Abstract
BackgroundAlthough insulin therapy achieves effective glycemic control, it may aggravate hyperinsulinemia. Nonetheless the benefits of insulin as first-line treatment for women with GDM are controversial. This work aimed to investigate the effect of insulin on maternal GDM.MethodsThis retrospective cohort study recruited 708 women with GDM of whom 616 underwent lifestyle intervention and 92 were prescribed insulin therapy. Differences in variables between the two groups were analyzed by univariate analysis and multivariate analysis. Propensity score matching was used to control for age, pre-pregnancy BMI, time and BP at GDM diagnosis, and family history of diabetes and hypertension. Paired sample test was applied to evaluate the changes in BP after intervention in the two groups of women.ResultsThere was no significant difference in mode of delivery, newborn weight or incidence of macrosomia between women prescribed insulin and those who adopted lifestyle modifications. Insulin therapy was associated with a slight increase in maternal weight compared with the lifestyle intervention group and was attributed to short-term treatment (about 12 weeks). In addition, insulin therapy remarkably increased maternal blood pressure, an effect that persisted after matching age, pre-pregnancy BMI, time and BP at GDM diagnosis, and family history of diabetes and hypertension. Between commencing insulin therapy and delivery, systolic blood pressure significantly increased by 6mmHg (P = 0.015) and diastolic blood pressure by 9 mmHg (P < 0.001). Increase in BP was significantly higher in the insulin group compared with the lifestyle intervention group (P < 0.001). Logistic regression analysis with enter selection confirmed that insulin therapy was closely correlated with development of gestational hypertension (GH).ConclusionsThis work suggested that short-term insulin therapy for GDM was associated with a slight increase in maternal weight but a significant risk of increasing maternal blood pressure.
Highlights
Gestational diabetes mellitus (GDM) is defined as “diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation” [1]
Characteristics of subjects in lifestyle intervention group and insulin therapy group in full cohort In women diagnosed with GDM, Treatment with insulin was added to the diet regimen after one week if fasting and postprandial blood glucose didn’t achieve the target
There were no significant differences in pre-pregnancy body mass index (BMI), HOMA-Homeostatic Model Assessment of Insulin Resistance (IR), serum lipid parameters, or systolic blood pressure (SBP) and diastolic blood pressure (DBP) at baseline between the two groups
Summary
Background Gestational diabetes mellitus (GDM) is defined as “diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation” [1]. GDM is associated with a higher risk of serious complications for the mother (preeclampsia, caesarean section and development of type 2 diabetes) and the offspring (fetal macrosomia and childhood obesity) [2, 3,4,5,6]. Metformin and glyburide should be used only as second-line treatment since both can cross the placenta to the fetus. Exposure of the fetus to metformin may result in rapid growth after birth and a higher body mass index (BMI) by mid-childhood (5 to 9 years), effects associated with long-term metabolic consequences in later life such as obesity, type 2 diabetes, and cardiovascular disease [10]. Insulin is considered safe for the fetus since it does not cross the placenta to a measurable extent and is currently the first-line recommended treatment for GDM. The benefits of insulin as first-line treatment for women with GDM are controversial. This work aimed to investigate the effect of insulin on maternal GDM
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