Prediction Of Different Treatment Modalities In Women With Gestational Diabetes Mellitus In Minia University Maternity Hospital. A Prospective Cohort Study

Abstract

Backgroud: Gestational diabetes mellitus (GDM) is glucose intolerance first recognized in pregnancy, often managed with diet or medication to reduce maternal and neonatal complications.

Aim: To develop a predictive model for the necessity of different treatment modalities in women with GDM in Minia University Maternity Hospital [MUMH].

Patients and methods: This prospective cohort study included 109 GDM patients at MUMH (May 2022–December 2023). Diagnosis was based on IADPSG criteria, excluding pre-existing diabetes. Management was stepwise: diet first, then metformin if uncontrolled, and insulin if needed. Patients were classified into three groups: diet only (n=32), metformin (n=42), and insulin (n=35).

Results: The three groups were comparable in age, BMI, gravidity, parity, gestational age at delivery, mode of delivery, and neonatal birth weight (p > 0.05). Fasting and postprandial glucose levels were significantly higher in Groups II and III compared to Group I (p < 0.001). Neonatal outcomes showed no deaths in Groups I and II, while Group III had one neonatal death (2.9%) and two IUFD cases (5.7%). Congenital anomalies were more frequent in Group III (17.1%), and significant differences were observed in neonatal hypoglycemia (p = 0.048) and macrosomia (p = 0.003), whereas other complications were not statistically different.

Concluion: Higher fasting and postprandial glucose levels in women with GDM were associated with the need for more intensive treatment, underscoring the importance of close glucose monitoring to guide management.