Comparison of different treatment modalities in gestational diabetes mellitus and their maternal and fetal outcomes

Abstract

Background: Gestational diabetes mellitus (GDM) is associated with significant maternal and fetal morbidity. Optimal management strategies after failure of lifestyle modification remain debated. Objectives were to compare maternal and fetal outcomes among women with GDM managed with medical nutrition therapy (MNT) alone, MNT with metformin, and MNT with metformin plus insulin. Methods: This prospective observational study was conducted in a tertiary care teaching hospital over 18 months. Ninety pregnant women diagnosed with GDM were enrolled and managed as per institutional protocol and endocrinology consultation. Participants were grouped based on treatment modality: diet alone (n=51), diet plus metformin (n=27), and diet plus metformin with insulin (n=12). Maternal outcomes (mode of delivery, pre-eclampsia, puerperal sepsis, shoulder dystocia) and fetal outcomes (birth weight, NICU admission, congenital malformations, perinatal mortality) were analysed. Appropriate statistical tests were applied with p≤0.05 considered significant. Results: Majority of women (56.7%) were managed with diet alone. Post prandial blood sugar differed significantly across treatment groups (p<0.001). Caesarean section rates increased with treatment intensity (27.5% in diet alone versus 83.3% in insulin group; p=0.004). NICU admissions were significantly higher in the insulin group (41.7%; p=0.027). No statistically significant differences were observed in pre-eclampsia, congenital malformations, or perinatal mortality among groups. Conclusions: Most women with GDM can be effectively managed with medical nutrition therapy alone. Requirement of pharmacotherapy reflects higher glycemic burden and is associated with increased operative deliveries and NICU admissions, without a significant increase in major adverse maternal or fetal outcomes