Predictors of the need for insulin therapy in gestational diabetes mellitus and the relationship between the need for insulin and the condition of newborns

Objective. To determine the factors influencing the need for insulin therapy in gestational diabetes mellitus (GDM), and to compare perinatal outcomes in groups of patients receiving diet therapy and insulin therapy. Materials and methods. A retrospective study of 308 cases of pregnancies complicated by GDM was conducted, depending on the GDM therapy used in late premature and term delivery. Group 1 included 277 pregnant women who were prescribed diet therapy, group 2 included 31 pregnant women who received insulin therapy. Results. The patients of the 2nd group were obese 2 times more often than the patients of the 1st group. In group 2, GDM was diagnosed before 24 weeks of pregnancy in 22.6% of cases, and in group 1 — in 8.7%. Hypertensive disorders during pregnancy in group 2 were diagnosed 4 times more often than in group 1: in 13 (41.9%) and 27 (9.7%) women, respectively. The birth rate of children large for the corresponding gestational age (over the 90th percentile) in women in labor with GDM was 16.6%, among them 44 (15.9%) were born in patients of the 1st group and 7 (22.6%) — in women of the 2nd group. Asphyxia of moderate severity at birth was found only in the 2nd group in 1 child (3.2%). Intrauterine hypoxia, first noted during childbirth, was diagnosed in 9 (3.2%) children in group 1 and in 1 (3.2%) child in group 2. Newborns in group 2 needed respiratory support more often: 2 (0.7%) in group 1 and 2 (6.5%) in group 2. Conclusion. The need for insulin therapy increases in pregnant women with an early diagnosis of GDM (up to 24 weeks of pregnancy) and with the presence of obesity. In the group of patients who required insulin therapy, hypertensive disorders were more often detected during pregnancy, the frequency of perinatal asphyxia and respiratory support for newborns increased.