Comparison of neonatal birthweights and fetomaternal outcomes in gestational diabetes-on diet, metformin and insulin

Siddhi Shree Dixit; Sudha S.; Greeshma C. R.

doi:10.18203/2320-1770.ijrcog20221684

Authors

Siddhi Shree Dixit Department of Obstetrics and Gynecology, Kerala, India
Sudha S. Department of Obstetrics and Gynecology, Kerala, India
Greeshma C. R. Department of Biostatistics, Amrita Institute, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20221684

Keywords:

Macrosomia, GDM, Metformin, Insulin, Diet control

Abstract

Background: Review suggested that neonatal birthweight in insulin group was higher than in metformin and diet and metformin had overall better fetomaternal outcomes. We wanted to understand the trend in the patients visiting our hospital.

Methods: This is an observational comparative study conducted in Department of Obstetrics and Gynaecology, AIMS Kochi from 2019-2021. All antenatal patients were screened and total of 153 patients meeting inclusion and exclusion criteria were studied. The data was collected and analysed using SPSS 20 software.

Results: The neonatal birthweight the three groups were comparable, with no significant difference (3.05±0.42 kgs in diet; 2.92±0.37 kgs in metformin; 3.11±0.41 kgs in insulin; p=0.092) and maternal pre-pregnancy weight was associated with birthweight. Insulin group had higher age (31.17±5.54 years versus 27.59±4.62 years in OHA and 29.43±4.56 years in diet; p<0.001). Insulin group delivered at an earlier gestation (37 weeks versus 38 weeks; p<0.001) and most common mode of delivery was cesearean section (74.6% in insulin; 54.2% in diet and 49.8% in OHA). NICU admission (45.8% versus 10.8% in diet and 15.4% in OHA; p<0.001) and need for phototherapy (1.5% in metformin versus 5.4% in diet and 11.8% in insulin; p=0.067) was lesser in metformin group.

Conclusions: Strict glycemic control is important in preventing macrosomia Metformin overall has good fetomaternal outcomes compared to diet or insulin.

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References

Leveno KJ, Spong CY, Dashe JS, Casey BM, Hoffman BL, Cunningham FG, et al. Williams Obstetrics, 25th Edition. McGraw-Hill Education; 2018. Available at: https://books.google.co.in/books? id=mhOdAQAACAAJ. Accessed on 10 Jan, 2021.

Tertti K, Ekblad U, Vahlberg T, Rönnemaa T. Comparison of Metformin and Insulin in the Treatment of Gestational Diabetes: A Retrospective, Case-Control Study. Rev Diabet Stud RDS. 2008;5(2):95-101.

Benhalima K, Robyns K, Van Crombrugge P, Deprez N, Seynhave B, Devlieger R, et al. Differences in pregnancy outcomes and characteristics between insulin- and diet-treated women with gestational diabetes. BMC Pregnancy Childbirth. 2015;15(1):271.

Gaudet L, Ferraro ZM, Wen SW, Walker M. Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis. BioMed Res Int. 2014;2014:640291.

Gestational Diabetes Mellitus. Available at: https://nhm.gov.in/NewUpdates2018/NHMComponents/RMNCHMHGuidelines/Gestational-Diabetes-Mellitus.pdf. 2021 Aug 23.

Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Arthi T, Thamizharasi M, et al. Prevalence of gestational diabetes mellitus in South India (Tamil Nadu)-a community-based study. J Assoc Physicians India. 2008;56:329-33.

Li Y, Ren X, He L, Li J, Zhang S, Chen W. Maternal age and the risk of gestational diabetes mellitus: A systematic review and meta-analysis of over 120 million participants. Diabetes Res Clin Pract. 2020;162:108044.

Laine MK, Kautiainen H, Gissler M, Raina M, Aahos I, Järvinen K, et al. Gestational diabetes in primiparous women-impact of age and adiposity: a register-based cohort study. Acta Obstet Gynecol Scand. 2018;97(2):187-94.

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 Maced J Med Sci. 2018;6(5):803-7.

Tertti K, Ekblad U, Koskinen P, Vahlberg T, Rönnemaa T. Metformin vs. insulin in gestational diabetes. A randomized study characterizing metformin patients needing additional insulin. Diabetes Obes Metab. 2013;15(3):246-51.

Balani J, Hyer SL, Rodin DA, Shehata H. Pregnancy outcomes in women with gestational diabetes treated with metformin or insulin: a case-control study. Diabet Med J Br Diabet Assoc. 2009;26(8):798-802.

Gui J, Liu Q, Feng L. Metformin vs Insulin in the Management of Gestational Diabetes: A Meta-Analysis. PLoS ONE. 2013;8(5):e64585.

Kalra B, Gupta Y, Kalra S. Timing of Delivery in Gestational Diabetes Mellitus: Need for Person-Centered, Shared Decision-Making. Diabetes Ther. 2016;7(2):169-74.

Gandhi P, Bustani R, Madhuvrata P, Farrell T. Introduction of metformin for gestational diabetes mellitus in clinical practice: has it had an impact? Eur J Obstet Gynecol Reprod Biol. 2012;160(2):147-50.

Oral hypoglycaemic agents in 118 diabetic pregnancies Hellmuth 2000 Diabetic Medicine Wiley Online Library. Available at: https://onlinelibrary. wiley.com/doi/abs/10.1046/j.1464-5491.2000. 00314.x. Accessed on 27 November 2021.