.1% vs. 37.8%, p < 0.0001 and 24.8% vs. 7.7%, p < 0.0001) and higher HbA1c levels (5.5 ± 0.6 vs 5.2 ± 0.5, p < 0.0001). ISSI-2 (1.3 ± 0.5 vs. 1.7 ± 0.5, p < 0.0001) and 1/HOMA-IR [0.01 (0.001-0.002) vs. 0.02 (0.01-0.03), p = 0.027] were lower in women on insulin. Women on insulin more often received corticoids in preparation of preterm delivery (11.0% vs. 2.4%, p < 0.0001). CONCLUSION:Compared to diet-treated women with GDM, women treated with insulin have a higher risk profile, impaired beta-cell function and lower insulin sensitivity. Rates of LGA and cesarean sections were higher in insulin-treated women.
journal_name
BMC Pregnancy Childbirthjournal_title
BMC pregnancy and childbirthauthors
Benhalima K,Robyns K,Van Crombrugge P,Deprez N,Seynhave B,Devlieger R,Verhaeghe J,Mathieu C,Nobels Fdoi
10.1186/s12884-015-0706-xsubject
Has Abstractpub_date
2015-10-23 00:00:00pages
271issn
1471-2393pii
10.1186/s12884-015-0706-xjournal_volume
15pub_type
杂志文章abstract:BACKGROUND:Women in pregnancy and postpartum have an increased vulnerability to develop an affective disorder. Affective disorders in pregnancy are associated with an increased risk of prematurity, dysmaturity (foetal weight below the 10th percentile as determined by ultrasound) and the development of postpartum depres...
journal_title:BMC pregnancy and childbirth
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更新日期:2014-08-14 00:00:00
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journal_title:BMC pregnancy and childbirth
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章,随机对照试验
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pub_type: 杂志文章
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journal_title:BMC pregnancy and childbirth
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更新日期:2017-11-08 00:00:00
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pub_type: 杂志文章,meta分析
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更新日期:2018-06-25 00:00:00
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journal_title:BMC pregnancy and childbirth
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更新日期:2020-07-23 00:00:00
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更新日期:2020-10-07 00:00:00
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更新日期:2018-01-03 00:00:00
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pub_type: 杂志文章,评审
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pub_type: 杂志文章
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更新日期:2011-06-01 00:00:00