Endocrine Abstracts

Objective: Though many studies have looked at the neonatal outcomes in patients with gestational diabetes on different medications, there is no consensus on the preferred drug for initiation of therapy. We aim to compare the neonatal outcome in a cohort of patients attending our service, to determine if one modality is superior to the other.

Methods: This study is a prospective observational study from 1-07-2015 to 31-04-2016. The data of all gestational diabetic patients referred to the Joint Diabetic Clinic, in a local secondary Hospital, who required pharmacological intervention were entered into an excel spreadsheet. This included their antenatal, intrapartum and postnatal details. P values calculated with Student’s t-test. Statistical significance if P< 0.05.

Results: The total number of patients studied was 107. There were 58 patients (54%) who were treated with Metformin only, their BMI at booking was 30 kg/m², average HbA1c 5.69%. The average birth weight of the neonates of this group was 3287.78 g and there were 9 (15.51%) Neonatal ICU admissions. 17 patients were commenced on insulin, thier HbA1c was 5.78% and their booking BMI was 32. The average birth weight in this subgroup was 3409.24 g with 2 (11.76%) NICU admissions. 32 (29.90%) of our patients required Metformin and insulin. Their average weight at booking was 35, and thier HbA1c was 5.8%. In this subgroup, the average birth weight was 3494.56 g with 5(15.62%) requiring NICU admission. The least birth weight was observed in the subgroup with Metformin alone (54% of our patients), P<0.4. The subgroups with insulin showed a higher neonatal birth weight. The least NICU admissions were in the insulin only group.

Discussion: The least birth weight was observed in the subgroup with Metformin alone (54% of our patients), with the subgroups with insulin showed a higher neonatal birth weight. However, the least NICU admissions were seen in the insulin only group.

Conclusion: Whether the increase in birth weight seen in patients on insulin, is indicative of uncontrolled blood sugars or due to the direct effect of insulin as shown in some studies, requires further evaluation. Further analysis of the ongoing cohort is needed before we can recommend any one mode of treatment as the preferred choice in our setting.