RESUMO
Objective@#To determine the efficacy of metformin and insulin in the management of gestational diabetes mellitus (GDM). @*Methodology@#Randomized controlled trials (RCT) were retrieved from the databases. All references cited in the articles were also searched by hand to identify additional publications. Studies included were limited to trials on metformin and insulin in the management of GDM in singleton pregnancies. Four RCTs were analyzed in the study. The risk of bias was assessed using Preferred Reporting Items for Systematic reviews and Meta-Analyses Cochrane Collaboration’s tool (Rob 2). Random effects meta-analysis was carried out to pool the data. All analyses were conducted in Review Manager 5.3.5 (2014). @*Results@#Meta-analysis of four RCT involving 807 participants (405 were treated with metformin and 402 were treated with insulin) shows that there was no significant difference between metformin and insulin in achieving glycemic control as to fasting blood sugar (FBS), postprandial blood glucose (PPBG), and glycosylated hemoglobin, mean difference (MD) −0.43 (95% confidence interval [CI] −2.77–1.91; P = 0.72), MD −2.13 (95% CI −5.16–0.90, P = 0.17), MD −0.09 (95% CI −0.20–0.02, P = 0.10), respectively. For maternal outcomes, there was a statistically significant 69% decreased risk of hypoglycemia in the metformin group (risk ratio [RR] 0.31, 95% CI 0.20–0.49; P < 0.001). There was no difference in terms of risk of preterm birth (RR 1.11, 95% CI 0.75–1.64, P = 0.60); hypertensive disorders (RR 1.06, 95% CI 0.71–1.60, P = 0.77); polyhydramnios (RR 1.04, 95% CI 0.51–2.14, P = 0.91); and risk of cesarean delivery (RR 0.90, 95% CI 0.75–1.08, P = 0.27). For neonatal outcomes, there was statistically significant 34% reduction on the risk of neonatal hypoglycemia (RR 0.66, 95% CI 0.46–0.94; P = 0.02) in the metformin group. There was no statistical difference in terms of mean birthweight (MD − 81.34, 95% CI −181.69–19.02, P = 0.11). Metformin has decreased the risk of newborns weighing more than 4000 g, babies with birthweight >90th percentile by 27% (RR 0.73, 95% CI 0.28–1.90, P = 0.52), and 20% (RR 0.80, 95% CI 0.54–1.18,P = 0.26), respectively, but these were not statistically significant. There was no significant difference in terms of risk of birthweight <10th percentile (RR 1.17, 95% CI 0.60–2.31, P = 0.65); APGAR <7 (RR 1.17, 95% CI 0.65–2.08, P = 0.60), birth trauma (RR 0.77, 95% CI 0.23–2.58, P = 0.67), and jaundice requiring phototherapy RR 1.04, 95% CI 0.66–1.65, P = 0.85). Neonatal intensive care unit admission (RR 0.89, 95% CI 0.64–1.23, P = 0.48), respiratory distress syndrome (RR 0.73, 95% CI 0.36–1.50, P = 0.39), transient tachypnea (RR 0.78, 95% CI 0.27–2.19, P = 0.63), and any congenital anomaly (RR 0.58, 95% CI 0.20–1.67, P = 0.31) were decreased in the metformin group but was not statistically significant. @*Conclusion@#There was no significant difference between metformin and insulin in achieving glycemic control as to FBS and PPBG among patients with GDM. There was a statistically significant reduction in the risk of maternal and neonatal hypoglycemia in the use of metformin.
Assuntos
Diabetes Gestacional , Controle Glicêmico , Insulina , MetforminaRESUMO
Background@#Diagnosing hypertensive disorders in pregnancy utilizes systolic blood pressure (BP) of >140 mmHg and/or diastolic of >90 mmHg. However, since 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) have been endorsing lower BP thresholds for diagnosing hypertension.@*Objectives@#This study determines if antenatal lower threshold BP elevations under elevated BP and Stage 1 hypertension from ACC/AHA show an increased risk of gestational hypertension, preeclampsia, and adverse perinatal outcomes.@*Materials and Methods@#This retrospective cohort study included service patients with prenatal consultations and deliveries at a private tertiary-level hospital from February 2016 to 2020. Antenatal BP measurements, categorized into “normal,” “elevated BP,” and “Stage 1 hypertension” under ACC/AHA classifications, had crude and adjusted relative risks (aRRs) and 95% confidence intervals (CIs) estimated to determine their associations with hypertensive disorders of pregnancy.@*Results@#Stage 1 hypertension was twice more likely to develop gestational hypertension (aRR: 2.314, 95% CI: 1.08–4.98) and thrice more likely to develop preeclampsia (aRR: 3.673, 95% CI: 2.30–5.86), whether without (aRR: 3.520, 95% CI: 1.33–9.29) or with severe features (aRR: 3.717, 95% CI: 2.16–6.41). There was a slightly increased risk for adverse perinatal outcomes from Stage 1 hypertension, as well as all outcomes from elevated BP, but was not statistically significant. Majority of BP elevations were during the third trimester.@*Conclusion@#Lower threshold Stage 1 hypertension showed an increased risk of developing hypertensive disorders of pregnancy, with a three-fold increased risk for preeclampsia. There may be advantages in its application for diagnosing preeclampsia or having increased monitoring for these patients.
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Hipertensão Induzida pela GravidezRESUMO
Objective@#This study aimed to determine the maternal clinical factors associated with neonatal respiratory morbidity and other adverse neonatal outcomes in meconium-stained labor among term parturients.@*Methodology@#A retrospective cohort study was done on admitted obstetric patients with term gestation and had meconium-stained labor. Maternal clinical factors such as age, parity, gestational age, manner of delivery, duration of labor, presence of term prelabor rupture of membranes (PROM), character of meconium-stained liquor (MSL), and presence of comorbidities were identified and analyzed to determine their association with neonatal respiratory morbidity and other adverse neonatal outcomes. @*Results@#In this study, there were 986 cases identified to have meconium-stained labor, and 168 developed neonatal respiratory morbidity. As to primary outcome, maternal clinical factors, such as age >35 years, multiparity, age of gestation >41 weeks, prolonged labor, presence of PROM, significant MSL upon admission, presence of change from nonsignificant to significant MSL, presence of intrauterine growth restriction, and hypertension, were all shown to be statistically significant. @*Conclusion@#The presence of maternal clinical factors in meconium-stained labor was observed to be a risk factor in developing neonatal respiratory morbidity and other adverse neonatal outcomes. Hence, identification of maternal risk factors and early detection of meconium-stained amniotic fluid are vital in administering timely intervention to labor and delivery to reduce neonatal complications.