No abstract

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.

I read with interest the article 'Hormonal contraception and mood disorders', but noted that it overlooked the 4 mg drospirenone 24/4 progestogen-only pill (Slinda). 1 The article also did not consider the 20 microgram ethinylestradiol/3 mg drospirenone preparation which has an indication for treatment of premenstrual dysphoric disorder.Perhaps the authors might consider that the benefits shown in their pilot study may be due to a 24/4 preparation (also noted in the studies referenced in reducing pill-free interval) as well as the active ingredient?