Predicting the Need for Insulin Treatment: A Risk-Based Approach to the Management of Women with Gestational Diabetes Mellitus
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Clinical Characteristics
3.2. Multivariable Logistic Regression
3.3. Prediction Statistics for Treatment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Category | n | All GDM n = 1104 | GDM-Diet n = 822 | GDM-Insulin n = 282 | p |
---|---|---|---|---|---|---|
Maternal age, years * | 1104 | 31.9 (5.0) | 31.8 (5.0) | 32.0 (5.0) | 0.513 | |
Maternal age, years ^ | ≤30 | 1104 | 442 (40.0%) | 328 (39.9%) | 114 (40.4%) | 0.888 |
>30 | 662 (60.0%) | 494 (60.1%) | 168 (59.6%) | |||
Ethnicity ^ | Caucasian | 948 (86.9%) | 710 (87.0%) | 238 (86.6%) | 0.549 | |
Afro-Caribbean | 132 (12.1%) | 95 (11.6%) | 37 (13.5%) | |||
Asian | 5 (0.5%) | 5 (0.6%) | 0 (0.0%) | |||
Oriental | 4 (0.4%) | 4 (0.5%) | 0 (0.0%) | |||
Other | 2 (0.2%) | 2 (0.3%) | 0 (0.0%) | |||
Ethnicity ^ | Caucasian | 1091 | 948 (86.9%) | 710 (87.0%) | 238 (86.6%) | 0.837 |
Non-Caucasian | 143 (13.1%) | 106 (13.0%) | 37 (13.5%) | |||
Current smoker ^ | Yes | 1043 | 61 (5.9%) | 27 (3.4%) | 34 (14.1%) | <0.001 |
Prepregnancy BMI, kg/m2 # | 1100 | 27.1 (8.8) | 26.1 (8.1) | 29.7 (10.3) | <0.001 | |
Prepregnancy BMI, kg/m2 ^ | <30 | 1100 | 746 (67.8%) | 600 (73.3%) | 146 (52.0%) | <0.001 |
≥30 | 354 (32.3%) | 219 (36.7%) | 135 (48.0%) | |||
Nulliparous ^ | Yes | 1104 | 490 (44.4%) | 385 (46.8%) | 105 (37.2%) | 0.005 |
Prior history of GDM ^ | Yes | 614 | 216 (35.2%) | 127 (29.1%) | 89 (50.3%) | <0.001 |
Prior fetal macrosomia ^ | Yes | 614 | 43 (7.0%) | 26 (6.0%) | 17 (9.6%) | 0.117 |
Family history of diabetes ^ | Yes | 1104 | 635 (57.5%) | 493 (60.0%) | 142 (50.4%) | 0.005 |
Gestational age at OGTT, weeks # | 1053 | 28 (4) | 28 (4) | 28 (9) | <0.001 | |
Gestational age at OGTT, weeks ^ | <24 | 1053 | 232 (22.0%) | 141 (17.8%) | 91 (35.1%) | <0.001 |
≥24 | 821 (78.0%) | 653 (82.2%) | 168 (64.9%) | |||
2-h OGTT result, mmol/L # | 1051 | 9.8 (1.5) | 9.7 (1.1) | 10.8 (2.6) | <0.001 | |
2-h OGTT result, mmol/L ^ | <10.7 | 1051 | 757 (72.0%) | 633 (79.9%) | 124 (47.9%) | <0.001 |
≥10.7 | 294 (28.0%) | 159 (20.1%) | 135 (52.1%) | |||
HbA1c at diagnosis, %[mmol/mol] # | 1085 | 5.4 (2.8) [35 (7)] | 5.3 (2.7) [34 (6)] | 5.7 (3.0) [39 (9)] | <0.001 | |
HbA1c at diagnosis, %[mmol/mol] ^ | <5.5 [37] | 1085 | 688 (63.4%) | 595 (74.0%) | 93 (33.1%) | <0.001 |
≥5.5 [37] | 397 (36.6%) | 209 (26.0%) | 188 (66.9%) | |||
HbA1c prior to delivery, %[mmol/mol] # | 915 | 5.5 (2.8) [37 (7)] | 5.4 (2.6) [35 (5)] | 5.8 (2.7) [40 (7)] | <0.001 | |
HbA1c differences, %[mmol/mol] # | 919 | 2.3 (2.4) [2 (3)] | 2.3 (2.4) [2 (3)] | 2.2 (2.7) [1 (6)] | 0.032 |
Variable | Category | n | All GDM n = 1104 | GDM-Diet n = 822 | GDM-Insulin n = 282 | p |
---|---|---|---|---|---|---|
Onset of labor ^ | Spontaneous | 1032 | 448 (25.2%) | 377 (45.9%) | 71 (25.2%) | <0.001 |
Induction of labor | 447 (50.4%) | 305 (37.1%) | 142 (50.4%) | |||
C-section | 137 (12.4%) | 76 (9.3%) | 61 (21.6%) | |||
Mode of birth ^ | Vaginal | 1098 | 771 (70.2%) | 604 (73.7%) | 167 (60.1%) | <0.001 |
Vacuum | 26 (2.4%) | 15 (1.8%) | 11 (4.0%) | |||
Elective C-section | 153 (13.9%) | 98 (12.0%) | 55 (19.8%) | |||
Emergency C-section | 148 (13.5%) | 103 (12.6%) | 45 (16.2%) | |||
Gestation at birth, weeks # | 1104 | 39 (2) | 39 (2) | 38 (1) | <0.001 | |
Infant sex ^ | Female | 1104 | 512 (46.4%) | 378 (46.0%) | 134 (47.5%) | 0.678 |
