Gestational diabetes is a kind of diabetes that develops during pregnancy and can result in health problems for both the mother and the baby. Management and therapy often include dietary adjustments, exercise, and, in some cases, insulin or other blood sugar-controlling drugs.
A research experiment involving over 500 pregnant women to treat gestational diabetes revealed what the lead academic termed as a big step forward for women. The study discovered benefits for both mothers and their newborn kids, as well as relieved worries about the drug metformin’s use, such as reduced weight gain for moms, no evidence of an increase in preterm birth, and no changes in bad neonatal outcomes.
Researchers at the University of Galway have taken a big step forward in the management of gestational diabetes mellitus after a clinical trial involving pregnant women gave expectant moms suffering from the condition new hope. The trial’s findings have been published in JAMA: the Journal of the American Medical Association.
Gestational diabetes is a worldwide health problem that affects over 3 million pregnant women each year. It is a syndrome characterized by high blood sugar levels during pregnancy, offering additional health hazards to both women and their kids.
In our search for a safe and effective treatment option, we investigated an alternative approach: administering metformin. A prior experiment compared metformin to insulin and found it to be helpful, although there were still concerns, particularly for preterm birth and infant size.
Professor Fidelma Dunne
Professor Fidelma Dunne, Professor of Medicine at University of Galway and Consultant Endocrinologist at Saolta University Health Care Group, managed the EMERGE, randomised, placebo-controlled trial, involving more than 500 pregnant women.
It found:
- Women assigned to metformin were 25% less likely to need insulin, and when insulin was necessary, it was started later in the pregnancy. Metformin is used routinely in the treatment of Type 2 Diabetes and has been widely available for over 60 years.
- Fasting and post-meal sugar values in the mother were significantly lower in the metformin exposed group at weeks 32 and 38.
- Women receiving metformin gained less weight throughout the trial and maintained this weight difference at the 12-week post-delivery visit.
- Importantly, delivery occurred at the same mean gestational age (39.1 weeks) in both groups. There was no evidence of any increase in preterm birth (defined as birth before 37 weeks) among those who received metformin.
- Infants born to mothers who received metformin weighed, on average, 113g less at birth, with significantly fewer infants classified as large at birth, or weighing over 4kg (8lbs 8ounces).
- While there was a slight reduction in infant length (0.7cm), there were no other significant differences in baby measurements.
- There were slightly more babies who were small at birth but this did not reach statistical significance.
The study also revealed no differences in adverse neonatal outcomes, including the need for intensive care treatment for new-borns, respiratory support, jaundice, congenital anomalies, birth injuries or low sugar levels. Additionally there were no variations in rates of labour induction, caesarean delivery, maternal haemorrhage, infection or blood pressure issues during or after birth.
Professor Fidelma Dunne presented the results at the 59th Annual Meeting of the European Association for the Study of Diabetes in Hamburg, Germany.
Professor Dunne went on to say: “While there is convincing evidence that improved sugar control is associated with improved pregnancy outcomes, there was uncertainty about the optimal management approach following a diagnosis of gestational diabetes.”
“In our search for a safe and effective treatment option, we investigated an alternative approach: administering metformin. A prior experiment compared metformin to insulin and found it to be helpful, although there were still concerns, particularly for preterm birth and infant size.”
To address concerns comprehensively, the team at University of Galway conducted a ground-breaking placebo-controlled-trial, filling a critical gap in the gestational diabetes treatment landscape.
- 535 pregnant women took part, with 268 receiving metformin and 267 a placebo.
- 98% of women remained in the trial until delivery, with 88% completing the 12-week post-delivery follow up assessment.
- Only 4.9% of women discontinued medication due to side effects, highlighting the safety of the interventions.
“Traditionally, gestational diabetes has been managed initially through dietary advice and exercise, with insulin introduced if sugar levels remain suboptimal,” said Professor Dunne. While insulin is useful in lowering poor pregnancy outcomes, it is associated with complications such as low blood sugars in both the mother and newborn, which may necessitate neonatal intensive care, excess weight gain in mothers, and greater cesarean delivery rates. Mothers with gestational diabetes are also more likely to have high blood pressure and preeclampsia.”
“Babies born to mothers with gestational diabetes face unique risks, including excessive birth weight, birth injuries, respiratory difficulties, and low sugar levels after delivery, which may necessitate admission to neonatal intensive care.” Gestational diabetes raises the risk of diabetes for these moms and their children for the rest of their lives. Furthermore, moms have a higher lifelong risk of cardiovascular disease. Furthermore, low- and middle-income countries carry a disproportionate share of the burden of gestational diabetes cases.”
