Neonatal Outcomes in Patients with Gestational Diabetes Mellitus Treated with Metformin: A Retrospective Study in Saudi Arabia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethical Approval
2.2. Study Design
2.3. Diagnosis and Management of GDM
2.4. Subjects
2.5. Data Collection
2.6. Statistical Analysis
3. Results
3.1. Study Population and Demographics
3.2. Glycemic Control
3.3. Neonatal Outcomes
3.4. Multiple Regression Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Maternal Characteristics | Total (234) | Metformin (78) | Insulin (78) | Diet (78) | Metformin vs. Insulin p Value | Metformin vs. Diet Only p Value |
---|---|---|---|---|---|---|
Maternal age (years ± SD) | 33.09 ± 5.57 | 33.88 ± 5.67 | 34.59 ± 5.36 | 30.79 ± 4.97 | 0.426 | 0.002 a |
Maternal BMI (Kg/m2 ± SD) | 33.34 ± 5.47 | 34.29 ± 5.58 | 33.16 ± 5.64 | 32.55 ± 5.12 | 0.214 | 0.044 a |
Parity | 2.67 ± 2.05 | 2.58 ± 1.99 | 3.09 ± 2.28 | 2.32 ± 1.8 | 0.137 | 0.24 |
Diagnosis of GDM (weeks ± SD) | 27.16 ± 4.51 | 26.47 ± 4.62 | 26.84 ± 4.43 | 28.17 ± 4.36 | 0.612 | 0.02 a |
Previous GDM, n (%) | 80 (34.2) | 27 (34.60) | 40 (51.3) | 13 (16.70) | 0.035 a | 0.01 a |
Family history of T2DM, n (%) | 46 (19.7) | 14 (17.90) | 22 (28.20) | 10 (12.80) | 0.128 | 0.375 |
Previous macrosomia, n (%) | 10 (4.3) | 3 (3.80) | 7 (9.00) | 0 | 0.191 | 0.08 |
Previous abortion, n (%) | 92 (39.3) | 32 (41) | 28 (35.90) | 32 (41) | 0.51 | 1 |
Pre-pregnancy HTN, n (%) | 0 | 0 | 0 | 0 | NA b | NA b |
Pregnancy-induced HTN, n (%) | 7 (3) | 4 (5.1) | 3 (3.8) | 0 | 0.699 | 0.043 a |
Pre-eclampsia, n (%) | 5 (2.1) | 3 (3.8) | 2 (2.6) | 0 | 0.649 | 0.08 |
OGTT 0 h (mmol/L ± SD) | 5.34 ± 1.19 | 5.27 ± 0.85 | 5.83 ± 1.65 | 4.94 ± 0.7 | 0.01 a | 0.008 a |
OGTT 1 h (mmol/L ± SD) | 10.87 ± 1.85 | 10.73 ± 1.95 | 11.39 ± 2.07 | 10.54 ± 1.54 | 0.043 a | 0.489 |
OGTT 2 h (mmol/L ± SD) | 9.16 ± 2.11 | 9.42 ± 2.13 | 9.42 ± 2.05 | 8.67 ± 2.07 | 0.991 | 0.027 a |
Gestational age at initiation of pharmacotherapy (weeks ± SD) | 31.46 ± 4.55 | 30.88 ± 4.65 | 32.04 ± 4.4 | NA | 0.114 | NA |
Total daily dose of metformin reached (mg ± SD) | NA | 1166.03 ± 486.61 | NA | NA | NA | NA |
Total daily dose of insulin reached (units ± SD) | NA | NA | 16.88 ± 16.54 | NA | NA | NA |
Average HbA1c before delivery (%) | 6.41 ± 3.7 | 5.7 | 6.44 ± 1.12 | 6.41 ± 4.78 | 0.525 | 0.885 |
Average FBS before delivery (mmol/L ± SD) | 5.27 ± 1 | 5.42 ± 0.73 | 5.54 ± 1.29 | 4.69 ± 0.58 | 0.49 | 0.000 a |
Average 2 h PP before delivery (mmol/L ± SD) | 7.23 ± 1.53 | 7.7 ± 1.38 | 7.53 ± 1.69 | 6.1 ± 0.74 | 0.519 | 0.000 a |
Gestational age at delivery (weeks ± SD) | 38 ± 1.67 | 37.69 ± 2 | 37.6 ± 1.24 | 38.72 ± 1.44 | 0.737 | 0.000 a |
Parameter | Metformin | Insulin | Diet | Overall p Value | Metformin vs. Insulin p Value | Metformin vs. Diet Only p Value |
---|---|---|---|---|---|---|
Preterm birth (%) | 10.30 | 14.10 | 5.10 | 0.168 | 0.463 | 0.229 |
NICU admission (%) | 17.90 | 20.5 | 9 | 0.116 | 0.685 | 0.101 |
Neonatal hypocalcemia (%) | 2.60 | 6.40 | 1.30 | 0.186 | 0.246 | 0.56 |
