Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc
Journal website https://www.jofem.org

Original Article

Volume 12, Number 1, February 2022, pages 32-39


Predictors of Antenatal Insulin Requirement in Women With Gestational Diabetes Mellitus: A Prospective Observational Cohort Study

Figures

Figure 1.
Figure 1. STROBE flow diagram.
Figure 2.
Figure 2. ROC curve showing diagnostic performance of predictors for antenatal insulin requirement. ROC: receiver operating characteristic.

Tables

Table 1. Maternal Baseline Characteristics
 
ParametersOverall, median (IQR)GroupP value
MNT (n = 121)Insulin (n = 30)
Data are expressed as median (IQR), except primigravida expressed as frequency (percentage). *Statistically significant with P-value < 0.05. aWilcoxon-Mann-Whitney U test. bChi-squared test. MNT: medical nutrition therapy; BMI: body mass index; 75-g OGTT: 75-gram oral glucose tolerance test; IQR: interquartile range.
Age (years)*29 (25-30)27 (25 - 30)30 (29.3 - 32)< 0.001a
Primigravida*73 (58.3%)52 (43.0%)21 (70.0%)0.008b
Weight (kg)*58 (54 - 62)58 (53 - 60)61 (59.5 - 74.3)< 0.001a
Height (m)*1.56 (1.52 - 1.6)1.56 (1.51 - 1.58)1.58 (1.55 - 1.61)0.014a
BMI (kg/m2)*23.8 (22 - 25.8)23.8 (21.9 - 25.3)24.9 (23.8 - 27.4)0.003a
Gestational age at diagnosis of GDM (weeks)27.8 (20.5 - 32.7)27 (25 - 30)30 (29.2 - 32)0.579a
Blood glucose (after 75-g OGTT) (mg/dL)*157 (149 - 175)156 (149 - 168)165.5 (149.7 - 186.7)0.032a

 

Table 2. Maternal Outcomes
 
ParametersOverallGroupRR (95% CI)P value
MNT (n = 121)Insulin (n = 30)
*Significant at P-value < 0.05. **Expressed as mean ± SD. #Expressed as frequency (percentage). aWilcoxon-Mann-Whitney U test. bChi-squared test. cFisher’s exact test. MNT: medical nutrition therapy; RR: relative risk; 95% CI: 95% confidence interval; U: units; GA: gestational age; PPH: postpartum hemorrhage; CD: cesarean delivery; CDMR: cesarean done on maternal request; APH: antepartum hemorrhage; CPD: cephalopelvic disproportion; PROM: pre-labor rupture of membranes.
Gestational hypertension*, #36 (23.8%)22 (18.2%)14 (46.7%)0.71 (0.52 - 0.89)0.001b
GA at diagnosis of gestational hypertension (weeks)-34.02 ± 4.62**33.73 ± 3.58**-0.537a
  20 - 276/7-2 (9.1%)1 (7.1%)-1.000c
  ≥ 2820 (90.9%)13 (92.9%)
Instrumental delivery#2 (1.3%)1 (0.8%)1 (3.3%)0.62 (0.12 - 1.14)0.359c
Cesarean delivery*, #111 (73.5%)84 (69.4%)27 (90.0%)0.82 (0.71 -0.96)0.022b
PPH#4 (2.6%)4 (3.3%)0 (0.0%)1.26 (0.64 - 1.38)0.585c
Surgical site infection#5 (3.3%)2 (1.7%)3 (10.0%)0.49 (0.14 - 1.95)0.054c
Indication for CD#-0.161c
  Previous CD26 (23.4%)20 (23.8%)6 (22.2%)
  Failed induction20 (18.0%)15 (17.9%)5 (18.5%)
  Non-reassuring fetal status20 (18.0%)11 (13.1%)9 (33.3%)
  CDMR16 (14.4%)11 (13.1%)5 (18.5%)
  Dysfunctional labor9 (8.1%)9 (10.7%)0 (0.0%)
  Obstructed labor8 (7.2%)8 (9.5%)0 (0.0%)
  Malpresentation5 (4.5%)4 (4.8%)1 (3.7%)
  APH2 (1.8%)2 (2.4%)0 (0.0%)
  CPD2 (1.8%)2 (2.4%)0 (0.0%)
  Contracted pelvis1 (0/9%)1 (1.2%)0 (0.0%)
  Prolonged PROM1 (0.9%)1 (1.2%)0 (0.0%)
  Uterine anomaly1 (0.9%)0 (0.0%)1 (3.7%)

 

Table 3. Neonatal Outcomes
 
ParametersOverallGroupP-value
MNT (n = 121)Insulin (n = 30)
*Statistically significant at P-value < 0.05. **Expressed as mean ± SD. aWilcoxon-Mann-Whitney U test. bChi-squared test. cFisher’s exact test. MNT: medical nutrition therapy; LGA: large for gestational age.
Gestational age at delivery (weeks)*37.95 ± 1.57**38.21 ± 1.42**36.88 ± 1.70**< 0.001a
Fetal maturity0.075c
  Early preterm2 (1.3%)1 (0.8%)1 (3.3%)
  Late preterm19 (12.6%)12 (9.9%)7 (23.3%)
  Term130 (86.1%)108 (89.3%)22 (73.3%)
LGA9 (6.0%)9 (7.4%)0 (0.0%)0.206c
Hypoglycemia3 (2.0%)2 (1.7%)1 (3.3%)0.488c
Hypocalcemia0 (0.0%)0 (0.0%)0 (0.0%)1.000b
Polycythemia11 (7.3%)7 (5.8%)4 (13.3%)0.230c
Hyperbilirubinemia*17 (11.3%)9 (7.4%)8 (26.7%)0.007c
Heart disease2 (1.3%)2 (1.7%)0 (0.0%)1.000c
Death5 (3.3%)5 (4.1%)0 (0.0%)0.583c

 

Table 4. Performance of Primary Diagnostic Parameters for Prediction of Antenatal Insulin Requirement
 
VariableSensitivitySpecificityPPVNPVDiagnostic accuracy
PPV: positive predictive value; NPV: negative predictive value; GDM: gestational diabetes mellitus; BMI: body mass index; 75-g OGTT: 75-gram oral glucose tolerance test; ROC: receiver operating characteristic.
Gestational age at diagnosis of GDM (weeks) (cutoff: 33.286 by ROC)30.0% (15 - 49)80.2% (72 - 87)27.3% (13 - 46)82.2% (74 - 89)70.2% (62 - 77)
BMI (kg/m2) (cutoff: 24.7 by ROC)63.3% (44 - 80)69.4% (60 - 77)33.9% (22 - 48)88.4% (80 - 94)68.2% (60 - 76)
BMI (kg/m2) (cutoff: ≥ 25)50.0% (31 - 69)73.6% (65 - 81)31.9% (19 - 47)85.6% (77 - 92)68.9% (61 - 76)
Blood glucose (after 75-g OGTT) (mg/dL) (cutoff: 162 by ROC)63.3% (44 - 80)67.8% (59 - 76)32.8% (21 - 46)88.2% (80 - 94)66.9% (59 - 74)