Neonatal outcomes of gestational diabetes mellitus (GDM) mothers: A cross-sectional study comparing medical nutritional therapy, metformin, and insulin treatments at a tertiary care centre

Abstract

Gestational Diabetes Mellitus (GDM) poses a rising global health challenge, affecting 10-14.3% of pregnant women. This study aimed to investigate and compare neonatal outcomes among mothers with GDM treated with Medical Nutritional Therapy (MNT), metformin, and insulin at a tertiary care center. Understanding the impact of these treatments on neonatal outcomes is crucial for optimal care.Conducted at a tertiary care center in Chennai, India, this cross-sectional study included 160 GDM mothers identified through medical records from December 2021 to December 2023. Inclusion criteria covered women aged 18 and above, experiencing singleton pregnancies, diagnosed with GDM, and maintaining regular follow-up. Data analysis included birth weight, Apgar scores, neonatal hypoglycemia, and preterm birth rates. Multinomial logistic regression determined adjusted odds ratios.The study analyzed the distribution of perinatal factors among 160 neonates, revealing that 41.3% were delivered vaginally, while 58.8% were through cesarean section. The majority were preterm, with 118 being appropriate for gestational age.Neonatal Intensive Care Unit (ICU) admission was noted in 34.4% of cases, while 62.7% did not. Neonatal hypoglycemia was observed in 36.3% of cases, and seizures were present in 19.4%. Apgar scores were low in 23.8% of cases.A multinomial logistic analysis found that the Metformin, Insulin, and Metformin + Insulin groups had significantly higher odds of having a Cesarean section compared to the diet-only group. However, the Metformin group had lower odds of preterm birth, NICU admission, neonatal hypoglycemia, seizures, and AGA. The Metformin group had higher odds of LGA and Apgar score <7 at both the 1st and 5th minutes. No significant differences were found in the odds of preterm birth, NICU admission, or seizures between the diet-only and Metformin groups.This pioneering South Indian study of 160 neonates born to GDM mothers compared different treatment options. Metformin, alone or with insulin, showed comparable neonatal outcomes to insulin. Caution in GDM deliveries is recommended for optimal well-being. The study emphasizes the need for further research considering maternal outcomes as potential confounders to comprehensively understand GDM treatments and neonatal outcomes.