Treatment of Early Gestational Glucose Intolerance with Metformin reduces Primary neonatal outcomes in hospital-based Cohort

Abstract

Background: Early detection of dyglycemia during I^st Trimester specially during 8-10 weeks can help us to Prevent Gestational diabetes mellitus in later period of pregnancy. A 2-hour PPBG ≥110 mg/dL at week 8-10 weeks screening and early treatment with Medical Nutrition Therapy & Metformin may mitigate primary neonatal complications. Objective: To understand the efficacy of Medical Nutrition therapy with metformin on primary neonatal outcomes in early glucose intolerance (PPBG) ≥110 mg/dL at 8-10 Weeks of gestation; and to compare it with Medical Nutrition therapy only. The prevention of Gestational Diabetes Mellitus by 32 weeks in MNT and Metformin Group compare to MNT only. Method: A Cohort study based on pregnant women with Post Prandial Blood Glucose (PPBG) of ≥110 mg/dl during 8-10 weeks of gestational randomised in two group; one group received MNT and low does Metformin 250 mg two times a day and other group received MNT only which were followed till delivery. Results: The mean postprandial blood glucose (PPBG) levels were significantly lower in the Metformin MNT group compared to the MNT group at 16 weeks (110.74 vs. 118.23), 24 weeks (109.54 vs. 117.78), and 32 weeks (112.8 vs. 118.8), with P-values ≤0.001. Additionally, the primary adverse neonatal composite outcomes were significantly higher in the MNT group (55 cases, 52.3%) compared to the Metformin-MNT group (35 cases, 37.6%) with P ≤ 0.038. The MNT group also reported 20 spontaneous abortions (16%) and 12 stillbirths (9.6%), while the Metformin group reported none. Conclusion: It is our responsibility to prevent fetal hyperinsulinemia by ensuring that maternal 2-hour postprandial blood glucose (PPBG) levels are below 110 mg/dl by the 10th week of pregnancy. Fetal beta cells typically begin secreting insulin around the 11th week. This underscores the crucial role of maintaining good glycaemic control during pregnancy, not only for preventing gestational diabetes but also for ensuring the health of the fetus.