Neonatal Outcomes in Case of Euglycemic Control in Gestational Diabetes using Insulin versus Metformin. Randomized Controlled Trial

Abstract

Gestational diabetes mellitus (GDM) is a major global public health issue, with prevalence increasing in recent years due to the epidemic of obesity and type 2 diabetes. GDM is defined as a condition in which a woman without diabetes develops the glucose intolerance resulting in hyperglycemia of variable degree during pregnancy. Risk factors of developing GDM include being overweight, polycystic ovary syndrome, maternal age, and a family history with type 2 diabetes. GDM generally exhibit no symptoms, but it increases the risk of preeclampsia, depression, and the incidence of cesarean section. Moreover, children born to mothers with badly treated GDM are at higher risk of LGA, hypoglycemia, and jaundice or at increased risk of being overweight and developing type 2 diabetes. So the management of GDM is primarily aimed at glycemic control to reduce the incidence of adverse pregnancy outcomes. Insulin therapy is the most validated treatment option when medical nutrition therapy fails to achieve the target glycemic control. Despite emerging evidence supporting the use of glyburide or metformin in the management of GDM, many guidelines continue to recommend insulin as the first-line therapy.