Assisted conception as a potential prognostic factor predicting insulin therapy in pregnancies complicated by gestational diabetes mellitus
Tóm tắt
Advanced maternal age, family history of diabetes, pre-gestational obesity, increased level of HbA1c, history of gestational diabetes mellitus (GDM), and poor pregnancy consequences are considered risk factors for antenatal insulin requirement in women with GDM. However, the role of assisted reproductive technology (ART) in increasing the risk of insulin therapy in pregnancies complicated with GDM remained elusive. The current study aimed to determine the role of ART in predicting insulin therapy in GDM women and investigate the clinical and biochemical factors predicting the need for insulin therapy in pregnancies complicated with GDM. In this prospective cohort study, 236 Iranian women with GDM were diagnosed by one-step oral glucose tolerance test (OGTT) between October 2014 and June 2017. They were mainly assigned to two groups; the first group (n = 100) was designated as ART which was further subdivided into two subgroups as follows: 60 participants who received medical nutrition therapy (MNT) and 40 participants who received MNT plus insulin therapy (MNT-IT). The second group (n = 136) was labeled as the spontaneous conception (SC), consisting of 102 participants receiving MNT and 34 participants receiving MNT in combination with IT (MNT-IT). The demographic, clinical, and biochemical data were compared between groups. Multivariate logistic regression was performed to estimate prognostic factors for insulin therapy. A higher rate of insulin therapy was observed in the ART group as compared with the SC group (40% vs. 25%; P < 0.001). Multivariate logistic regression demonstrated that maternal age ≥ 35 years [OR: 2.91, 95% CI: (1.28–6.62)], high serum FBS [1.10: (1.04–1.16)], HbA1c [1.91 (1.09–3.34)], and ART treatment [2.94: (1.24–6.96)] were independent risk factors for insulin therapy in GDM women. Apart from risk factors mentioned earlier, ART may be a possible prognostic factor for insulin therapy in pregnancies complicated with GDM.
Tài liệu tham khảo
Tobias DK, Chavarro JE, Williams MA, Buck Louis GM, Hu FB, Rich-Edwards J, et al. History of infertility and risk of gestational diabetes mellitus: a prospective analysis of 40,773 pregnancies. Am J Epidemiol. 2013;178(8):1219–25.
Pinborg A, Wennerholm U-B, Romundstad L, Loft A, Aittomaki K, Söderström-Anttila V, et al. Why do singletons conceived after assisted reproduction technology have adverse perinatal outcome? Systematic review and meta-analysis. Hum Reprod Update. 2012;19(2):87–104.
Catalano PM, McIntyre HD, Cruickshank JK, McCance DR, Dyer AR, Metzger BE, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012;35(4):780-86.
Holst S, Kjær SK, Jørgensen ME, Damm P, Jensen A. Fertility problems and risk of gestational diabetes mellitus: a nationwide cohort study. Fertil Steril. 2016;106(2):427–34 e1.
Wang Y, Nikravan R, Smith H, Sullivan E. Higher prevalence of gestational diabetes mellitus following assisted reproduction technology treatment. Hum Reprod. 2013;28(9):2554–61.
Saisho Y, Miyakoshi K, Tanaka M, Shimada A, Ikenoue S, Kadohira I, et al. Beta cell dysfunction and its clinical significance in gestational diabetes. Endocr J. 2010;57(11):973–80.
Abell SK, De Courten B, Boyle JA, Teede HJ. Inflammatory and other biomarkers: role in pathophysiology and prediction of gestational diabetes mellitus. Int J Mol Sci. 2015;16(6):13442–73.
Association AD. 13. Management of diabetes in pregnancy: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018;41(Supplement 1):S137–S43.
Simeonova-Krstevska S, Bogoev M, Bogoeva K, Zisovska E, Samardziski I, Velkoska-Nakova V, et al. Maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus treated with diet, metformin or insulin. Open Access Macedonian J Med Sci. 2018;6(5):803.
Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S, et al. Treatments for gestational diabetes: a systematic review and meta-analysis. BMJ Open. 2017;7(6):2016–015557.
Barnes RA, Wong T, Ross GP, Jalaludin BB, Wong VW, Smart CE, et al. A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus. Diabetologia. 2016;59(11):2331–8.
Sapienza AD, Francisco RPV, Trindade TC, Zugaib M. Factors predicting the need for insulin therapy in patients with gestational diabetes mellitus. Diabetes Res Clin Pract. 2010;88(1):81–6.
