Impact of metformin versus dietary interventions on placental morphology in women with gestational diabetes mellitus.

Objective: To evaluate the effects of dietary control and Metformin on placental morphology in women with Gestational Diabetes Mellitus (GDM). Study Design: Clinical study. Setting: Services Hospital Lahore and Shaikh Zayed Hospital Lahore. Period: June 2023 till June 24. Methods: A total of 56 women with GDM were enrolled after providing informed consent. Of these, 28 women with blood sugar levels of 140 mg/dl or less were assigned to Group B (2500-3000 kcal/day diet and 30-minute walks three times a week) and were placed on dietary control. The remaining 28 women with blood sugar levels greater than 140 mg/dl were assigned to Group C, where they were managed with a diet and Metformin (500 mg TDS). A control group (Group A) consisted of 25 healthy pregnant women. Placental tissue samples were collected and analyzed for morphology after delivery. Results: Group B exhibited heavier placentas with more extensive villous immaturity, charangoids, and syncytial knots. In contrast, Group C showed signs of fibrinoid necrosis and calcification. Significant differences in placental and cord widths were observed in Group B compared to Group A, while only cord width differed significantly in Group C compared to Group A in gross morphology. Light microscopy revealed the presence of charangoids, infarction, and syncytial loops in Group B, along with increased villous maturity. Charangoids and syncytial knots were observed in Group B compared to Group C, with minimal differences noted between Group C and Group A in placental width. Conclusion: Metformin demonstrated more favorable effects on placental morphology compared to dietary control, with results comparable to those observed in normal pregnancies.