DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20211505

Interventions for gestational diabetes: impact of assisted reproduction

Preethi Ravi, Lakshmi Shanmuga Sundaram, Kundavi Shankar

Abstract


Background: This study was to assess whether assisted conception acts as a predictor for insulin therapy in gestational diabetes (GDM) treatment. The secondary aim of this study was to analyse the type of interventions that aided control of blood glucose. The role of ART as a risk factor that increases the risk of insulin therapy in GDM remains elusive. Many studies have established the increased association of GDM with ART conceptions. Factors like advanced maternal age, polycystic ovarian syndrome or obesity that increase GDM risk also contribute to subfertility. Increased level of  Hb A1C, elevated FBS values are considered as risk factors for antenatal insulin therapy in women with GDM. This study was to assess if assisted reproduction is an independent variable associated with insulin therapy.

Methods: In this retrospective study, GDM was diagnosed by fasting blood sugar and 2 hours postprandial or 75 gms OGTT based on IADPSG criteria with FBS >90, 2hr >140. Among the 121 GDM mothers, 42 women were ART conceptions and 79 were spontaneous conceptions. The entire study population (121) was divided into 3 groups based on the treatment required. Diet and lifestyle modifications only, diet and life style modifications with OHA and OHA with or without insulin therapy. The demographic, clinical, biochemical data were compared between groups. Details were obtained from case notes and entered in an excel sheet and SSPS software was used for statistical analysis. Inclusion criteria was all GDM pregnancies in the study period (4 years; January 2014 to December 2017) for whom case notes were available. Exclusion criteria was women with diabetes prior to pregnancy, those who moved elsewhere for delivery and multiple gestations.

Results: There was no difference in the insulin requirement between ART conception and spontaneous conceptions. Out of 121 women, 34 women (28%) required diet and life style management, 38 women required OHA (31%), 49 women required insulin (40%). 73% of women who were managed with diet were spontaneous conceptions. Preterm labor was the commonest complication encountered (17%). ART women had more number of perinatal complications, in all treatment groups.

Conclusions: ART was not a predictor for insulin therapy in this study group. The largest group of intervention for GDM was with insulin, 40%. Perinatal complications were seen more in ART mothers with GDM compared with spontaneous conceptions. Spontaneous conceptions women had more percentage of management with diet and life style modifications.


Keywords


ART, GDM, Predictors of insulin

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References


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.

Mithal A, Bansal B, Kalra S. Gestational diabetes in India: science and society. Ind J Endocrinol Metabol. 2015;19(6):701-4.

Kayal A, Mohan V, Malanda B, Anjana RM, Bhavadharini B, Mahalakshmi MM, et al. Women in India with gestational diabetes mellitus strategy (WINGS): methodology and development of model of care for gestational diabetes mellitus (WINGS 4). Ind J Endocrinol Metabol. 2016;20(5):707-15.

ICMR guidelines for ART 2010

Maman E, Lunenfeld E, Levy A, Vardi H, Potashnik G. Obstetric outcome of singleton pregnancies conceived by in vitro fertilization and ovulation induction compared with those conceived spontaneously. Fertil Steril. 1998;70(2):240-5.

Shoupe D, Kumar DD, Lobo RA. Insulin resistance in polycystic ovary syndrome. Am J ObstetGynecol. 1983;147(5):588-92.

Shevell T, Malone FD, Vidaver J, Porter TF, Luthy DA, Comstock CH, et al. Assisted reproductive technology and pregnancy outcome. Obstet Gynecol. 2005;106(5 Pt 1): 1039-45.

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, daSilva AM, Praxedes-Garcia P, Valle MM, et al. Progesterone induces apoptosis of insulin-secreting cells: insights into the molecular mechanism. J Endocrinol. 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):881-8.

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):199-206.

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.