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Am J Perinatol 2019; 36(12): 1250-1255
DOI: 10.1055/s-0038-1676615
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Response to Medical Nutritional Therapy and Need for Pharmacological Therapy in Women with Gestational Diabetes

Maisa N. Feghali
1   Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Kaleab Z. Abebe
2   Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Diane M. Comer
2   Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Steve Caritis
1   Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Janet M. Catov
1   Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Christina M. Scifres
3   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations Funding Maisa N. Feghali is supported by the National Institutes of Health through grant number K23HD092893. The funding source had no involvement in the preparation, analysis, and interpretation of the data or submission of this report.
Further Information

Publication History

12 July 2018

10 November 2018

Publication Date:
21 December 2018 (online)

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Abstract

Objective We assessed if the initial response to medical nutritional therapy (MNT) can help predict the need for pharmacological therapy in women with gestational diabetes mellitus (GDM).

Study Design We identified 1,174 women with GDM who underwent standardized dietary counseling and reported glucose values from the first week of MNT. We compared women who required pharmacological therapy with those who did not use bivariate statistics, and used multivariable logistic regression modeling to assess for factors predicting the need for pharmacological therapy.

Results We identified 819 women (69.8%) who needed pharmacological therapy. They had higher prepregnancy body mass index, higher rates of GDM diagnosis before 24 weeks, and higher oral glucose tolerance test values. After adjustment for covariates, age (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.01–1.08), obesity (OR: 2.49; 95% CI: 1.70–3.66), and ≥33% of abnormal glucose values from the first week of MNT (OR: 13.84; 95% CI: 9.4–20.20) were associated with the need for pharmacological therapy. Area under the curve of the regression model was 0.83, with a sensitivity of 72.2%, a specificity of 86.8%, and a positive predictive value of 92.5%.

Conclusion Glucose values from the first week of MNT were the strongest predictor of needing pharmacological therapy. Further studies are needed to define metabolic predictors of response to MNT in women with GDM.

Keywords

gestational diabetes mellitus - pregnancy - treatment - nutrition - pharmacological therapy

Supplementary Material

 

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