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Received: 23 May 2017 Revised: 14 August 2017 Accepted: 17 October 2017 DOI: 10.1002/ijgo.12354
CLINICAL ARTICLE Obstetrics
Factors associated with patients with gestational diabetes in Japan being at increased risk of requiring intensive care Hiroshi Yamashita | Ichiro Yasuhi* | Yukari Kugishima | So Sugimi | Yasushi Umezaki | Sachie Suga | Masashi Fukuda | Nobuko Kusuda Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura, Japan *Correspondence Ichiro Yasuhi, Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan. Email:
[email protected]
Abstract Objective: To investigate factors associated with high-risk gestational diabetes (GDM) among patients with GDM. Methods: The present retrospective study included women with singleton pregnancies diagnosed with GDM using International Association of Diabetes and Pregnancy Study Group criteria at a single tertiary perinatal care center in Japan between July 1, 2010, and October 31, 2014. High-risk GDM was defined as patients who required at least 20 units of insulin therapy a day, delivering a large-for-gestational age neonate regardless of insulin therapy, or both. Maternal characteristics and diagnostic test results were investigated to identify associations with the high-risk criteria, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Among 217 patients, 95 (43.8%) were categorized as high risk. After adjusting for confounders, a fasting plasma glucose level at diagnosis of at least 4.66 mmol/L (adjusted OR 2.88, 95% CI 1.51–5.58) and pre-pregnancy body mass index (calculated as weight in kilograms divided by the square of height in meters) of at least 24 (adjusted OR 3.27, 95% CI 1.60–6.90) were independently associated with meeting the high-risk criteria. Conclusion: Among Japanese patients with GDM, pre-pregnancy body mass index and fasting plasma glucose levels could be used to identify high-risk patients requiring intensive care during pregnancy. KEYWORDS
Diagnosis; Gestational diabetes; Management; Risk factor
1 | INTRODUCTION
medical resource limitations are an issue in the management of GDM patients in the clinical setting.
Gestational diabetes (GDM), defined as mild hyperglycemia dur-
Several studies have addressed risk factors for fetal overgrowth
ing pregnancy by the International Association of Diabetes and
in patients with GDM; maternal obesity and hyperglycemia (espe-
Pregnancy Study Group (IADPSG),1 is associated with adverse peri-
cially fasting hyperglycemia) have been reported to be independently
natal outcomes.2 The Japan Society of Obstetrics and Gynecology
associated with fetal macrosomia.2,4–7 Thus, maternal obesity and
accepted and introduced the IADPSG criteria in July 2010. Since then,
the severity of hyperglycemia are suggested to be key risk factors for
the prevalence of GDM in the Japanese population has increased
adverse perinatal outcomes in patients with GDM.
at least 2.7-fold in comparison to that estimated using the previous
Given the increasing prevalence of GDM resulting from the adop-
Japan Society of Obstetrics and Gynecology criteria.3 Consequently,
tion of the IADPSG criteria, it appears practical to use risk factors
Int J Gynecol Obstet 2017; 1–5
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Yamashita ET AL.
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associated with fetal macrosomia to triage women with high-risk GDM
in meters], family history of diabetes [≤2 degrees]), and the results of
for more intensive care, including insulin therapy; patients with GDM
diagnostic OGTT (pregnancy duration at testing, fasting, 1- and 2-h
at lower risk of adverse perinatal outcomes could be managed with
plasma glucose values, number of anomalous OGTT plasma glucose
less intensive care, such as diet alone.
values, and HbA1c values) were assessed. First, a univariate logistic
The aim of the present study was to investigate major risk factors
regression analysis was performed to identify candidate risk factors.
associated with high-risk GDM in a Japanese population, with the view
Factors with P
