Maternal and Perinatal Outcomes in Women with Gestational Diabetes Mellitus Requiring Pharmacological Management: A Prospective Cohort Study

Abstract

Introduction: Gestational Diabetes Mellitus (GDM), a common medical complication of pregnancy, is an independent risk factor for obstetric complications and adverse perinatal outcomes. Insulin has been the treatment modality for many years. Recent studies indicate that metformin, an oral hypoglycaemic agent, may be a safe and effective alternative. Aim: To evaluate and compare the effectiveness of metformin and insulin in managing glycaemic control, and assessing maternal and newborn outcomes among women diagnosed with GDM. Materials and Methods: The present prospective cohort study was conducted in the Department of Obstetrics, Fernandez Hospital, Hyderabad, Telangana, India, from December 2020 to November 2021. The study population included women attending antenatal check-ups after meeting the inclusion and exclusion criteria. Those who failed to respond to lifestyle modifications were started on either metformin or insulin as per the attending physician’s advice. A total of 369 pregnant women were included in the study. Parameters such as weight gain during pregnancy, need for additional pharmacologic treatment, maternal hypoglycaemia, onset of Hypertensive Disorders of Pregnancy (HDP), gestational age at delivery, mode of delivery and neonatal details such as birth weight, occurrence of Large for Gestational Age (LGA), Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, birth injuries, neonatal hypoglycaemia, hyperbilirubinemia, respiratory distress, and neonates requiring Neonatal Intensive Care Unit (NICU) admissions were recorded. Data were subjected to statistical analysis. Analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 22.0. A p-value of <0.05 was considered statistically significant. Results: Among the study population, 338 (91.6%) patients were on metformin, while 31 (8.40%) patients were on insulin. The metformin group exhibited good glycaemic control, whereas those on insulin had inadequate glycaemic control (p-value<0.001), a higher incidence of LGA babies (p-value=0.038) and more infants requiring phototherapy (p-value=0.022). Conclusion: The metformin group demonstrated effective control regarding both Fasting Blood Sugar (FBS) levels and postprandial blood glucose levels. Conversely, the group receiving insulin treatment exhibited a higher prevalence of neonates born LGA, a greater need for phototherapy, and inadequate maternal glycaemic control.

Keywords

• hyperbilirubinemia
• hypoglycaemia
• insulin
• metformin