Metformin-treated-GDM has lower risk of macrosomia compared to diet-treated GDM- a retrospective cohort study

Bashir, Mohammed; Aboulfotouh, Mahmoud Elmorsi; Dabbous, Zeinab; Mokhtar, Marwa; Siddique, Mashhood A.; Wahba, Ramy M; Ibrahim, Amin; Brich, S; Konje, Justin C.; Abou‐Samra, Abdul‐Badi

doi:10.1080/14767058.2018.1550480

Cited by 26 publications

(19 citation statements)

References 25 publications

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“…All GDM patients are managed by nutritional therapy for 1-2 weeks. If 20% or more of the self-monitoring blood glucose readings are above the ADA targets (FBG ≤ 5.3 mmol/L, I-hour post prandial ≤ 7.8 mmol/L or 2 h ≤ 6.7 mmol/L), medical therapy is then added 17,18 . Metformin is the first-line medical therapy unless it is contraindicated, unacceptable to the patient, or is not tolerated.…”

Section: Methodsmentioning

confidence: 99%

Screening pregnant women in a high-risk population with WHO-2013 or NICE diagnostic criteria does not affect the prevalence of gestational diabetes

Bashir

Ibrahim

Eltaher

et al. 2021

Sci Rep

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There are currently several diagnostic criteria for gestational diabetes (GDM). Both the WHO -2013 and NICE diagnose GDM based on a single step 75 g OGT; however; each uses different glucose thresholds. Previous studies have shown that the prevalence of GDM using the NICE criteria (GDM-N) is lower than that using the WHO-2013 criteria (GDM-W). Qatar has national diabetes in pregnancy program in which all pregnant women undergo OGTT screening using the WHO-2013 criteria. This study aims to define the prevalence of GDM using both criteria in a high-risk population. This retrospective study included 2000 women who underwent a 75 g (OGTT) between Jan 2016 and Apr 2016 and excluded patients with known pre-conception diabetes, multiple pregnancy, and those who did not complete the OGTT. We then classified the women into GDM-W positive, GDM-N positive but GDM-W negative, and normal glucose tolerance (NGT) population. A total of 1481 women (74%) had NGT using the NICE or the WHO-2013 criteria. The number of patients who met both criteria was 279 subjects (14%) with a good agreement (Kappa coefficient 0.67, p < 0.001). The NICE and the WHO-2013 criteria were discordant in 240 subjects (12% of the cohort); 6.7% met the WHO -2013 criteria only and only 5.3% met the NICE criteria. The frequency of pre-eclampsia, pre-term delivery, Caesarean-section, LGA and neonatal ICU admissions were significantly increased in the GDM-W group. However, the GDM-N positive but GDM-W negative had no increased risk of maternal or fetal complications apart from pregnancy-induced hypertension. The WHO-2013 and the NICE criteria classified a similar proportion of pregnant women, 21.5% and 20.1%, respectively, as having GDM; however, they were concordant in only 14% of the cases. Women who are GDM-N positive but GDM-W negative are not at increased risk of maternal and fetal pregnancy complications, except for pregnancy-induced hypertension. As the NICE criteria are more specific to the UK population, we would recommend the use of the WHO-2013 criteria to diagnose GDM in the MENA region and possibly other regions that do not have the same set-up as the UK.

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Section: Methodsmentioning

confidence: 99%

Screening pregnant women in a high-risk population with WHO-2013 or NICE diagnostic criteria does not affect the prevalence of gestational diabetes

Bashir

Ibrahim

Eltaher

et al. 2021

Sci Rep

Self Cite

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“…The prevalence of GDM varies between 10% and 20% according to the diagnostic criteria, ethnicity, and personal and family history (DeSisto et al, 2014;Chiefari et al, 2017;Bashir et al, 2018). Approximately 1 out of 7 pregnancies is affected (International Diabetes Federation, 2017;Chow et al, 2018).…”

Section: Gestational Diabetesmentioning

confidence: 99%

“…However, metformin has a high percentage of ineffectiveness in the management of glycemia in GDM patients and 46% of women in metformin group needed to incorporate insulin into their treatment (Rowan et al, 2008). A study in a retrospective cohort of Qatar women with GDM observed that metformin in comparison with nutritional therapy, reduces some adverse effects of GDM on pregnancy outcomes, such as maternal weight gain, risk of macrosomia, and neonatal hypoglycemia (Bashir et al, 2018). It is important to note that metformin has been proposed as a safe medication without teratogenic effects (Ainuddin et al, 2015;Jiang et al, 2015;Given et al, 2018).…”

