الفهرس 
GESTATIONAL DIABETESOnly 14 pages are availabe for public view
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Abstract
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SUMMARY
estational diabetes mellitus (GDM) is among the most frequent and most serious complications following pregnancy. In Egypt, there are approximately 2 million deliveries per year, therefore assuming a GDM incidence of at least 5% and a 50% rate of GDM women ending up on insulin, the rate of Egyptian GDM women needing insulin would be approximately 50 000 per year, causing a huge medical and economic burden.
Fetal and neonatal complication of GDM including intrauterine fetal demise, congenital anomaly, fetal macrosomia, birth traumas, hypoglycemia, hyperbilirubinemia, respiratory distress, cardiomyopathy, hypocalcemia, prematurity, and pulmonary hyaline membrane disease. Further complications that may arise from GDM in later stages of childhood include metabolic syndrome and metabolic disorders, such as obesity, hypertension, dyslipidemia, and glucose intolerance.
Maternal short‐term complications of GDM include increased chance of cesarean section, hyperglycemia crisis, urinary tract infections, and preeclampsia. Moreover, long‐term complications include predisposition to developing type 2 diabetes as well as cardiovascular disorders such as hyperlipidemia and hypertension.
This study aimed to assess the efficacy of metformin in controlling maternal blood glucose level compared to insulin in women with GDM.
During this study, 138 patients were assessed for eligibility and 100 patients were included in the study (50 in each group). Of all eligible patients, 32 patients were excluded from the study based on the inclusion criteria and 6 patients refused to participate in of the study.
Ultimately, the analysis was based on the data of 100 patients who diagnosed with GDM and accepted to participate in the study.
Our results revealed that nine (18 %) of 50 women in metformin group required supplemental insulin for adequate glycemic control.
Regarding to the glycemic control, there was no significant difference in mean glucose levels at enrollment time before treatment between the two groups as fasting glucose levels were 139.1±11.9 mg/dl in metformin treated group versus 140.4±12.7 mg/dl in insulin treated group and 2-hours postprandial glucose levels were 193.2±29.2 in metformin treated group versus 194.9±31.5 mg/dl in insulin treated group.
However, after introduction of the drugs, Fasting blood glucose after one week and at the last week after randomization were lower in metformin group, but the differences were significant only at last week. Fasting blood glucose reductions were higher in metformin group, but the differences were significant only at last week.
Regarding mode of delivery, Cesarean delivery was non-significantly less frequent in Metformin group. 48% of patients in metformin group underwent cesarean delivery versus 52% in insulin group.
Regarding neonatal complications, there were no significant differences between the two groups in fetal growth restrictions, fetal macrosomia, neonatal hypoglycemia, or congenital malformations.
We concluded that metformin as an oral anti-diabetic drug was found to be safe and effective in controlling GDM with comparable maternal and neonatal outcomes to insulin therapy and has the following beneficial effect of reduction of rate of shoulder dystocia, reduction of rate of cesarean section, reduction of rate of macrosomia more than insulin, low risk of neonatal hypoglycemia and less maternal weight gain.
Metformin is recommended as an alternative to insulin therapy in control of blood glucose in patients with GDM when diet therapy and exercise fail to reduce blood glucose values sufficiently.