Gestational diabetes–Predictors of response to treatment and obstetric outcome

Ali, Amanda; Shastry, Sangeetha; Nithiyananthan, Ratnasingam; Ali, Amira Mohammed; Ganapathy, Ramesh

doi:10.1016/j.ejogrb.2017.11.014

Cited by 17 publications

(27 citation statements)

References 11 publications

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“…First, our study reflects the experience of one tertiary hospital and its results can be generalized only to other perinatal centers using the same practices (systematic ambulatory procedure after diagnosis of GDM, strict education, systematic self‐monitoring of blood glucose, regular lifestyle intervention, medical nutrition therapy, and AIT after 1 or 2 weeks of inefficiency dietary therapy). Second, we reported a high rate of AIT (36.0%), consistent with some studies (30%–50%), but lower than in others (10.8%) . This difference may be explained by our experience in systematic active management with strict multidisciplinary survey (obstetrician, midwife, and endocrinologist) of women with GDM.…”

Section: Discussionsupporting

confidence: 89%

“…Several studies have analyzed maternal characteristics (age, pre‐pregnancy BMI, ethnicity, or previous GDM) or biological parameters (FPG, HbA1c >5.4%, and elevated OGTT values) that should be associated with AIT . A large retrospective study analyzed outcomes according to pre‐pregnancy BMI categories (normal weight, overweight, and obese), and by diet or AIT and glycemic control .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have analyzed maternal characteristics (age, prepregnancy BMI, ethnicity, or previous GDM) or biological parameters (FPG, HbA1c >5.4%, and elevated OGTT values) that should be associated with AIT. [5][6][7][8][9][10][11][12][13][14][15][16][23][24][25] A large retrospective study analyzed outcomes according to pre-pregnancy BMI categories (normal weight, overweight, and obese), and by diet or AIT and glycemic control. 24 In obese women with GDM, achievement of targeted levels of glycemia was associated with enhanced outcome only in women treated with insulin.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have successfully identified one or more maternal characteristics or biochemical parameters at diagnosis of GDM that are associated with AIT . In a large retrospective study, Barnes et al .…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have successfully identified one or more maternal characteristics or biochemical parameters at diagnosis of GDM that are associated with AIT. [5][6][7][8][9][10][11][12][13][14][15][16] In a large retrospective study, Barnes et al 15 successfully validated a model that predicts AIT using seven dichotomized independent variables at diagnosis of GDM (age, prepregnancy body mass index [BMI], gestational age at diagnosis, fasting plasma glucose [FPG], glycated hemoglobin [HbA1c] at diagnosis , family history of type 2 diabetes, and previous GDM). Early screening of these predictors may be important to identify high-risk women who require high priority in our perinatal center.…”

Section: Introductionmentioning

confidence: 99%

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Predictive factors of subsequent insulin requirement for glycemic control during pregnancy at diagnosis of gestational diabetes mellitus

Ducarme

Roure

Grange

et al. 2019

Intl J Gynecology & Obste

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Objective To determine maternal and biological parameters at diagnosis of gestational diabetes mellitus (GDM) as predictors of antenatal insulin therapy (AIT) for glycemic control. Methods In this planned secondary analysis of a prospective observational study, we recruited women diagnosed with GDM between July 1, 2014, and October 31, 2015. Maternal and biological parameters were analyzed as predictors of AIT using multivariable logistic regression analyses. Predictive accuracy of a cut‐off value for a biological predictor was determined using the area under the receiver operating characteristic curve (AUC) and the Youden index (J). Results Of 200 women included (mean gestational age 22 ± 6 weeks), 72 (36%) required AIT. No maternal characteristic was associated with AIT. Glycated hemoglobin (HbA1c; adjusted odds ratio [aOR] 3.15, 95% CI 1.03–9.69) and elevated 1‐hour oral glucose tolerance test (OGTT; aOR 1.23, 95% CI 1.13–1.46) were predictors of AIT. Analyses suggested inaccurate prediction of AIT, with an optimal cut‐off HbA1c value of 5.4% (J=0.14; AUC 0.58, 95% CI 0.48–0.67), and an optimal 1‐hour plasma glucose OGTT value of 1.77 mg/dL (J=0.24; AUC 0.62, 95% CI 0.50–0.74). Conclusion HbA1c at diagnosis of GDM and elevated 1‐hour OGTT were independent predictors of AIT for glycemic control. Clinicaltrials.gov: NCT02159378.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Predictive factors of subsequent insulin requirement for glycemic control during pregnancy at diagnosis of gestational diabetes mellitus

Ducarme

Roure

Grange

et al. 2019

Intl J Gynecology & Obste

View full text Add to dashboard Cite

show abstract

Multifaceted therapeutic approach via thiazolidinedione-infused magnolol in chitosan nanoparticles targeting hyperlipidemia and oxidative stress in gestational diabetes mellitus in experimental mice

2024

Naunyn-Schmiedeberg's Arch Pharmacol

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Factors Associated with the Need for Insulin as a Complementary Treatment to Metformin in Gestational Diabetes Mellitus

Souza

Silva

et al. 2019

Rev Bras Ginecol Obstet

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Objective To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM). Methods A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes. Results A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG) < 90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235–0.815]; p = 0.009], as well as primiparity (OR: 0.280 [0.111–0.704]; p = 0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063–4,039]; p = 0,032). Conclusion Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG < 90 mg/dL and primiparity were protective factors.

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Gestational diabetes–Predictors of response to treatment and obstetric outcome

Cited by 17 publications

References 11 publications

Predictive factors of subsequent insulin requirement for glycemic control during pregnancy at diagnosis of gestational diabetes mellitus

Predictive factors of subsequent insulin requirement for glycemic control during pregnancy at diagnosis of gestational diabetes mellitus

Multifaceted therapeutic approach via thiazolidinedione-infused magnolol in chitosan nanoparticles targeting hyperlipidemia and oxidative stress in gestational diabetes mellitus in experimental mice

Factors Associated with the Need for Insulin as a Complementary Treatment to Metformin in Gestational Diabetes Mellitus

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