Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Gynecology and Obstetrics

Aim: To compare maternal and neonatal outcomes in pregnant diabetic women treated with either insulin and metformin or insulin only. Methods: 220 pregnant diabetic women with type 1, 2 or gestational diabetes were randomisely assigned into two groups .each group is 110 pregnant diabetic women. One group takes insulin and metformin treatment to achieve glycemic targets and other take insulin only treatment. Pregnancy outcomes in the 110 women who remained exclusively on insulin were compared with 110 pregnant diabetic women treated with insulin and metformin matched for age, weight and ethnicity. Results: There were no significant differences in baseline maternal risk factors. Group {u2161} had significantly greater mean weight gain from enrolment to term (5.9 vs. 4.3 kg; P < 0.000). There was no difference between group {u2160} and group {u2161}, respectively, comparing gestational hypertension (14.5 vs. 19.1%, P = 0.367), pre-eclampsia (7.27 vs. 9,09%, P = 0.622),insulin dosage was decreased in group {u2160} statistically significant (mean 39.5±16.5 vs. 55.4±17.5 units, P = 0.000), vaginal delivery (41.8 vs. 47.3%, P = 0.416) or rate of elective Caesarean section (39.1 vs. 32.7%, P = 0.325) rate of emergency caesarean section (19.1 vs. 20%, P=0.865) ,perinatal loss 4 cases in group {u2161} vs. 3 case in group {u2160}. Neonatal morbidity was improved in group {u2160}; prematurity (16.63 vs. 24.55%, P = 0.417), neonatal hypoglycemia (7.3 vs. 24.5 %, P= 0.000), respiratory distress (13.64 vs. 30 %, P= 0.003), neonatal jaundice (13.6 vs. 33.6%, P < 0.000) and admission to neonatal unit (24.55 vs. 35.45%, P = 0.077). The incidence of macrosomia (birth weight centile > 90) was significantly different [group {u2160} (16.4%) vs. group {u2161} 29.1%; P = 0.024

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