Insulin therapy use in gestational diabetes: Frequency and predictive factors

Gestational diabetes mellitus (GDM) is a considerable health issue during pregnancy. It poses immediate risks to both the mother and the fetus while also increasing the likelihood of long-term metabolic complications. The aim of this study was to determine the factors associated with insulin requirement in patients with GDM. A retrospective review of the clinical characteristics of 96 women with GDM who attended the department in 2022 was conducted. Data on GDM diagnosis, maternal age, pre-pregnancy body mass index (BMI), gestational weight gain, glycemic control, diagnostic and test results were analyzed. Insulin resistance was defined by HOMA index > 2.4. Mean age was 33.3 ± 4.7 years. Among the 96 patients studied, 25% were classified as obese while 35.4% were categorized as overweight. Half of the study population (51.3%) had a family history of type 2 diabetes while 22.9% had a personal history of GDM. Hypertension and/or pre-eclampsia in previous pregnancies were found in 6.3% of patients. Antenatal insulin therapy (AIT) was required by 37.5% of the patients, the mean duration between diagnosis and insulin therapy was 2.06 ± 3.9 weeks. AIT was significantly associated with primiparity (27.8% vs. 49%; P = 0.047), pre-gestational obesity (46.9% vs. 10.6%; P = 0.001) as well as insulin resistance (79.4% vs. 35.6%; P < 0.001). Advanced maternal age (> 40 years) at moment of diagnosis ( P = 0.563), family history of diabetes ( P = 0.947), history of GDM ( P = 0.303), and AIT in previous pregnancies ( P = 0.303) were not found to be significantly associated with AIT. Fetal complications such as macrosomia ( P = 0.483) and hydramnios ( P = 0.235) were not associated with AIT. Understanding associated factors with the use of insulin therapy as demonstrated by the results of our study will enable early and optimal management of these patients.