Kouhkan A, Khamseh ME, Moini A, Pirjani R, Valojerdi AE, Arabipoor A, et al. Predictive factors of gestational diabetes in pregnancies following assisted reproductive technology: a nested case–control study. Arch Gynecol Obstet. 2018;298(1):199-06.
Jalaludin B. Gestational diabetes mellitus: who requires insulin therapy? Aust N Z J Obstet Gynaecol. 2011;51(5):432–6.
Mitra S, Nayak PK, Sahoo J, Mathew A, Padma A, Kamalanathan S, et al. Predictors for antenatal insulin requirement in gestational diabetes. Gynecol Endocrinol. 2014;30(8):565–8.
Jafari-Shobeiri M, Ghojazadeh M, Azami-Aghdash S, Naghavi-Behzad M, Piri R, Pourali-Akbar Y, et al. Prevalence and risk factors of gestational diabetes in Iran: a systematic review and meta-analysis. Iran J Public Health. 2015;44(8):1036.
Poolsup N, Suksomboon N, Amin M. Effect of treatment of gestational diabetes mellitus: a systematic review and meta-analysis. PLoS One. 2014;9(3):e92485.
Chen M, Wu L, Zhao J, Wu F, Davies MJ, Wittert GA, et al. Altered glucose metabolism in mouse and humans conceived by in-vitro fertilization (IVF). Diabetes. 2014;63(10):3189-98.
Watanabe M, Katayama A, Kagawa H, Ogawa D, Wada J. Risk factors for the requirement of antenatal insulin treatment in gestational diabetes mellitus. J Diabetes Res. 2016;2016:9648798.
Pertot T, Molyneaux L, Tan K, Ross GP, Yue DK, Wong J. Can common clinical parameters be used to identify patients who will need insulin treatment in gestational diabetes mellitus? Diabetes Care. 2011;34(10):2214–6.
Bakiner O, Bozkirli E, Ozsahin K, Sariturk C, Ertorer E. Risk factors that can predict antenatal insulin need in gestational diabetes. J Clin Med Res. 2013;5(5):381.
Meshel S, Schejter E, Harel T, Maslovitz S, Germez N, Elimelech B, et al. Can we predict the need for pharmacological treatment according to demographic and clinical characteristics in gestational diabetes? J Matern Fetal Neonatal Med. 2016;29(13):2062–6.
González-Quintero VH, Istwan NB, Rhea DJ, Tudela CM, Flick AA, De la Torre L, et al. Antenatal factors predicting subsequent need for insulin treatment in women with gestational diabetes. J Women's Health. 2008;17(7):1183–7.
Cerny D, Sartori C, Rimoldi SF, Meister T, Soria R, Bouillet E, et al. Assisted reproductive technologies predispose to insulin resistance and obesity in male mice challenged with a high-fat diet. Endocrinology. 2017;158(5):1152–9.
Szymanska M, Horosz E, Szymusik I, Bomba-Opon D, Wielgos M. Gestational diabetes in IVF and spontaneous pregnancies. Neuro Endocrinol Lett. 2011;32(6):885–8.
Nunes VA, Portioli-Sanches EP, Rosin MP, da Silva Araújo M, Praxedes-Garcia P, Valle MM, et al. Progesterone induces apoptosis of insulin-secreting cells: insights into the molecular mechanism. Journal of Endocrinology. 2014;221(2):273–84.
Wada T, Hori S, Sugiyama M, Fujisawa E, Nakano T, Tsuneki H, et al. Progesterone inhibits glucose uptake by affecting diverse steps of insulin signaling in 3T3-L1 adipocytes. Am J Physiol-Endocrinol Metab. 2010;298(4):E881–E8.
Yildizfer F, Donma O, Yen M, Ekmekci O, Kul ZAK, Keser Z, et al. In vitro fertilization, levels of pro-inflammatory factors and lipid peroxidation. Int J Fertility Sterility. 2015;9(3):277.
Kumari R, Singh H. The prevalence of elevated high-sensitivity C-reactive protein in normal pregnancy and gestational diabetes mellitus. J Fam Med Primary Care. 2017;6(2):259.
Brahimaj A, Ligthart S, Ghanbari M, Ikram MA, Hofman A, Franco OH, et al. Novel inflammatory markers for incident pre-diabetes and type 2 diabetes: the Rotterdam study. Eur J Epidemiol. 2017;32(3):217–26.