Risk stratification for healthcare planning in women with gestational diabetes mellitus

S. H. Koning*, K. A. Scheuneman, H. L. Lutgers, F. J. Korteweg, G. van den Berg, K. M. Sollie, A. Roos, A. J. van Loon, T. P. Links, K. M. van Tol, K. Hoogenberg, Paul Berg, van den, B. H. R. Wolffenbuttel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)

Abstract

Background: To identify relevant factors predicting the need for insulin therapy in women with gestational diabetes mellitus (GDM) and secondly to determine a potential 'low-risk' diet-treated group who are likely to have good pregnancy outcomes.

Methods: A retrospective analysis between 2011-2014. Multivariable backward stepwise logistic regression was used to identify the predictors of the need for insulin therapy. To identify a 'low-risk' diet-treated group, the group was stratified according to pregnancy complications. Diet-treated women with indications for induction in secondary care were excluded.

Results: A total of 820 GDM women were included, 360 (44%) women required additional insulin therapy. The factors predicting the need for insulin therapy were: previous GDM, family history of diabetes, a previous infant weighing >= 4500 gram, Middle-East/North-African descent, multiparity, pre-gestational BMI >= 30 kg/m(2), and an increased fasting glucose level >= 5.5 mmol/l (OR 6.03; CI 3.56-10.22) and two-hour glucose level > 9.4 mmol/l after a 75-gram oral glucose tolerance test at GDM diagnosis. In total 125 (54%) women treated with diet only had pregnancy complications. Primiparity and higher weight gain during pregnancy were the best predictors for complications (predictive probability 0.586 and 0.603).

Conclusion: In this GDM population we found various relevant factors predicting the need for insulin therapy. A fasting glucose level = 5.5 mmol/l at GDM diagnosis was by far the strongest predictor. Women with GDM who had good glycaemic control on diet only with a higher parity and less weight gain had a lower risk for pregnancy complications.

Original languageEnglish
Pages (from-to)262-269
Number of pages8
JournalThe Netherlands Journal of Medicine
Volume74
Issue number6
Publication statusPublished - Jul-2016

Keywords

  • Diet
  • gestational diabetes mellitus
  • insulin therapy
  • predictors
  • risk stratification
  • INCREASING PREVALENCE
  • DIAGNOSTIC-CRITERIA
  • PREGNANCY OUTCOMES
  • GLUCOSE-TOLERANCE
  • INSULIN-TREATMENT
  • NEED
  • IMPACT
  • THERAPY

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