Maternal and perinatal outcome in patients with gestational diabetes mellitus treated with metformin versus insulin – A comparative study

ABSTRACT Background: The aim of the present study is to determine the effectiveness of metformin, a convenient alternative to insulin, in management of gestational diabetes mellitus and to determine the effect of metformin and insulin on maternal and neonatal outcomes. Methods: A prospective observational study was done, where 304 pregnant women who had impaired oral glucose tolerance test (120 mg/dl–200 mg/dl) were selected from the outpatient department of Obstetrics and Gynecology. All the pregnant women with gestational diabetes were divided into two groups: Group M, 152 pregnant women with GDM treated with metformin, and Group I, 152 pregnant women with GDM treated with insulin. Results: A statistically increased cesarean section and instrumental delivery and birth weight of neonates among pregnant women of group I ( P- value < 0.0001) was observed. There was a significant increase in number of neonates requiring NICU admission in group I when compared with group M neonates ( P- value 0.028). All the neonatal outcomes such as RDS, P- value 0.001; hypoglycemia, P- value 0.04; hyperbilirubinemia, P- value 0.076; sepsis, P- value 0.047; and birth trauma, P- value 0.032, showed a statistically significant increase in values among group I compared to group M. Conclusions: A statistically significant increase in weight gain during pregnancy, cesarean section rate, instrumental deliveries, NICU admissions, hyperbilirubinemia, RDS, sepsis, birth trauma, birth weight of neonates, and neonatal hypoglycemia among group insulin compared to metformin group.