title: ATLANTIC DIP: Insulin Therapy for Women With IADPSG-Diagnosed Gestational Diabetes Mellitus. Does It Work?
abstract: BACKGROUND
  Approximately 40% of women with gestational diabetes mellitus (GDM) diagnosed using International Association of the Diabetes and Pregnancy Study Group (IADPSG) criteria require insulin therapy.
  
  
  OBJECTIVE
  We assessed whether the outcomes for women with GDM treated with insulin are comparable to women with normal glucose tolerance (NGT).
  
  
  METHODS
  This retrospective cohort study included 752 women with insulin-treated GDM and 2496 women with NGT during pregnancy. Maternal and fetal outcomes were examined.
  
  
  RESULTS
  Infants of women with insulin-treated GDM had rates of macrosomia [adjusted odds ratio (aOR), 1.19; 95% confidence interval (CI), 0.87 to 1.63; P = 0.26], large for gestational age (LGA) (aOR, 1.07; 95% CI, 0.77 to 1.47; P = 0.67), and small for gestational age (SGA) (aOR, 0.70; 95% CI, 0.38 to 1.38; P = 0.26) similar to women with NGT. They were more likely to be hypoglycemic at birth (aOR, 6.85; 95% CI, 2.31 to 20.28; P < 0.01) and to require neonatal intensive care unit care (NICU) (aOR, 12.09; 95% CI, 8.72 to 16.76; P < 0.01), predominantly for nonmedical reasons. Maternal rates of hypertensive disorders (preeclampsia: aOR, 0.64; 95% CI, 0.34 to 1.12; P = 0.17; pregnancy-induced hypertension: aOR, 1.11; 95% CI, 0.74 to 1.66; P = 0.60) and hemorrhage (ante partum hemorrhage: aOR, 0.56; 95% CI, 0.19 to 1.58; P = 0.27; postpartum hemorrhage: aOR, 1.17; 95% CI, 0.68 to 2.03; P = 0.55) were similar between groups, but the risk of polyhydramnios was increased in the GDM cohort (aOR, 7.75; 95% CI, 3.96 to 15.16; P < 0.01).
  
  
  CONCLUSIONS
  Insulin treatment of IADPSG-diagnosed GDM results in rates of macrosomia, LGA, SGA, and maternal hypertensive disorders similar to those of women with NGT. Although NICU admissions are greater in the GDM cohort, they are primarily for nonmedical reasons. Neonatal hypoglycemia and polyhydramnios remain greater among women with insulin-treated GDM.
authors.affiliation: Diabetes Research Centre, Galway SW4 671, Ireland; and.
authors.forename: Delia
authors.initials: D
authors.lastname: Bogdanet
authors.affiliation: Diabetes Research Centre, Galway SW4 671, Ireland; and.|College of Medicine Nursing and Health Sciences, National University of Ireland, Galway SW4 794, Ireland.
authors.forename: Aoife M
authors.initials: AM
authors.lastname: Egan
authors.affiliation: Diabetes Research Centre, Galway SW4 671, Ireland; and.
authors.forename: Catriona
authors.initials: C
authors.lastname: Reddin
authors.affiliation: Diabetes Research Centre, Galway SW4 671, Ireland; and.
authors.forename: Oratile
authors.initials: O
authors.lastname: Kgosidialwa
authors.affiliation: Diabetes Research Centre, Galway SW4 671, Ireland; and.
authors.forename: Breda
authors.initials: B
authors.lastname: Kirwan
authors.affiliation: Diabetes Research Centre, Galway SW4 671, Ireland; and.
authors.forename: Louise
authors.initials: L
authors.lastname: Carmody
authors.affiliation: Diabetes Research Centre, Galway SW4 671, Ireland; and.|College of Medicine Nursing and Health Sciences, National University of Ireland, Galway SW4 794, Ireland.
authors.forename: Fidelma P
authors.initials: FP
authors.lastname: Dunne
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000188:drug therapy*; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007003:Hypoglycemia / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D007236:Infant, Small for Gestational Age; D007328:Insulin / Q000627:therapeutic use*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D006831:Polyhydramnios / Q000453:epidemiology*; D006473:Postpartum Hemorrhage / Q000453:epidemiology*; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin