Comparison of Diet, Metformin and Insulin in the Treatment of Gestational Diabetes Mellitus

Objective: The aim of the study was to compare maternal and neonatal outcomes in patients with gestational diabetes mellitus (GDM) treated with metformin versus those with insulin, or diet alone. Material and methods: The study included 24 GDM women treated with metformin, 21 treated with insulin, and 17 women only on diet. All patients were from Outpatient Department of Endocrinology in the period from May, 2008 to October, 2010. Results: The three groups were comparable with respect to age, pre-pregnancy body mass index (BMI), weight gain during pregnancy, gestational week at enrolment, smoking cigarettes and positive family history for diabetes. Mean glycosylated haemoglobin (HbA1c) at 37 gestation week was lower in diet and metformin groups than insulin group (4,5±0,9, 5,3±0,7, and 6,1± 1,3 %, respectively, p< 0,01). Postprandial glycaemia (PPG) statistically significant differed in diet from metformin group (6,2±2,1 v.s. 7,5±1,1 mmol/L, p< 0,05) and in diet as to insulin group (6,2±2,1 v.s. 8,3±2,3 mmol/L, p< 0,01). There were statistically significant difference in mean gestational age at delivery, between the three (diet, metformin and insulin) groups (39,1±2,2; 38,7±1,6 and 37,3±2,4 gestation week, respectively, p< 0,05). The incidence of neonatal hypoglycemia was higher in the insulin group (52,4%) than in the metformin (33,3%) and diet group (17,6%), but there was statistically difference between insulin and diet group (p=0,04). No differences between the groups were observed in mode of delivery, birth weight, and incidence for large or small for gestational age. Conclusion: Metformin is effective, easy and safe in controlling GDM. Author Keywords: Gestational diabetes mellitus, metformin, insulin, glycaemia

Effect of lipid parameters on fetal growth in type 2 diabetes mellitus and gestational diabetes mellitus pregnancies

Background: During pregnancy,complex changes occur in lipid profiles. The aim of the study was to evaluate the effect of lipid parameters on fetal growth in type 2 diabetes mellitus (D.M) and gestational diabetes mellitus (GDM) pregnancies. Material and methods: In forty three type 2D.M. and two hundred GDM women pregnancies were analyzed: age, body mass index (BMI), lipid parameters, HbA1c in first, second and third trimester of pregnancy, preeclampsia, and baby birth weight. Results: D.M. tip 2 and GDM group were statistically significant different in the following variables: total lipids, triglycerides, total cholesterol, BMI, age, baby birth weight, and incidence of SGA (9.4±2,3 vs. 11,0±2,3mmol/L, 2,4±1,4 vs. 3,4±1,6mmol/L, 5,5±1,2 vs. 6,4±1,4mmol/L, 30,6±5,4 vs. 26,9±5,2 kg/m2, 34±7,8 vs. 31,5±5,6 years, 3183±972 vs. 3533±699 g., 20% vs. 7,5%, respectively, p<0,05). Statistically significant correlations were found between triglycerides and HbA1c (r=0,18, p<0,05), HDL-C and HbA1c (r=-0,19, p<0,05), HDL-C and large for gestational age (LGA) (r=-0,17, p<0,05), small for gestational age (SGA) and Hba1c (r=0,29, p<0,05). LinearmultipleregressionanalysisdemonstratedthatLDL-C,triglycerides, and total cholesterol were independent predictors of LGA (p<0,05). Conclusion:LDL-C and triglycerides are predictors for macrosomia in type 2 D.M and GDM pregnancies.Thus, with good regulation of lipid profile we can avoid macrosomia from type 2 D.M and GDM pregnancies. Key words: lipid parameters, gestational diabetes mellitus, type 2 diabetes mellitus, macrosomia

Prevalence of thyroid dysfunction and autoimmunity in pregnant women with gestational and diabetes type 1

Abs t r a c t: Objective: The aim of the present study was to determine the prevalence of abnormal thyroid function and antithyroid antibodies during pregnancy in women with diabetes type 1 and gestational diabetes mellitus (GDM). Methods: The study group included 83 pregnant women who attended the Outpatient Department of the Endocrinology, Diabetes and Metabolic Disorders Clinic in the period from 05.2009 to 11.2009. The one hundred-g. oral glucose tolerance test (OGTT) was conducted on the pregnant women except for women with diabetes type 1. Thyroid functions were evaluated in all the pregnant women. After routine screening for GDM, thirty of the pregnant women were healthy and GDM was diagnosed in forty of them. The rest, thirteen women, had diabetes type 1. Results: The women who developed GDM showed a mean free thyroxin concentration (fT4) significantly lower than that observed in the healthy pregnant women and women with diabetes type 1. Among the pregnant women with GDM, 10 women or 25% had fT4 concentrations below the lower cut-off with normal thyroidstimulating hormone concentrations (TSH). A statistically significant difference was found in the prevalence of antithyroid antibodies (anti-TPO) between the (30%) women with diabetes type 1 and (10%) healthy pregnant women (p < 0.05). In the women positive for anti-TPO, TSH was significantly higher (p < 0.05). Conclusion: The significantly higher prevalence of hypothyroxinemia in GDM pregnancies and anti-TPO titres in pregnancies with diabetes type 1, than in healthy pregnant women warrants routine screening for thyroid abnormalities in these groups of pregnant women. Key words: pregnancy, gestational diabetes, diabetes type 1, thyroid function, OGTT

