Predictors for pharmacological therapy and perinatal outcomes with metformin treatment in women with gestational diabetes
BackgroundThe prevalence of gestational diabetes mellitus (GDM) has been increasing in Australia and worldwide. The study aims were to examine, in comparison with dietary intervention, perinatal outcomes for women with gestational diabetes who were attending a single hospital clinic and to identify...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1119134/full |
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| author | Malgorzata M. Brzozowska Malgorzata M. Brzozowska Malgorzata M. Brzozowska Anita Puvanendran Dana Bliuc Dana Bliuc Andrew Zuschmann Andrew Zuschmann Agata K. Piotrowicz Agata K. Piotrowicz Anthony O’Sullivan Anthony O’Sullivan |
| author_facet | Malgorzata M. Brzozowska Malgorzata M. Brzozowska Malgorzata M. Brzozowska Anita Puvanendran Dana Bliuc Dana Bliuc Andrew Zuschmann Andrew Zuschmann Agata K. Piotrowicz Agata K. Piotrowicz Anthony O’Sullivan Anthony O’Sullivan |
| author_sort | Malgorzata M. Brzozowska |
| collection | DOAJ |
| description | BackgroundThe prevalence of gestational diabetes mellitus (GDM) has been increasing in Australia and worldwide. The study aims were to examine, in comparison with dietary intervention, perinatal outcomes for women with gestational diabetes who were attending a single hospital clinic and to identify predictors for their pharmacological GDM treatment.MethodsA prospective, observational study of women with GDM, treated with “Diet, N= 50”, “Metformin, N = 35”, “Metformin and Insulin, N = 46” or “Insulin, N = 20”.FindingsThe mean BMI for the whole cohort was 25.8 ± 4.7 kg/m2. The Metformin group, compared to the Diet group, had OR=3.1 (95% CI:1.13 to 8.25) for caesarean section birth (LSCS) compared to normal vaginal birth mode with no longer such a significant association after controlling for the number of their elective LSCS. The insulin treated group had the highest number of small for gestational age neonates (20%, p<0.05) with neonatal hypoglycaemia (25%, p< 0.05). Fasting glucose value on oral GTT (glucose tolerance test) was the strongest predictor for a pharmacological intervention requirement with OR = 2.77 (95CI%: 1.16 to 6.61), followed by timing of OGTT with OR=0.90 (95% CI: 0.83 to 0.97) and previous pregnancy loss with OR=0.28 (95% CI:0.10 to 0.74).InterpretationThese data suggest that metformin may be a safe alternative treatment to insulin treatment in GDM. Raised fasting glucose on oral GTT was the strongest indicator that GDM women with BMI < 35 kg/m2 may require pharmacological therapy. Further studies are needed to identify the most effective and safe management of gestational diabetes within the public hospital setting.Australian New Zealand Clinical Trial Registry ANZCTR Trial IdACTRN12620000397910. |
| first_indexed | 2024-04-10T19:35:51Z |
| format | Article |
| id | doaj.art-b196cae175c74566911b7f7a3a12d72f |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-04-10T19:35:51Z |
| publishDate | 2023-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-b196cae175c74566911b7f7a3a12d72f2023-01-30T05:32:47ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-01-011410.3389/fendo.2023.11191341119134Predictors for pharmacological therapy and perinatal outcomes with metformin treatment in women with gestational diabetesMalgorzata M. Brzozowska0Malgorzata M. Brzozowska1Malgorzata M. Brzozowska2Anita Puvanendran3Dana Bliuc4Dana Bliuc5Andrew Zuschmann6Andrew Zuschmann7Agata K. Piotrowicz8Agata K. Piotrowicz9Anthony O’Sullivan10Anthony O’Sullivan11The Sutherland Hospital, Endocrinology, Sydney, NSW, AustraliaUNSW Sydney, Faculty of Medicine, Sydney, NSW, AustraliaGarvan Institute of Medical Research, Healthy Ageing Theme, Sydney, NSW, AustraliaThe Sutherland Hospital, Endocrinology, Sydney, NSW, AustraliaUNSW Sydney, Faculty of Medicine, Sydney, NSW, AustraliaGarvan