The impact of metformin therapy for gestational diabetes on fetal growth in women with risk factors for fetal growth restriction- a registry-based study from Qatar

Background Gestational diabetes mellitus (GDM) has been the most prevalent medical condition in pregnancy, often managed by a multidisciplinary team. Numerous studies have demonstrated that metformin therapy for GDM offers advantages including a reduced risk of macrosomia, neonatal hypoglycemia, and admission to neonatal intensive care units (NICU). However, its use has been linked to fetal growth restriction (FGR) as well. Our study aims to investigate the effect of metformin when given to women with GDM and additional risk factors for FGR like hypertension, inherited or acquired thrombophilia, anemia, and autoimmune disorders such as anti-phospholipid syndrome, lupus erythematosus. Methods Women who had singleton live births and diagnosed with gestational diabetes (GDM) were selected. They were divided into two groups based on the presence of additional risk factors for FGR during their pregnancies. Each of these groups were further divided based on use of metformin for the management of GDM- resulting in four comparison groups. The outcomes were birthweight (BW), birthweight centiles, small for date baby (SFD), low birth weight (LBW), preterm birth (PTB), large for date baby (LGA), macrosomia, admission to NICU and mode of delivery. Results Of the 4,290 women included in the study, 18% had risk factors for FGR, 27% of whom took metformin for GDM. Among the women with no risk factors, 29% took metformin. In women who were taking metformin, those having risk factors had lower mean BW (3015± 608.1 gms vs 3179.2± 506.2 grams; p Conclusion The results of this study suggest that in women with additional risk factors for FGR, the concurrent use of metformin significantly decreases the birthweight and increases the risk for LBW, SFD, PTB and admission to NICU. The use of metformin in these women should be judicious and increased fetal surveillance during pregnancy is warranted.</p

Prophylactic Sildenafil in Preterm Infants at Risk of Bronchopulmonary Dysplasia: A Pilot Randomized, Double-Blinded, Placebo-Controlled Trial

Bronchopulmonary dysplasia (BPD) is the need for oxygen therapy at 36 weeks postmenstrual age (PMA). Sildenafil has been shown to enhance the lung alveolarization and vascularization in newborn animal models after lung injury and has possible therapeutic potential for the prevention of BPD. To perform a proof-of-concept, Phase II, pilot randomized, double-blind, clinical trial to study the efficacy of sildenafil in preventing BPD, in postnatal (Other Information Published in: Clinical Drug Investigation License: https://creativecommons.org/licenses/by-nc/4.0See article on publisher's website: http://dx.doi.org/10.1007/s40261-019-00834-0</p

Impact of timing and severity of COVID-19 infection in pregnancy on intrauterine fetal growth- a registry-based study from Doha-Qatar

Background The novel coronavirus disease (COVID-19) pandemic has impacted pregnant women, increasing maternal and neonatal morbidity. The placenta is a potential target for the pathophysiological processes due to the increased thrombotic inflammatory activation and inadequate uteroplacental perfusion and oxygenation, potentially causing intrauterine growth restriction. This study investigates the impact of gestational age at diagnosis of COVID-19 and the presence of symptoms on intrauterine fetal growth in pregnant women. Methods A retrospective review of COVID-19 positive pregnant women in Qatar from March 2020 to March 2021 was conducted. They were divided based on trimester of pregnancy in which they were infected. The outcomes included birthweight, customised fetal birthweight centiles, small for gestational age (SGA) baby and daily growth increments, compared between the trimesters and between symptomatic and asymptomatic women. Results In our cohort, 218 women (20.5%) were infected in the first trimester, 399 (37.5%) in the second and 446 (42%) in the third. Women in the second trimester were significantly younger and symptomatic. Women infected in the first trimester were least likely to have diabetes. The mean birthweight,risk of SGA (11.5% vs 10% vs 14.6%, p=0.302), and median customized growth centiles (47.6% vs 45.9% vs 46.1%)were similar between the groups.. Symptomatic women had significantly lower mean birthweight (3147 gms vs 3222 gms) and median birthweight centiles (43.9% vs 54.0%)compared to the asymptomatic (p Conclusion This study shows that women with symptomatic disease had lower birth centiles and birth weights. This was regardless of the gestational age at which they were infected. Early symptomatic disease seems to have an impact on fetal growth velocity; however, larger studies are needed to corroborate these findings.</p