Association between Foetal Growth and Different Maternal Metabolic Characteristics in Women with Gestational Diabetes Mellitus

Abstract: Objective: The aim of the study was to investigate the association between foetal growth and different maternal metabolic characteristics in women with gestational diabetes mellitus (GDM). Methods: The study group included 200 consecutive pregnant women who attended the Endocrinology, Diabetes and Metabolic Disorders Outpatient Department in the period from 02.2006 to 02.2009 with singleton pregnancy and GDM diagnosed following ADA criteria. The following parameters were studied: pre-pregnancy maternal body mass index (BMI), 3-hours 100g oral glucose tolerance test (OGTT) results, glycosylated haemoglobin (HbA1c), total lipids (TL), total cholesterol (TH), triglycerides (TG), HDL- and LDL-cholesterol levels at admission. Neonatal birth weight and the prevalence of being large for gestational age (LGA) was an end-point. Results: We found a significant association between birth weight and pre-pregnancy BMI, HDL-C and birth weight of a large child born previously. Birth weight of a large child born previously was the strongest independent predictor for LGA. The prevalence of LGA (from 27% to 80%) was related to a number of altered maternal characteristics. Conclusion: Pre-pregnancy BMI, HDL-C and birth weight of a large child born previously are the independent predictors for LGA, but results of glucose levels during OGTT are not useful in the prediction of LGA in GDM pregnancies. Probably morefactors and other maternal metabolic parameters than glucose levels during OGTT are responsible for the risk of LGA. Key words: gestational diabetes, LGA, macrosomia, maternal characteristics, OGTT

Gestational Diabetes Mellitus – The Impact оf Maternal Body Mass Index аnd Glycaemic Control оn Baby’s Birth Weight

Abstract: Objectives. To asses the influence of the maternal BMI and glycaemic control in women with GDM on the baby's birth weight (BW). Material and methods: We analysed 180 women with GDM. Macrosomia has been defined as BW > 4000 gm, small for gestational age < 2700 gm and appropriate for gestational age between both. According to the baby´s BW the pregnant women were divided into three groups: group 1 (G1) with BW < 2700 gm (n = 26); group 2 (G2) with BW between 2700 to 4000 gm (n = 117), and group 3 (G3) with BW > 4000 gm (n = 37). We also analysed BMI (kg/m²), HbA1c (%), PPG (mmol/L) and time of delivery (WG). Results: Comparisons between G1 and G2 showed: BMI (30.7 ± 5 & 31 ± 5.2; p < 0.7), HbA1c (6.4 ± 0.8 & 5.1 ± 0.8, p < 0.002), PPG (8.2 ± 1.7 & 6.9 ± 1.5, p < 0.02), time of delivery (35.2 ± 3.8 & 38.6 ± 1.5, p < 0.0001) and BW (2289 ± 504 & 3474 ± 334, p < 0.0001). Comparisons between G2 and G3 showed: BMI (31 ± 5. 2 & 33.4 ± 6.1; p < 0.02), HbA1c (5.2 ± 1.1 & 6.4 ± 2.3, p < 0.02), PPG (6.9 ± 1.5 & 8.2 ± 1.9, p < 0.02), time of delivery (38.6 ± 1.5 & 39.3 ± 1.4, p < 0.01) and BW (3474 ± 334 & 4431 ± 302, p < 0.0001). Comparisons between G1 and G3 showed the difference at delivery time and the baby's BW (p < 0.0001). Conclusions: Maternal obesity and PPG contribute to macrosomia and also PPG to SGE. Key words: gestational diabetes, large for gestational age, small for gestational age, birth weight, postprandial glycaemia

Maternal 75 g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus

Objective: Our goal was to investigate the effects of glucose levels from 75-g oral glucose tolerance test (OGTT) on large for gestational age (LGA) newborns in women with gestational diabetes mellitus (GDM). Material and methods: A prospective study was undertaken in Outpatient Department of Clinics for Endocrinology, Diabetes and Metabolic Disorders. One hundred and eighteen pregnant women were prospectively screened for GDM between 24 and 28 weeks of pregnancy. Results: From 118 pregnancies, 78 (66.1%) women were with GDM, and 40 (33.9%) without GDM. Twenty-one (30.4%) of the neonates in the GDM group were LGA (adjusted weight at or above the 90th percentile). This proportion significantly differ from the proportion (5.5%) for the control group (P<0.01). There were significant correlations between LGA from GDM pregnancies with fasting, and 1-h OGTT plasma glucose levels (r=0.46 and 0.23 respectively, P<0.05). Gestation week of delivery and fasting glucose levels were independent predictors for LGA (β=0.58 and β=0.37 respectively, P<0.001). Areas under the receiver operator characteristic curve (AUC) were compared for the prediction of LGA. The AUC were: 0.782 (0.685–0.861) for fasting, 0.719 (0.607–0.815) for 1-h, and 0.51 (0.392–0.626) for 2-h OGTT plasma glucose levels. Conclusion: Fasting and 1-h plasma glucose levels from OGTT may predict LGA babies in GDM pregnancies. Key Words: gestational diabetes, oral glucose tolerance test (OGTT), large for gestational age