Am J Perinatol 2014; 31(02): 105-112
DOI: 10.1055/s-0033-1338174
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Predicting the Need for Medical Therapy in Patients with Mild Gestational Diabetes

Hector Mendez-Figueroa
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Julie Daley
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Vrishali V. Lopes
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Donald R. Coustan
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
› Author Affiliations
Further Information

Publication History

26 December 2013

10 January 2013

Publication Date:
18 March 2013 (online)

Abstract

Objective The enforcement of a one-step gestational diabetes mellitus (GDM) diagnosis would capture more patients with milder forms of glucose intolerance thereby increasing the incidence. We propose to identify characteristics predicting the need for medical therapy in such patients.

Study Design Retrospective chart review of patients with mild GDM, defined as a fasting plasma glucose (FPG) < 95 mg/dL on the 3-hour 100-g oral glucose tolerance test (OGTT). Patients requiring medical therapy for glucose control were compared with diet-controlled patients. A predictive model was constructed with variables of significance.

Results Included were 143 patients requiring medical therapy and 224 diet-treated patients. Mean FPG on 3-hour OGTT, prepregnancy body mass index (BMI), and BMI at 26 to 30 weeks were all significantly higher in patients requiring therapy. Combining several variables produced a predictive model with 76% sensitivity, 52% specificity, 48% positive predictive value, and 78% negative predictive value.

Conclusions Antenatal factors (alone or in combination) do not allow for prediction of the possible need for therapy in mild GDM patients.

 
  • References

  • 1 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33 (Suppl. 01) S62-S69
  • 2 Getahun D, Nath C, Ananth CV, Chavez MR, Smulian JC. Gestational diabetes in the United States: temporal trends 1989 through 2004. Am J Obstet Gynecol 2008; 198: 1-5
  • 3 Landon MB, Spong CY, Thom E , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361: 1339-1348
  • 4 Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477-2486
  • 5 Pirc LK, Owens JA, Crowther CA, Willson K, De Blasio MJ, Robinson JS. Mild gestational diabetes in pregnancy and the adipoinsular axis in babies born to mothers in the ACHOIS randomised controlled trial. BMC Pediatr 2007; 7: 18
  • 6 Tamashiro KL, Moran TH. Perinatal environment and its influences on metabolic programming of offspring. Physiol Behav 2010; 100: 560-566
  • 7 Chen Y, Quick WW, Yang W , et al. Cost of gestational diabetes mellitus in the United States in 2007. Popul Health Manag 2009; 12: 165-174
  • 8 Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 144: 768-773
  • 9 Catalano PM, McIntyre HD, Cruickshank JK , et al; HAPO Study Cooperative Research Group. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care 2012; 35: 780-786
  • 10 Park SH, Goo JM, Jo CH. Receiver operating characteristic (ROC) curve: practical review for radiologists. Korean J Radiol 2004; 5: 11-18
  • 11 González-Quintero VH, Istwan NB, Rhea DJ , et al. Antenatal factors predicting subsequent need for insulin treatment in women with gestational diabetes. J Womens Health (Larchmt) 2008; 17: 1183-1187
  • 12 HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. Diabetes 2009; 58: 453-459
  • 13 McFarland MB, Langer O, Conway DL, Berkus MD. Dietary therapy for gestational diabetes: how long is long enough?. Obstet Gynecol 1999; 93: 978-982
  • 14 Kahn BF, Davies JK, Lynch AM, Reynolds RM, Barbour LA. Predictors of glyburide failure in the treatment of gestational diabetes. Obstet Gynecol 2006; 107: 1303-1309
  • 15 Conway DL, Gonzales O, Skiver D. Use of glyburide for the treatment of gestational diabetes: the San Antonio experience. J Matern Fetal Neonatal Med 2004; 15: 51-55
  • 16 Sapienza AD, Francisco RP, Trindade TC, Zugaib M. Factors predicting the need for insulin therapy in patients with gestational diabetes mellitus. Diabetes Res Clin Pract 2010; 88: 81-86
  • 17 Wong VW, Jalaludin B. Gestational diabetes mellitus: who requires insulin therapy?. Aust N Z J Obstet Gynaecol 2011; 51: 432-436
  • 18 Nanda S, Savvidou M, Syngelaki A, Akolekar R, Nicolaides KH. Prediction of gestational diabetes mellitus by maternal factors and biomarkers at 11 to 13 weeks. Prenat Diagn 2011; 31: 135-141
  • 19 Jensen DM, Mølsted-Pedersen L, Beck-Nielsen H, Westergaard JG, Ovesen P, Damm P. Screening for gestational diabetes mellitus by a model based on risk indicators: a prospective study. Am J Obstet Gynecol 2003; 189: 1383-1388
  • 20 Retnakaran R, Qi Y, Sermer M, Connelly PW, Hanley AJ, Zinman B. Glucose intolerance in pregnancy and future risk of pre-diabetes or diabetes. Diabetes Care 2008; 31: 2026-2031
  • 21 Metzger BE, Gabbe SG, Persson B , et al; International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-682