Hope for pregnant women with gestational diabetes - Study

A new study is offering hope for pregnant women for safe and effective gestational diabetes treatment.

Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don't already have diabetes.

Researchers have taken a significant step forward in the management of gestational diabetes mellitus after a clinical trial involving pregnant women provided new hope for expectant mothers suffering from the condition.

The study from the University of Galway and published in the Journal of American Medical Association-JAMA reduces concerns over metformin drugs for mothers and babies.

Gestational diabetes is a global health issue affecting almost three million pregnant women worldwide every year.

In addition, low and middle-income countries including Kenya bear a significant burden of gestational diabetes cases.

Professor Fidelma Dunne, Professor of Medicine at the University of Galway said gestational diabetes is a condition characterised by elevated blood sugar levels during pregnancy, posing increased health risks for both mothers and their babies.

Dunne said the study found out that women assigned to metformin were 25 per cent 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 more than 60 years. Fasting and post-meal sugar values in the mother were significantly lower in the metformin-exposed group at weeks 32 and 38,” she said.

The study showed that 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.

She further added that 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 4kgs.

“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,” Dunne said.  

The study also revealed no differences in adverse neonatal outcomes, including the need for intensive care treatment for newborns, 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 Dunne said: “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 pursuit of a safe and effective treatment option, we explored an alternative approach – administering the drug metformin. A previous trial compared metformin to insulin and found it to be effective, yet concerns remained, especially regarding preterm birth and infant size.” 

Dunne said traditionally, gestational diabetes has been managed initially through dietary advice and exercise, with insulin introduced if sugar levels remain sub-optimal.

“While effective in reducing poor pregnancy outcomes, insulin use is associated with challenges, including low sugars in both the mother and infant which may require neonatal intensive care, excess weight gain for mothers, and higher caesarean birth rates,” she said.

She added that there is a greater risk of high blood pressure and preeclampsia for mothers with gestational diabetes.

Babies born to mothers with gestational diabetes face their own set of risks, such as excessive weight at birth, birth injuries, respiratory difficulties and low sugar levels after delivery potentially requiring admission to neonatal intensive care.

Gestational diabetes also increases the lifetime risk of diabetes for these mothers and their children. In addition, mothers have an elevated lifetime risk of cardiovascular disease.

“The results from the EMERGE study are a significant step forward for women with gestational diabetes," Dunne said.

"Metformin has emerged as an effective alternative for managing gestational diabetes, offering new hope for expectant mothers and healthcare providers worldwide."