Male | 592 (53.6%) | 444 (54.0%) | 148 (52.5%) | |||
Apgar 1 min # | 1072 | 10 (1) | 10 (1) | 10 (1) | 0.002 | |
Apgar 5 min # | 1069 | 10 (0) | 10 (0) | 10 (0) | 0.007 | |
Apgar 10 min # | 997 | 10 (0) | 10 (0) | 10 (0) | 0.419 | |
Birthweight, grams * | 1103 | 3515 (556) | 3464 (530) | 3663 (603) | <0.001 | |
Birthweight, Z-score * | 1103 | 0.24 (1.24) | 0.032 (1.10) | 0.87 (1.44) | <0.001 | |
Size category ^ | SGA | 1103 | 94 (8.5%) | 76 (9.3%) | 18 (6.4%) | <0.001 |
AGA | 813 (73.7%) | 652 (79.3%) | 161 (57.3%) | |||
LGA | 196 (17.8%) | 94 (11.4%) | 102 (36.3%) |
Bivariable n = 1104 | Multivariable n = 978 | ||||||
---|---|---|---|---|---|---|---|
Variable | Category | OR | 95% CI | p | aOR | 95% CI | p |
Family history of diabetes | No | 0.68 | 0.52, 0.89 | 0.005 | 0.87 | 0.61, 1.24 | 0.426 |
Yes | 1 | — | — | 1 | — | — | |
Current smoker | Smoker | 4.69 | 2.76, 7.94 | <0.001 | 4.20 | 2.21, 8.01 | <0.001 |
Non-smoker | 1 | — | — | 1 | — | — | |
Parity | Nulliparous | 1 | — | — | 1 | — | — |
Multiparous | 1.49 | 1.13, 1.96 | 0.005 | 1.39 | 0.96, 2.00 | 0.078 | |
Prepregnancy BMI, kg/m2 | <30 | 1 | — | — | 1 | — | — |
≥30 | 2.53 | 1.91, 3.35 | <0.001 | 1.71 | 1.19, 2.46 | 0.004 | |
Gestational age at OGTT, weeks | <24 | 2.51 | 1.83, 3.43 | <0.001 | 2.86 | 1.92, 4.26 | <0.001 |
≥24 | 1 | — | — | 1 | — | — | |
2-h OGTT result, mmol/L | <10.7 | 1 | — | — | 1 | — | — |
≥10.7 | 4.33 | 3.21, 5.85 | <0.001 | 3.16 | 2.19, 4.57 | <0.001 | |
HbA1c at diagnosis, %[mmol/mol] | <5.5 [37] | 1 | — | — | 1 | — | — |
≥5.5 [37] | 5.76 | 4.29, 7.72 | <0.001 | 3.79 | 2.64, 5.44 | <0.001 |
Risk Score Tabulation | Prediction Statistics for Treatment | ||||||
---|---|---|---|---|---|---|---|
Risk Score | Total n = 1104 | GDM-Diet n = 822 | GDM-Insulin n = 282 | Risk Score | Total n = 1104 | GDM-Diet n = 822 | GDM-Insulin n = 282 |
0 | 37 (3.4%) | 36 (4.4%) | 1 (0.4%) | <3 | 642 (58.2%) | 565 (68.7%) | 77 (27.3%) |
1 | 275 (24.9%) | 250 (30.4%) | 25 (8.9%) | ≥3 | 462 (41.9%) | 257 (31.3%) | 205 (72.7%) |
2 | 330 (29.9%) | 279 (33.9%) | 51 (18.1%) | Total | 1104 (100.0%) | 822 (100.0%) | 282 (100.0%) |
3 | 263 (23.8%) | 175 (21.3%) | 88 (31.2%) | Sensitivity 72.7% (95% CI 67.1, 77.8) Specificity 68.7% (95% CI 65.4, 71.9) PPV 44.4% (95% CI 39.8, 49.0) NPV 88.0% (95% CI 85.2, 90.4) | |||
4 | 144 (13.0%) | 62 (7.5%) | 82 (29.1%) | ||||
5 | 43 (3.9%) | 16 (2.0%) | 27 (9.6%) | ||||
6 | 12 (1.1%) | 4 (0.5%) | 8 (2.8%) |
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Koefoed, A.S.; McIntyre, H.D.; Gibbons, K.S.; Poulsen, C.W.; Fuglsang, J.; Ovesen, P.G. Predicting the Need for Insulin Treatment: A Risk-Based Approach to the Management of Women with Gestational Diabetes Mellitus. Reprod. Med. 2023, 4, 133-144. https://doi.org/10.3390/reprodmed4030014
Koefoed AS, McIntyre HD, Gibbons KS, Poulsen CW, Fuglsang J, Ovesen PG. Predicting the Need for Insulin Treatment: A Risk-Based Approach to the Management of Women with Gestational Diabetes Mellitus. Reproductive Medicine. 2023; 4(3):133-144. https://doi.org/10.3390/reprodmed4030014
Chicago/Turabian StyleKoefoed, Anna S., H. David McIntyre, Kristen S. Gibbons, Charlotte W. Poulsen, Jens Fuglsang, and Per G. Ovesen. 2023. "Predicting the Need for Insulin Treatment: A Risk-Based Approach to the Management of Women with Gestational Diabetes Mellitus" Reproductive Medicine 4, no. 3: 133-144. https://doi.org/10.3390/reprodmed4030014