Ford Heather Louise, Champion Isabella, Wan Anna, Reddy Maya, Mol Ben Willem, Rolnik Daniel Lorber
Monash Health, Department of Obstetrics and Gynaecology, Melbourne, Australia; Monash University, Department of Obstetrics and Gynaecology, Melbourne, Australia.
Monash Health, Department of Obstetrics and Gynaecology, Melbourne, Australia.
Eur J Obstet Gynecol Reprod Biol. 2022 May;272:177-181. doi: 10.1016/j.ejogrb.2022.03.025. Epub 2022 Mar 14.
Gestational diabetes mellitus (GDM) affects about 15% of pregnancies in Australia, with approximately 30% of those diagnosed with GDM requiring insulin therapy. There are several established risk factors for developing GDM, however limited studies show how these can be used to predict need for insulin treatment. The aim of this study is to identify predictors of insulin therapy in women diagnosed with GDM once an oral glucose tolerance test (OGTT) is performed during pregnancy.
This is a retrospective cohort study of women with singleton pregnancies complicated by GDM between 2016 and 2017 at a single, large health network in Melbourne, Australia. Data were obtained from hospital record and pathology result systems. Univariable and multivariable logistic regression models were fit to the data to obtain crude and adjusted odds ratios.
Of 2,048 women diagnosed with GDM, 647 (31.6%) required insulin therapy. Positive predictors included in the final multivariable model after backwards, stepwise elimination were an elevated fasting result on an OGTT (adjusted odds ratio (AOR) 2.93 [95% CI 2.34-3.66]), previous birth weight greater than 90th% (AOR 2.04 [95% CI 1.412.94]), previous diagnosis of GDM (AOR 1.68 [95% CI 1.28-2.21]), being born in the South Asian region (AOR 1.58 [95% CI 1.27-1.98]), the 2hr OGTT result (AOR 1.14 [95% CI 1.05-1.24]), body mass index (BMI; AOR 1.13 [95% CI 1.04-1.23]) and age (AOR 1.03 [95% CI 1.00-1.05]) The final predictive model had an area under the receiver-operating characteristics (ROC) curve of 0.744 (95% CI 0.720-0.767).
This study highlights the possible predictors of insulin use, informing counselling for women who are newly diagnosed with gestational diabetes.
妊娠期糖尿病（GDM）影响澳大利亚约15%的孕妇，其中约30%被诊断为GDM的孕妇需要胰岛素治疗。已有多种GDM发病的危险因素，但仅有有限的研究表明如何利用这些因素来预测胰岛素治疗的需求。本研究的目的是确定在孕期进行口服葡萄糖耐量试验（OGTT）后被诊断为GDM的女性中胰岛素治疗的预测因素。
这是一项对2016年至2017年期间在澳大利亚墨尔本一个大型单一健康网络中患有单胎妊娠并合并GDM的女性进行的回顾性队列研究。数据来自医院记录和病理结果系统。对数据拟合单变量和多变量逻辑回归模型，以获得粗略和调整后的比值比。
在2048名被诊断为GDM的女性中，647名（31.6%）需要胰岛素治疗。经过向后逐步排除后，最终多变量模型中的阳性预测因素包括OGTT空腹结果升高（调整后的比值比[AOR]为2.93[95%置信区间2.34 - 3.66]）、既往出生体重高于第90百分位数（AOR为2.04[95%置信区间1.41 - 2.94]）、既往GDM诊断（AOR为1.68[95%置信区间1.28 - 2.21]）、出生于南亚地区（AOR为1.58[95%置信区间1.27 - 1.98]）、2小时OGTT结果（AOR为1.14[95%置信区间1.05 - 1.24]）、体重指数（BMI；AOR为1.13[95%置信区间1.04 - 1.23]）和年龄（AOR为1.03[95%置信区间1.00 - 1.05]）。最终预测模型的受试者工作特征（ROC）曲线下面积为0.744（95%置信区间0.720 - 0.767）。
本研究突出了胰岛素使用的可能预测因素，为新诊断为妊娠期糖尿病的女性的咨询提供了依据。
