Effects of Glycaemic Control and Metformin Treatment during Pregnancy

This report examines glycaemic control during pregnancy, a critical issue due to the rising prevalence of diabetes mellitus. It explores the impact of poor glycaemic control on both maternal and foetal outcomes, highlighting risks like preterm delivery and macrosomia. The report focuses on the comparison between insulin and metformin as treatment options for gestational diabetes. While insulin is the standard, metformin is considered as an alternative due to its lack of association with weight gain and hypoglycaemia. However, it crosses the placenta, raising concerns about foetal development. The report discusses a New England Journal of Medicine study that compared the neonatal complications in women taking insulin alone versus those on insulin and metformin, finding no significant differences in neonatal complications. The report also reviews the need for tighter glycaemic control before fertilization for women with pre-existing diabetes and gestational diabetes. References are provided for further reading.

Glycaemic Control during pregnancy
The number of diabetes mellitus patients worldwide has risen consistently [1], and diabetes
mellitus has turned into a worldwide medical issue. Partly because of the change in criteria of
diagnosis for gestational diabetes mellitus, this pattern is additionally found in ladies of
childbearing age. It has as of late turned out to be obvious that mild unusual glucose
resilience increases the occurrence of perinatal maternal new-born child complications, thus
changing the definition and criteria for diagnosis for gestational diabetes mellitus [1].
Although the most common and preferred treatment for gestational diabetes is insulin
injection, it may be associated with weight gain or hypoglycaemia (low blood sugar).
Metformin is an alternative to insulin - it is not known to be associated with weight gain or
hypoglycaemia. Metformin increases insulin sensitivity (it is believed that metformin
activates AMP kinase, which helps activate glucose absorption when there is low energy in
cellular energy regulation). However, metformin crosses the placenta, which can adversely
affect fatal development. For both mother and baby, insulin is safe [2].
The results were generally favourable, but studies were not sufficient to confirm this. A “New
England Journal of Medicine” study compared the neonatal complications in women taking
insulin only to women taking insulin and metformin. No differences in the number of
neonatal complications in the two groups were observed. The women taking insulin and
metformin actually got less weight than women only took insulin [2].
Poor glycaemic control amid pregnancy is related with unfavourable material and deadly
outcomes like shortened gestational period, increased risk of abortion, increased likelihood of
surgical delivery, hypoglycaemia, macrosomia etc. Particularly at risk are those who already
have diabetes who would benefit from previous diabetic hearing and tighter glycaemic
control before fertilization [3].
References
1. Hashimoto K. Indicators of glycemic control in patients with gestational diabetes mellitus
and pregnant women with diabetes mellitus. World Journal of Diabetes. 2015;6(8):1045.
2. Rowan J, Hague W, Gao W, Battin M, Moore M. Metformin Versus Insulin for the
Treatment of Gestational Diabetes. Obstetrical & Gynecological Survey. 2008;63(10):616-
618.
3. Almalki M, Buhary B, Almohareb O, Aljohani N, Alzahrani S, Elkaissi S et al. Glycemic
control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective
study. Indian Journal of Endocrinology and Metabolism. 2016;20(4):481.