Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, 200240, Shanghai, China.
Department of Radiology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, 200240, Shanghai, China.
BMC Pregnancy Childbirth. 2021 Sep 27;21(1):657. doi: 10.1186/s12884-021-04066-z.
Although 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.
This 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.
There 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).
This 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.
尽管胰岛素治疗可实现有效的血糖控制，但它可能加重高胰岛素血症。尽管如此，胰岛素作为 GDM 女性一线治疗的益处仍存在争议。本研究旨在探讨胰岛素对 GDM 产妇的影响。
本回顾性队列研究纳入了 708 例 GDM 妇女，其中 616 例接受生活方式干预，92 例接受胰岛素治疗。通过单因素分析和多因素分析比较两组间变量的差异。采用倾向评分匹配法控制年龄、孕前 BMI、GDM 诊断时的时间和血压、糖尿病和高血压家族史。采用配对样本检验评估两组妇女干预后血压的变化。
胰岛素治疗组与生活方式干预组在分娩方式、新生儿体重或巨大儿发生率方面无显著差异。与生活方式干预组相比，胰岛素治疗组产妇体重略有增加，这与短期治疗（约 12 周）有关。此外，胰岛素治疗显著升高了产妇血压，这一影响在匹配年龄、孕前 BMI、GDM 诊断时的时间和血压以及糖尿病和高血压家族史后仍然存在。从开始胰岛素治疗到分娩，收缩压显著升高 6mmHg（P=0.015），舒张压升高 9mmHg（P<0.001）。与生活方式干预组相比，胰岛素组的血压升高幅度显著更高（P<0.001）。逐步进入的 logistic 回归分析证实，胰岛素治疗与妊娠期高血压（GH）的发生密切相关。
本研究表明，GDM 短期胰岛素治疗虽使产妇体重略有增加，但显著增加了产妇血压的风险。
