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Impact of pharmacological treatment of gestational diabetes on the mode of delivery and birth weight: a nationwide population-based study on a subset of singleton pregnant Portuguese women

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Abstract

Aims

To access the impact of increasing use of metformin on cesarean section and large for gestational age rates, when compared to insulin.

Methods

A retrospective observational study was developed using data from the Portuguese National Registry, between 2011 and 2019, of 5038 Portuguese women with single pregnancies and gestational diabetes treated with metformin and/or insulin. Three groups were defined according to the therapeutic regimen adopted: g1–insulin in monotherapy (n = 3027[60.1%]); g2–metformin in monotherapy (n = 1366[27.1%]); g3–metformin and insulin (n = 645[12.8%]). Multivariate analysis was adjusted for statistically significant covariates.

Results

The cesarean section rate in g1 was similar to g2 (g1:36.9% vs. g2:37%, p = 0.982), although g3 was associated with cesarean delivery (g3:43.6% vs. g1:36.9%, p = 0.005; g3:43.6% vs. g1:37.0%, p = 0.002), with no differences reported in the multivariate analysis adjusted for year of delivery and pregestational body mass index. A delivery of a large for gestational age newborn was less frequently observed in g2 than in g1 (g2:4.1% vs. g1:5.4%, p = 0.044) and in g3 (g2:4.1% vs. g3:9.1%, p < 0.001), and in g1, when compared to g3 (g1:5.4% vs. g3:9.1%, p < 0.001). In the multivariate analysis, g2 showed lower odds of delivering a large for gestational age newborn, compared to g1 (β = −0.511, OR = 0.596, CI95% = 0.428–0.832, p < 0.001).

Conclusions

The use of metformin was not associated with higher cesarean section rates, compared to insulin. Instead, it was suggested a protective role of metformin on large gestational age rates. The concomitant use of dual therapy suggests more complex pregnancies, requiring closer surveillance that mitigate serious perinatal and obstetrical outcomes.

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Funding

The authors declare that they have no financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

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Authors and Affiliations

  1. Endocrinology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Rua Conceição Fernandes S/N, 4434-502, Vila Nova de Gaia, Portugal

    Diogo Ramalho, Sara Correia, Gustavo Rocha, Helena Alves, Lúcia Almeida, Sara Monteiro & Maria João Oliveira

  2. Obstetrics Department, Centro Hospitalar e Universitário de São João. Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal

    Rodrigo Realista

  3. Nutrition Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Rua Conceição Fernandes S/N, 4434-502, Vila Nova de Gaia, Portugal

    Eva Ferreira

  4. Obstetrics Department, Maternidade Bissaya Barreto. Rua Augusta 36, 3000-045, Coimbra, Portugal

    Maria Céu Almeida

  5. Diabetes and Pregnancy Study Group of the Portuguese Society of Diabetology, Rua do Salitre 149, 1250-198, Lisbon, Portugal

    Maria Céu Almeida

Authors
  1. Diogo Ramalho
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  2. Sara Correia
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  3. Rodrigo Realista
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  4. Gustavo Rocha
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  5. Helena Alves
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  6. Lúcia Almeida
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  7. Eva Ferreira
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  8. Sara Monteiro
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  9. Maria João Oliveira
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  10. Maria Céu Almeida
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Consortia

Diabetes and Pregnancy Study Group of the Portuguese Society of Diabetology

Contributions

Conceptualization: DR, SC; Methodology: DR, SC, RR, HA, LA; Formal analysis and investigation: DR, GR, EF, SM, MJO, MCA; Writing—original draft preparation: DR, SC, RR, HA, LA; Writing—review and editing: GR, EF, SM, MJO, MCA; Resources: DR, MJO, MCA; Supervision: GR, EF, SM, MJO, MCA. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Diogo Ramalho.

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Conflict of interest

The authors declare that they have no conflict of interest.

Consent to participate

All the persons gave their informed consent prior to their inclusion in the analysis.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Each participating hospital’s institutional ethics committee has approved the study.

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This article belongs to the topical collection Pregnancy and Diabetes, managed by Antonio Secchi and Marina Scavini.

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Ramalho, D., Correia, S., Realista, R. et al. Impact of pharmacological treatment of gestational diabetes on the mode of delivery and birth weight: a nationwide population-based study on a subset of singleton pregnant Portuguese women. Acta Diabetol 59, 1361–1368 (2022). https://doi.org/10.1007/s00592-022-01931-x

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