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Cited by 55Gestational Diabetes Research and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsPregnancy and Medication Impact

Differences in pregnancy outcomes and characteristics between insulin- and diet-treated women with gestational diabetes

Open access
Benhalima, Katrien, Robyns, Karolien, Van Crombrugge, Paul, Deprez, Natascha, Seynhave, Bruno, Devlieger, Roland, Verhaeghe, Johan, Mathieu, Chantal +1 more·2015·BMC Pregnancy and Childbirth
DOI 10.1186/s12884-015-0706-xPMC PMC4619070
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Abstract

BACKGROUND: Our aim was to evaluate the difference in pregnancy outcomes and characteristics between insulin- and diet-treated women with gestational diabetes (GDM). METHODS: Retrospective analysis of the medical files from 2010-2013 of women with GDM diagnosed with the Carpenter & Coustan criteria attending two clinics, one in a university and another in a non-university hospital. Characteristics associated with insulin use were analyzed. Multivariable logistic regression was used to adjust for confounders. For women attending the university hospital, indices of insulin sensitivity such as the reciprocal of the homeostasis model assessment of insulin resistance (1/HOMA-IR) and an index of beta-cell function, the Insulin Secretion-Sensitivity Index-2 (ISSI-2) were calculated. RESULTS: Over a 4 year period, 601 women were identified with GDM of whom 22.9% were obese at first prenatal visit. 24.2% needed insulin. Insulin did not prevent adverse outcomes, as women on insulin had higher rates of large-for-gestational age infants (LGA) (28.5% vs. 13.1 %, p < 0.0001) and more cesarean sections (44.1% vs. 27.0%, p = 0.001), remaining significant after adjustment for confounders. Compared to diet-treated women, women on insulin more often had an ethnic minority background (33.3 % vs. 21.6%, p = 0.004), more often had a history of GDM (21.5% vs. 10.4%, p = 0.002), were more often multiparous (59.3% vs. 47.6%, p = 0.044) and were diagnosed with GDM earlier in pregnancy (weeks 25.3 ± 4.9 vs. 27.1 ± 3.7, p < 0.0001). When undergoing an oral glucose tolerance test, women treated with insulin had a higher fasting glycaemia (97.6 ± 18.8 vs.87.7 ± 10.3, p < 0.0001), a higher 1-hour glycaemia (197.7 ± 30.1 vs.184.5 ± 25.8, p < 0.0001), a higher 2-hour glycaemia (185.2 ± 28.5 vs. 175.0 ± 22.8, p < 0.0001), more often 3 and 4 abnormal values (58.1% vs. 37.8%, p < 0.0001 and 24.8% vs. 7.7%, p < 0.0001) and higher HbA1c levels (5.5 ± 0.6 vs 5.2 ± 0.5, p < 0.0001). ISSI-2 (1.3 ± 0.5 vs. 1.7 ± 0.5, p < 0.0001) and 1/HOMA-IR [0.01 (0.001-0.002) vs. 0.02 (0.01-0.03), p = 0.027] were lower in women on insulin. Women on insulin more often received corticoids in preparation of preterm delivery (11.0% vs. 2.4%, p < 0.0001). CONCLUSION: Compared to diet-treated women with GDM, women treated with insulin have a higher risk profile, impaired beta-cell function and lower insulin sensitivity. Rates of LGA and cesarean sections were higher in insulin-treated women.

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  • Belgium has no consensus on GDM diagnosis, two methods are used at the same time, and there is a lack of accurate data on GDM prevalence.

    “Belgium has no consensus on a GDM diagnosis, two methods are used at the same time. Additionally, there is a lack of accurate data on the GDM prevalence in this country [141].”

    From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [141]

    The Methods section states that accurate GDM prevalence data are lacking in Belgium and that screening practices vary across centers. It does not explicitly say there is no national consensus on diagnosis. The Methods and Results describe one diagnostic approach for the study cohort and 14 women in a separate study using different criteria, but do not establish that two diagnostic methods were generally used concurrently in Belgium. (LLM, conf=0.84)

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Research works printed but not linked: 19

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Cited by

Sorted by citations

Authors
Benhalima, K., Robyns, K., Van Crombrugge, P., Deprez, N., Seynhave, B., Devlieger, R., Verhaeghe, J., Mathieu, C., & Nobels, F.
Affiliations
  • Universitair Ziekenhuis Leuven (BE)
  • Onze Lieve Vrouwziekenhuis Hospital (BE)
Corresponding author
Benhalima, Katrien
ORCID
Venue
BMC Pregnancy and Childbirth
Publisher
Springer Science and Business Media LLC
Published
2015-10-23
Volume
15
Issue
1
Pages
271-271
ISSN
1471-2393 (ISSN-L)
DOI
10.1186/s12884-015-0706-x
PMC
PMC4619070
OpenAlex
W1884312435
Cited by
55
References
11
Citations by year
2026: 5 · 2025: 1 · 2024: 6 · 2023: 5 · 2022: 8 · 2021: 5 · 2020: 7 · 2019: 7 · 2018: 7 · 2017: 2 · 2016: 2
FWCI
4.17
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Pregnancy and Childbirth (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Lirias (submittedVersion, cc-by)
Funders
  • Fonds Wetenschappelijk Onderzoek
  • Vlaamse regering
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
Keywords
gestational diabetes mellitus, insulin therapy, dietary management, pregnancy outcomes, large for gestational age, cesarean section, insulin resistance, beta-cell function, HOMA-IR, ethnic minorities, multiparity, maternal obesity, oral glucose tolerance test
MeSH terms
Adult, Belgium, Blood Glucose, Cesarean Section, Fasting, Female, Fetal Macrosomia, Glucose Tolerance Test, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Insulin Resistance, Minority Groups, Parity, Pregnancy, Pregnancy Outcome, Retrospective Studies, Diabetes, Gestational, Insulin-Secreting Cells

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