Institute of Medical Research, Healthy Ageing Theme, Sydney, NSW, AustraliaThe Sutherland Hospital, Endocrinology, Sydney, NSW, AustraliaUNSW Sydney, Faculty of Medicine, Sydney, NSW, AustraliaLaunceston General Hospital, Endocrinology, Launceston, TAS, AustraliaFaculty of Medicine, The University of Sydney, Sydney, NSW, AustraliaUNSW Sydney, Faculty of Medicine, Sydney, NSW, AustraliaSt. George Hospital, Endocrinology, Sydney, NSW, AustraliaBackgroundThe prevalence of gestational diabetes mellitus (GDM) has been increasing in Australia and worldwide. The study aims were to examine, in comparison with dietary intervention, perinatal outcomes for women with gestational diabetes who were attending a single hospital clinic and to identify predictors for their pharmacological GDM treatment.MethodsA prospective, observational study of women with GDM, treated with “Diet, N= 50”, “Metformin, N = 35”, “Metformin and Insulin, N = 46” or “Insulin, N = 20”.FindingsThe mean BMI for the whole cohort was 25.8 ± 4.7 kg/m2. The Metformin group, compared to the Diet group, had OR=3.1 (95% CI:1.13 to 8.25) for caesarean section birth (LSCS) compared to normal vaginal birth mode with no longer such a significant association after controlling for the number of their elective LSCS. The insulin treated group had the highest number of small for gestational age neonates (20%, p<0.05) with neonatal hypoglycaemia (25%, p< 0.05). Fasting glucose value on oral GTT (glucose tolerance test) was the strongest predictor for a pharmacological intervention requirement with OR = 2.77 (95CI%: 1.16 to 6.61), followed by timing of OGTT with OR=0.90 (95% CI: 0.83 to 0.97) and previous pregnancy loss with OR=0.28 (95% CI:0.10 to 0.74).InterpretationThese data suggest that metformin may be a safe alternative treatment to insulin treatment in GDM. Raised fasting glucose on oral GTT was the strongest indicator that GDM women with BMI < 35 kg/m2 may require pharmacological therapy. Further studies are needed to identify the most effective and safe management of gestational diabetes within the public hospital setting.Australian New Zealand Clinical Trial Registry ANZCTR Trial IdACTRN12620000397910.https://www.frontiersin.org/articles/10.3389/fendo.2023.1119134/fullgestational diabetes mellitusdietary interventionperinatal outcomesmetformintreatment predictors |
| spellingShingle | Malgorzata M. Brzozowska Malgorzata M. Brzozowska Malgorzata M. Brzozowska Anita Puvanendran Dana Bliuc Dana Bliuc Andrew Zuschmann Andrew Zuschmann Agata K. Piotrowicz Agata K. Piotrowicz Anthony O’Sullivan Anthony O’Sullivan Predictors for pharmacological therapy and perinatal outcomes with metformin treatment in women with gestational diabetes Frontiers in Endocrinology gestational diabetes mellitus dietary intervention perinatal outcomes metformin treatment predictors |
| title | Predictors for pharmacological therapy and perinatal outcomes with metformin treatment in women with gestational diabetes |
| title_full | Predictors for pharmacological therapy and perinatal outcomes with metformin treatment in women with gestational diabetes |
| title_fullStr | Predictors for pharmacological therapy and perinatal outcomes with metformin treatment in women with gestational diabetes |
| title_full_unstemmed | Predictors for pharmacological therapy and perinatal outcomes with metformin treatment in women with gestational diabetes |
| title_short | Predictors for pharmacological therapy and perinatal outcomes with metformin treatment in women with gestational diabetes |
| title_sort | predictors for pharmacological therapy and perinatal outcomes with metformin treatment in women with gestational diabetes |
| topic | gestational diabetes mellitus dietary intervention perinatal outcomes metformin treatment predictors |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1119134/full |
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