title: Risk stratification for healthcare planning in women with gestational diabetes mellitus.
abstract: BACKGROUND
  To identify relevant factors predicting the need for insulin therapy in women with gestational diabetes mellitus (GDM) and secondly to determine a potential 'low- risk' diet-treated group who are likely to have good pregnancy outcomes.
  
  
  METHODS
  A retrospective analysis between 2011-2014. Multivariable backward stepwise logistic regression was used to identify the predictors of the need for insulin therapy. To identify a 'low-risk' diet-treated group, the group was stratified according to pregnancy complications. Diet-treated women with indications for induction in secondary care were excluded.
  
  
  RESULTS
  A total of 820 GDM women were included, 360 (44%) women required additional insulin therapy. The factors predicting the need for insulin therapy were: previous GDM, family history of diabetes, a previous infant weighing ≥ 4500 gram, Middle-East/North-African descent, multiparity, pre-gestational BMI ≥ 30 kg/m2, and an increased fasting glucose level ≥ 5.5 mmol/l (OR 6.03;CI 3.56-10.22) and two-hour glucose level ≥ 9.4 mmol/l after a 75-gram oral glucose tolerance test at GDM diagnosis. In total 125 (54%) women treated with diet only had pregnancy complications. Primiparity and higher weight gain during pregnancy were the best predictors for complications (predictive probability 0.586 and 0.603).
  
  
  CONCLUSIONS
  In this GDM population we found various relevant factors predicting the need for insulin therapy. A fasting glucose level ≥ 5.5 mmol/l at GDM diagnosis was by far the strongest predictor. Women with GDM who had good glycaemic control on diet only with a higher parity and less weight gain had a lower risk for pregnancy complications.
authors: Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors: S H
authors: SH
authors: Koning
authors: K A
authors: KA
authors: Scheuneman
authors: H L
authors: HL
authors: Lutgers
authors: F J
authors: FJ
authors: Korteweg
authors: G
authors: G
authors: van den Berg
authors: K M
authors: KM
authors: Sollie
authors: A
authors: A
authors: Roos
authors: A J
authors: AJ
authors: van Loon
authors: T P
authors: TP
authors: Links
authors: K M
authors: KM
authors: van Tol
authors: K
authors: K
authors: Hoogenberg
authors: P P
authors: PP
authors: van den Berg
authors: B H R
authors: BH
authors: Wolffenbuttel
mesh_terms: D000328:Adult; D018912:Arabs / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D001786:Blood Glucose / Q000378:metabolism; D016640:Diabetes, Gestational / Q000378:metabolism / Q000628:therapy*; D004035:Diet Therapy; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D005951:Glucose Tolerance Test; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D016015:Logistic Models; D015999:Multivariate Analysis; D009426:Netherlands; D009765:Obesity / Q000453:epidemiology; D010298:Parity; D010347:Patient Care Planning; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015430:Weight Gain
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin