الفهرس 
Gestational Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
The use of antidiabetic drugs to control gestational
diabetes was controversial. Some studies suggest a possible
link between the use of oral antidiadetics and fetal anomalies,
fetal macrosomia and neonatal hypoglycemia whereas others
have demonstrated no such relationship.
Metformin is a biguanide hypoglycemic agent that
reduces hepatic gluconeogenesis and increases peripheral
insulin sensitivity. Although it crosses placenta, metformin
appear to be safe in pregnancy.
Many studies have suggested the potential safety of
this drug in pregnancy and its ability to maintain adequate
glycemic control. In the present study, the aim was to
compare the efficacy of metformin with that of insulin in
treatment of gestational diabetes mellitus.
The present study included 100 pregnant women who
have been diagnosed as gestational diabetics at 25-33 weeks
gestation with singleton pregnancy. They had FBG level
ranging from 95-120 mg/ dl or 2-hour postprandial blood
glucose level ranging from 120-190 mg/dl. The exclusion
criteria include pregnant women with preexisting DM and
underlying diseases known to affect fetal growth or drug
clearance.
All patients were randomized to receive metformin
(n=50) or insulin (n=50).
All patients were followed up during their antenatal
visits in outpatient clinic. The HbA1C was measured before
the initiation of therapy. During each visit, fasting and 2 hrs
blood glucose level were assessed every week.
Metformin was started at an oral dose of 500mg tablet
taken daily with the evening meal; after a week, the dose is
increased to 500 mg twice daily, with the morning and
evening meals. Assuming this dose is tolerated, 1 week later,
the dose is further increased to 500 mg three times daily,
with tablets taken with the morning, midday, and evening
meals. Further increases were occasionally needed, to total
daily doses of 2000-2500 mg daily, in divided doses with
meals.
Comparison of the baseline characteristics was
performed between 2 groups and there were no significant
differences between the two groups regarding maternal age,
gravidity, parity, GA at time of diagnosis, GA at beginning
of treatment, and BMI at time of diagnosis
Additionally, it was noticed that women in the
metformin treated group reached sooner to the glucosetargets and maternal weight gain was less in the metformin
treated group.
About 23.4% of women in the metformin treated group
required supplemental insulin to achieve adequate glucose
level; it was found that women who required supplemental
insulin had higher BMI, earlier gestational age at the start of
treatment and higher levels of FBG and 2 hrs glucose level at
time of diagnosis.
Analysis of the results revealed that metformin was an
effective medication for control of blood glucose in women
with GDM who failed to achieve euglycemic with diet only.
The time for metformin as an alternative treatment to
insulin has come; however, it should be prescribed after
careful consideration of these patient characteristics to
minimize the need for supplemental insulin.