Gestational Diabetes: Which Clinical (Pre)gestational Features Are Able to Predict Failure of Lifestyle Intervention?

Background Controversy exists regarding risk factors in pregnant women that might be associated with a higher probability of failure of lifestyle intervention in the treatment of gestational diabetes (GD). These pregnant women's risk factors may highlight the need for closer surveillance at an early stage of pregnancy. Aims To identify predictors of pharmacological therapy need in early and late GD. Methods This was a retrospective observational study including women with GD diagnosed in the first (group 1) or second trimester (group 2) according to the criteria proposed by the International Association of Diabetes Pregnancy Study Group (IADPSG), singleton pregnancy and follow-up between January 2015 and December 2018, divided according to treatment (lifestyle intervention or pharmacological treatment (metformin and/or insulin)). Results A total of 278 and 273 women were included in groups 1 and 2, of which 48.6% and 55.3% underwent non-pharmacological treatment, respectively. In group 1, women requiring pharmacological therapy tended to be older and have previous GD or family history of diabetes, higher body mass index (BMI) and higher fasting blood glucose (FBG) levels. In group 2, pharmacological treatment need was associated with multiparity, previous GD, higher BMI, higher fasting glucose value in the oral glucose tolerance test (OGTT), and higher OGTT value at 60 minutes. The independent risk factors identified for pharmacological treatment requirement were maternal age (OR 1.10 (1.05-1.16), p<0.001), previous GD (OR 2.70 (1.10-6.58), p=0.029) and FBG (OR 1.07 (1.00-1.14), p=0.048) in group 1 while BMI (OR 1.07 (1.02-1.13), p=0.012) and fasting glucose value in the OGTT (OR 1.03 (1.01-1.05), p=0.006) were the factors identified in group 2. The cut-off values for FBG and fasting glucose value in the OGTT that predicted the necessity of pharmacological treatment were 95.50 mg/dL and 88.50 mg/dL, respectively. Conclusions In early GD, closer surveillance is necessary for older women with a previous GD and an FBG ≥ 95.50 mg/dL. In late GD, pre-gestational BMI and a fasting glucose value in the OGTT ≥ 88.50 mg/dL should prevail.