Adverse perinatal outcome in diabetic mother treated with oral hypoglycemic agents vs. insulin
Keywords:Gestational diabetes, Insulin, Oral hypoglycemic agent, Outcome
Background: Insulin has been the primary mode of therapy in diabetic mother for glycemic control as oral hypoglycemic agents (OHA) were initially thought to have teratogenic effect. Recent data supports the use of certain OHA; this study was designed to compare the perinatal outcomes in infants born to diabetic mother treated with insulin vs. oral hypoglycemic agents and to find out the relation of adverse perinatal events to glycemic control in both groups.
Methods: This prospective observational study was conducted in a tertiary care hospital. 108 neonates born to diabetic mother between October 2014 to September 2016 were taken for study immediately after delivery after excluding the mothers who were treated with lifestyle modification and/or dietary modification alone only. 60 mothers had received insulin and 48 OHA for glycaemic control. Glycemic control was assessed by HbA1C estimation on the day of delivery. The infants were followed up in neonatal care unit for perinatal complications. Main outcome measure(s): birth weight, gestational age, respiratory problems, birth injury, birth asphyxia, congenital anomalies, hypoglycemia, hypocalcaemia, hyperbillirubinemia.
Results: Out of 108 infants, 27 were born to pregestational and 81 to gestational diabetic mothers. 60(55.5%) were treated with insulin and rest with OHA, 53(49.1%) had optimal glycemic control. Both the groups had similar glycemic control in the third trimester. None of the perinatal outcomes showed significant difference between insulin and OHA group except neonatal hyperbillirubinemia. (p=0.013, RR=8 and OR=0.106). Within the optimal glycemic control (HbA1C <8), LGA has significant association with the insulin group than OHA (p=0.012, RR=2.217 and OR=4.2018).
Conclusions: As compared to insulin, oral hypoglycemic agents have similar glycemic control and no adverse perinatal outcomes and can be used in pregnant mothers with diabetes mellitus from poor socioeconomic and educational background for its low cost and better patient compliance. Within the glycemic control, maternal treatment with insulin showed significant difference in LGA compared to OHA which needs further studies for validation.
Jovanovic L, Pettitt DJ. Gestational diabetes mellitus. JAMA. 2001;286(20):2516-8.
Beischer NA, Oats JN, Henry OA, Sheedy MT, Walstab JE. Incidence and severity of gestational diabetes mellitus according to country of birth in women living in Australia. Diab Care. 1991;40(Suppl. 2):35-8.
Nagandla K, Somsubhra D, Sachchithanantham K. Oral Hypoglycemic Agents in pregnancy: An Update. J Obstet Gynaecol India. 2013;63(2): 82-7.
American academy of paediatrics and American heart association. Textbook of neonatal resuscitation Edited by Weiner GM, Jeanette Zaichkin J. 7th ed; 2015.
González-Quintero VH, Istwan NB, Rhea DJ, Rodriguez LI, Cotter A, Carter J et al. The impact of glycemic control on neonatal outcome in singleton pregnancies complicated by gestational diabetes. Diabetes Care. 2007;30:467-70.
Chmait R, Moore TR. Endocrine Disorders in pregnancy. In: Taeush, Ballard, Gleason, editors. Avery’s Diseases of the Newborn, 8th edition. 2005: 71-86.
Catalano PM, Alicia TRD, Presley H. Phenotype of infants of mothers with gestational diabetes. Diabetes Care. 2007;30(2):S156-S160.
Langer O, Levy J, Brustman L, Anyaegbunam A, Merkatz R, Divon M. Glycemic control in gestational diabetes mellitus – how tight is tight enough: Small for gestational age versus large for gestational age? Am J Obstet Gynecol. 1989;161(3):646-53.
Cornblath M, Hawdon JM, Williams AF, Aynsley-Green A, Ward-Platt MP, Schwartz R et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatr. 2002;105(5):1141-5.
Nold JL, Georgieff MK. Infants of diabetic mothers. Pediatr Clini North America. 2004;51(3): 619-37.
Tyrala EE. The infant of the diabetic mother. Obstet Gynecol Clini North America. 1996;23(1):221-41.
Cowett RM. The infant of the diabetic mother. In: Burg, Ingelfinger, Wald, Polin, editors. Gellis and Kagan’s current pediatric therapy, 17th ed. 1999:290-4.
Martin CR, Cloherty JP. Neonatal Hyperbilirubinemia. In: Cloherty JP, Eichenwald EC, Stark AR, editors. Manual of neonatal care, 5th edition: Philadelphia: Lippincott Williams and Wilkins; 2004:185-221.
Ranade AY, Merchant RH, Bajaj RT, Joshi NC. Infants of diabetic mothers: An analysis of 50 cases. Indian Pediatr. 1989;26:366-70.
Watson D, Rowan J, Neale L, Battin MR. Admissions to neonatal intensive care unit following pregnancies complicated by gestational and type 2 diabetes mellitus. Australian New Zealand J Obstet Gynaecol. 2003;143(6):429-32.
Gabbe SG, Lowensohn RI, Wu PY, Guerra G. Current patterns of neonatal morbidity and mortality in infants of diabetic mothers. Diabetes Care. 1978;1(6):335-9.
Deorari AK, Menon PSN, Gupta N. Outcome of infants born to diabetic women. Indian Pediatr. 1985;22:375-8.
Sudarshan K, Jain S, Jain RK. Study of morbidity and mortality pattern in infants born to diabetic mothers. J Obstet Gynaecol India. 1987;37:481-4.
Deorari AK, Kabra SK, Paul VK. Perinatal outcome of infants born to diabetic mothers. Indian Pediatr. 1991;28:1271-5.
Mangala R, Mhaskar R, Mhaskar A. Perinatal outcome in pregnancies complicated by diabetes. Int J Diab Developing countries. 1991;11:22-4.
Dhulkotia JS, Ola B, Fraser R, Farrell T. Oral hypoglycaemic agents vs. insulin in management of gestational diabetes: a systematic review and meta-analysis. Am J Obstet Gynecol. 2010;203:457e1-9.
Thomas N, Chinta AJ, Sridhar S, Kumar M, Kuruvilla KA, Jana AK. Perinatal outcome of infants born to diabetic mothers in a developing country-comparison of insulin and oral hypoglycaemic agents. Indian Pediatr. 2013;50:289-93.
Herranz L, Pallardo LF, Hillman N, Vaquero PM, Villaroel A, Fernandez A. Maternal third trimester hyperglycaemic excursions predict large-for-gestational –age infants in type1 diabetic pregnancy. Diabe Res Cinil Prac. 2007;75(1):42-6.