Section: Gestational Diabetesmentioning

confidence: 99%

Metformin during Pregnancy: Effects on Offspring Development and Metabolic Function

et al. 2020

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Maternal obesity during pregnancy and gestational diabetes mellitus (GDM) are both associated with of several postnatal diseases in the offspring, including obesity, early onset hypertension, diabetes mellitus, and reproductive alterations. Metformin is an oral drug that is being evaluated to treat GDM, obesity-associated insulin resistance, and polycystic ovary syndrome (PCOS) during pregnancy. The beneficial effects of metformin on glycemia and pregnancy outcomes place it as a good alternative for its use during pregnancy. In this line of thought, improving the metabolic status of the pregnant mother by using metformin should avoid the consequences of insulin resistance on the offspring's fetal and postnatal development. However, some human and animal studies have shown that metformin during pregnancy could amplify these alterations and be associated with excessive postnatal weight gain and obesity. In this minireview, we discuss not only the clinical and experimental evidence that supports the benefits of using metformin during pregnancy but also the evidence showing a possible negative impact of this drug on the offspring's development.

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“…Noteworthy, metformin is only prescribed when women are failing to achieve glucose targets with diet alone; therefore, glucose levels in this group are higher. Estimates from recent trials suggest that at higher doses metformin can reduce HbA1c by 1-2% (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) mmol/mol) (43), this is promising as it has been reported that a 1 % reduction in HbA1c in women with GDM is associated with improved maternal and offspring outcomes (44).…”

Section: Discussionmentioning

confidence: 99%

Observational assessments of the relationship of dietary and pharmacological treatment on continuous measures of dysglycemia over 24 hours in women with gestational diabetes

Dingena

Holmes

Campbell

et al. 2022

Preprint

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ObjectivesStudies that use continuous glucose monitoring (CGM) to monitor women with gestational diabetes (GDM) highlight the importance of managing dysglycemia over a 24-hour period. However, the effect of current treatment methods on dysglycemia over 24-hrs are currently unknown. This study aimed to characterise CGM metrics over 24-hrs in women with GDM and the moderating effect of treatment strategy.MethodsRetrospective analysis of CGM data from 128 women with GDM in antenatal diabetes clinics. CGM was measured for 7-days between 30-32 weeks gestation. Non-parametric tests were used to evaluate differences of CGM between periods of day (morning, afternoon, evening, and overnight) and between treatment methods (i.e., diet alone or diet+metformin). Exploratory analysis in a subgroup of 34 of participants was performed to investigate the association between self-reported macronutrient intake and glycaemic control.ResultsGlucose levels significantly differed during the day (i.e., morning to evening; P<0.001) and were significantly higher (i.e., mean blood glucose and AUC) and more variable (i.e., SD and CV) than overnight glucose levels. Morning showed the highest amount of variability (CV; 8.4% vs 6.5%, P<0.001 and SD; 0.49 mmol/L vs 0.38 mmol/L, P<0.001). When comparing treatment methods, mean glucose (6.09 vs 5.65 mmol/L; P<0.001) and AUC (8760.8 vs 8115.1 mmol/L.hr; P<0.001) were significantly higher in diet+metformin compared to diet alone. Finally, the exploratory analysis revealed a favourable association between higher protein intake (+1SD or +92 kcal/day) and lower mean glucose (−0.91 mmol/L p, P=0.02) and total AUC (1209.6 mmol/L.h, P=0.021).ConclusionsGlycemia varies considerably across a day, with morning glycemia demonstrating greatest variability. Additionally, our work confirms that individuals assigned to diet+metformin have greater difficulty managing glycemia and results suggest that increased dietary protein may assist with management of dysglycemia. Future work is needed to investigate the benefit of increased protein intake on management of dysglycemia.

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Metformin-treated-GDM has lower risk of macrosomia compared to diet-treated GDM- a retrospective cohort study

Cited by 26 publications

References 25 publications

Screening pregnant women in a high-risk population with WHO-2013 or NICE diagnostic criteria does not affect the prevalence of gestational diabetes

Screening pregnant women in a high-risk population with WHO-2013 or NICE diagnostic criteria does not affect the prevalence of gestational diabetes

Metformin during Pregnancy: Effects on Offspring Development and Metabolic Function

Observational assessments of the relationship of dietary and pharmacological treatment on continuous measures of dysglycemia over 24 hours in women with gestational diabetes

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