Neonatal hypoglycemia (%) | 9 | 10.30 | 1.30 | 0.056 | 0.786 | 0.029 a |
Congenital anomaly (%) | 10.30 | 11.50 | 10.30 | 0.956 | 0.797 | 1 |
Birth injury (%) | 0 | 0 | 2.60 | 0.133 | NA b | 0.155 |
Birth weight (g ± SD) | 3139.27 ± 632.59 | 3200.58 ± 454.85 | 3188.26 ± 413.11 | 0.729 | 0.488 | 0.568 |
Perinatal death (%) | 0 | 2.6 | 0 | 0.366 | 0.316 | NA b |
Five-minute APGAR score ± SD | 8.88 ± 0.36 | 8.84 ± 0.84 | 8.99 ± 0.3 | 0.257 | 0.698 | 0.055 |
Macrosomia (%) | 2.60 | 2.60 | 0 | 0.362 | 1 | 0.155 |
Shoulder dystocia (%) | 0 | 1.30 | 1.30 | 0.604 | 0.316 | 0.316 |
Neonatal jaundice/hyperbilirubinemia (%) | 26.9 | 23.10 | 14.1 | 0.134 | 0.579 | 0.047 a |
Respiratory distress (%) | 9 | 12.80 | 1.3 | 0.023 a | 0.441 | 0.029 a |
Large for gestational age (>90th percentile) (%) | 9 | 12.80 | 1.3 | 0.023 a | 0.441 | 0.029 a |
Small for gestational age (<10th percentile) (%) | 3 | 2.1 | 2.6 | 0.835 | 0.548 | 0.772 |
Parameter | Metformin vs. Insulin p Value; Adjusted OR d (95%CI) | Metformin vs. Diet Only p Value; Adjusted OR e (95%CI) |
---|---|---|
Preterm birth | 0.702; 1.25 (0.39–3.98) | 0.304; 2.04 (0.53–7.69) |
NICU admission | 0.465; 1.42 (0.55–3.66) | 0.233; 1.89 (0.66–5.56) |
Neonatal hypocalcemia | 0.871; 0.85 (0.12–6.21) | 0.928; 0.88 (0.05–14.29) |
Neonatal hypoglycemia | 0.852; 1.13 (0.31–4.19) | 0.120; 5.88 (0.63–50) |
Congenital anomaly | 0.774; 0.85 (0.27–2.61) | 0.494; 1.47 (0.48–4.55) |
Birth injury | NA | 0.511; 0.34 (0.01–8.3) |
Birth weight | 0.941; 0.01 | 0.126; −0.13 c |
Perinatal death | 0.177; 3.74 (0.55–25.39) | NA b |
Five-minute APGAR score | 0.641; 0.04 | 0.036 a; −0.18 c |
Macrosomia | 0.81; 1.3 (0.15–11.1) | 0.268; 2.86 (0.44–20) |
Shoulder dystocia | NA | 0.103; 0.08 (0.004–1.67) |
Neonatal jaundice/hyperbilirubinemia | 0.280; 1.55 (0.7–3.45) | 0.140; 1.92 (0.81–4.55) |
Respiratory distress | 0.655; 0.77 (0.24–2.45) | 0.102; 6.25 (0.69–50) |
Large for gestational age (>90th percentile) | 0.706; 0.8 (0.24–2.61) | 0.152; 5.26 (0.54–50) |
Small for gestational age (<10th percentile) | 0.874; 1.1 (0.33–3.73) | 0.575; 1.43 (0.42–4.76) |
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Aburisheh, K.H.; Barhoush, M.M.; Alahmari, A.N.; Altasan, Z.A.; Alharthi, M.H. Neonatal Outcomes in Patients with Gestational Diabetes Mellitus Treated with Metformin: A Retrospective Study in Saudi Arabia. Biomedicines 2024, 12, 2040. https://doi.org/10.3390/biomedicines12092040
Aburisheh KH, Barhoush MM, Alahmari AN, Altasan ZA, Alharthi MH. Neonatal Outcomes in Patients with Gestational Diabetes Mellitus Treated with Metformin: A Retrospective Study in Saudi Arabia. Biomedicines. 2024; 12(9):2040. https://doi.org/10.3390/biomedicines12092040
Chicago/Turabian StyleAburisheh, Khaled H., Mazen M. Barhoush, Abdulaziz N. Alahmari, Ziyad A. Altasan, and Muffarah H. Alharthi. 2024. "Neonatal Outcomes in Patients with Gestational Diabetes Mellitus Treated with Metformin: A Retrospective Study in Saudi Arabia" Biomedicines 12, no. 9: 2040. https://doi.org/10.3390/biomedicines12092040