Pregnant Women Offer Hope in Gestational Diabetes

Researchers have taken a big step forward in the management of gestational diabetes mellitus after a clinical trial involving pregnant women gave expectant moms suffering from the condition new hope.

JAMA, the Journal of the American Medical Association, reported the findings.

Gestational diabetes is a worldwide health problem that affects over 3 million pregnant women each year. It is a syndrome distinguished by high blood sugar levels during pregnancy, offering additional health hazards to both women and their kids.

Professor Fidelma Dunne, Professor of Medicine at the University of Galway and Consultant Endocrinologist at Saolta University Health Care Group, oversaw the EMERGE experiment, which included over 500 pregnant women.

Metformin has been commercially available for over 60 years and is frequently used in the treatment of Type 2 Diabetes.

At weeks 32 and 38, the mother's fasting and post-meal sugar levels were considerably lower in the metformin-exposed group.

Women who received metformin acquired less weight during the experiment and kept this weight differential at the 12-week post-delivery visit.

The EMERGE project, which included over 500 pregnant women, was overseen by Professor Fidelma Dunne, Professor of Medicine at the University of Galway and Consultant Endocrinologist at Saolta University Health Care Group.

Metformin has been on the market for almost 60 years and is commonly used in the treatment of Type 2 Diabetes.

The metformin-exposed mothers' fasting and post-meal sugar levels were significantly lower at weeks 32 and 38.

Women who took metformin gained less weight during the study and maintained this weight difference at the 12-week post-delivery visit.

There were no variations in bad neonatal outcomes, such as the requirement for intensive care therapy for newborns, respiratory assistance, jaundice, congenital malformations, delivery traumas, or low sugar levels, according to the study.

There were also no differences in the rates of labour induction, caesarean delivery, maternal haemorrhage, infection, or blood pressure problems during or after birth.

Professor Dunne said, “While there is convincing evidence that improved sugar control is associated with improved pregnancy outcomes, there was uncertainty about the optimal management approach following a diagnosis of gestational diabetes.

“In our pursuit of a safe and effective treatment option, we explored an alternative approach – administering the drug metformin. A previous trial compared metformin to insulin and found it to be effective, yet concerns remained, especially regarding preterm birth and infant size.”

To address concerns comprehensively, the team at the University of Galway conducted a ground-breaking placebo-controlled trial, filling a critical gap in the gestational diabetes treatment landscape.

Professor Dunne said, “Traditionally, gestational diabetes has been managed initially through dietary advice and exercise, with insulin introduced if sugar levels remain sub-optimal. While effective in reducing poor pregnancy outcomes, insulin use is associated with challenges, including low sugars in both the mother and infant which may require neonatal intensive care, excess weight gain for mothers, and higher caesarean birth rates.

“For mothers with gestational diabetes, they are also at greater risk of high blood pressure and preeclampsia.

“Babies born to mothers with gestational diabetes face their own set of risks, such as excessive weight at birth, birth injuries, respiratory difficulties and low sugar levels after delivery potentially requiring admission to neonatal intensive care. Gestational diabetes also increases the lifetime risk of diabetes for these mothers and their children. In addition, mothers have an elevated lifetime risk of cardiovascular disease. Furthermore, low and middle-income countries bear a significant burden of gestational diabetes cases.”

Professor Dunne added, “The results from the EMERGE study are a significant step forward for women with gestational diabetes. Metformin has emerged as an effective alternative for managing gestational diabetes, offering new hope for expectant mothers and healthcare providers worldwide.”