背景技术妊娠期糖尿病(GDM)被定义为在怀孕期间发作或首次识别的任何程度的葡萄糖耐受不良。根据口服葡萄糖耐量试验(OGTT)进行诊断,根据ACOG的指南,口服葡萄糖耐量试验将一小时试验后的血糖水平高于190mg/dL作为GDM的标准。GDM的一线药物是胰岛素注射;然而,它的成本很高,也会导致自身的胎儿-母体并发症,包括体重增加和羊水过多。相反,二甲双胍并发症少,更便宜,并且正在成为治疗2型糖尿病的一线药物的更好替代方案。在巴基斯坦,2018年所有三个月的GDM患病率为11.8%。因此,这项研究是为了确定非GDM和GDM患者的妊娠结局,二甲双胍,和综合治疗分别入院于雷曼医学研究所(RMI)开伯尔·普赫图赫瓦妇科病房,2019年的巴基斯坦。目的确定接受二甲双胍治疗的GDM患者的生母结局和接受胰岛素治疗的GDM患者的生母结局,并比较患有GDM的母亲与没有GDM的母亲的生母结局。方法这是一项回顾性研究,于2020年1月至4月对接受二甲双胍治疗的妊娠期糖尿病患者进行,胰岛素,或者两种疗法都被送到妇科病房,雷曼医学研究所(RMI)。在获得机构伦理批准委员会的伦理批准后,2019年全年的数据是根据形式收集的,变量为:人口统计数据,血糖控制(通过OGTT),劳动方式,原发性开角型青光眼(POAG),和胎儿母亲的结局。数据通过SPSS版本21.0(IBMSPSSStatisticsforWindows,IBM公司,Armonk,纽约),数据经过各种测试,包括描述性统计,交叉表格,和卡方。结果是在这些报告的基础上制定的,然后以图表和表格的形式呈现。结果在妇科病房住院分娩的150名母亲中,123名(82.0%)女性年龄在30-40岁之间。非妊娠期糖尿病患者为78(52%),而妊娠期糖尿病母亲为72(48%);在这些GDM阳性母亲中,有44(61.1%)服用二甲双胍,21例(29.1%)接受胰岛素治疗,7例(9.7%)接受联合治疗。在交付方式中,剖腹产是最常见的(113[76%]),主要在非GDM母亲中(95[45.1%]),其次是接受二甲双胍治疗的母亲(36[31.8%]).考虑到胎儿结局,NICU入院之间存在显着关联,新生儿黄疸,接受胰岛素治疗的母亲的臀位表现(p=0.06,p=0.003,p=0.004,分别CI=95%)。在产妇结局中,妊娠高血压综合征(PIH)与胰岛素治疗患者之间存在显着关联(p=0.02CI=95%),胎膜早破(PROM),和二甲双胍治疗的患者(p=0.01CI=95%),而子痫与未患有GDM的母亲显着相关(p=0.001CI=95%)。结论根据这些初步数据并考虑胎儿-产妇结局,二甲双胍在GDM治疗中与胰岛素相比似乎是一种更安全的药物,具有更高的依从性。
Introduction Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The diagnosis is made on the basis of the oral glucose tolerance test (OGTT) which according to the guidelines of ACOG regards a blood glucose level higher than 190mg/dL after the one-hour test as the criteria for GDM. The first-line agent for GDM is insulin injections; however, it has high costs and also causes its own feto-maternal complications which can include weight gain and polyhydramnios. On the contrary, metformin has fewer complications, is cheaper, and is emerging as a better alternative for the first-line agent for the treatment of diabetes mellitus type 2. GDM had a prevalence of 11.8% in the year 2018 in all trimesters of pregnancy in Pakistan. This study was thus conducted to determine the feto-maternal outcomes of non-GDM and GDM patients on insulin, metformin, and combined treatment respectively admitted to gynecology ward Rehman Medical Institute (RMI) Khyber Pakhtunkhwa, Pakistan in the year 2019. Objectives To determine the feto-maternal outcomes in patients of GDM on metformin treatment and the feto-maternal outcomes in patients of GDM on insulin treatment and to compare the feto-maternal outcomes of mothers with GDM to those without GDM. Methodology This is a retrospective study conducted from January to April 2020 on patients of gestational diabetes mellitus undergoing either metformin, insulin, or both therapies admitted to the gynecology ward, Rehman Medical Institute (RMI). After getting ethical approval from the institutional ethical approval board, data were collected for the entire year of 2019 on the basis of proforma with the variables: demographic data, glycemic control (via OGTT), mode of labor, primary open-angle glaucoma (POAG), and feto-maternal outcomes. Data was entered and analyzed via SPSS version 21.0 (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY) and the data were run through various tests including descriptive statistics, cross-tabulations, and chi-square. Results were formulated on the basis of these reports which were then presented in the form of graphs and tables. Results Out of 150 mothers who were admitted for delivery at the gynecology ward, 123 (82.0%) women were 30-40 years of age. Non-gestational diabetics patients were 78 (52%) whereas gestational diabetic mothers were 72 (48%); within these GDM-positive mothers 44 (61.1%) were on metformin, 21 (29.1%) were on insulin and seven (9.7%) were on combined treatment. Among modes of delivery, C-section was the most common (113 [76%]), mostly in non-GDM mothers (95 [45.1%]) followed by those on metformin treatment (36 [31.8%]). Considering fetal outcomes there was a significant association between NICU admissions, neonatal jaundice, and breech presentation with insulin-treated mothers (p=0.06, p=0.003, p=0.004, respectively CI=95%). Among maternal outcomes, there was a significant association between pregnancy-induced hypertension (PIH) and insulin-treated patients (p=0.02 CI=95%), premature rupture of membranes (PROM), and metformin-treated patients (p=0.01 CI=95%) whereas eclampsia was significantly associated with mothers not having GDM (p=0.001 CI=95%). Conclusion Based on this preliminary data and considering feto-maternal outcomes, metformin appears to be a safer drug as compared to insulin in the treatment of GDM with more compliance.