Metformin for preventing gestational diabetes in women with polycystic ovarian syndrome.

OBJECTIVE: To assess the effect of metformin in controlling Gestational Diabetes Mellitus (GDM) in women with Polycystic Ovarian Syndrome (PCOS). STUDY DESIGN: Comparative cohort study. PLACE AND DURATION OF STUDY: Gynecology Clinics of Mamji Hospital, Karachi, from 2008 to 2010. METHODOLOGY: Patients who had been diagnosed Polycystic Ovarian Syndrome (PCOS) with hyperinsulinemia and conceived and continued pregnancy, were divided in two groups; 50 patients received metformin throughout pregnancy and 32 did not. Development of GDM was ascertained in both groups. The patients were followed throughout pregnancy and in puerperium with OGTT as per WHO criteria. Primary outcome measure was development of gestational diabetes mellitus. Comparison of continuous variables was done using student 't' test. For categorical variables, frequency and percentages are reported while, odds ratio is also estimated for GDM during pregnancy. RESULTS: A total of 82 women with PCOS were included in this study, out of whom, 50 patients received metformin treatment while 32 patients did not. Pregnant women with PCOS in both groups were comparable in age, weight, parity and BMI. Mean fasting insulin levels at beginning of study entry were 17.22 ± 2.3 mIU/L and 16.93 ± 2.28 mIU/L in metformin and no metformin group respectively (p=0.589). Mean fasting blood sugar levels were 94.54 mg/dl in metformin and 99.59 mg/dl in no metformin group p < 0.001. A total of 5 (10%) patients in metformin group developed GDM while 11 (34.37% OR 4.71, p = 0.01) developed GDM in no metformin group. Patients not receiving metformin were 4.7 times likely to have GDM (OR: 4.71) compared to those who received it. CONCLUSION: The frequency of gestational diabetes, was significantly higher in patients with PCOS who had not received metformin compared to those who did.

Peripartum cardiomyopathy characteristics and outcome in a tertiary care hospital.

OBJECTIVE: To assess the incidence, risk factors ,maternal and foetal outcome in women with peripartum cardiomyopathy. METHODS: A descriptive study was conducted in the department of gynae obstetrics Civil Hospital, and Dow University of Health Sciences, Karachi from Oct, 2003 till Sept, 2007. Thirtytwo patients of any parity and age in their last months of pregnancy or within five months of delivery who met the criteria for diagnosis of peripartum cardiomyopathy were included in the study. Their epidemiologic data, risk factors, NYHA class and pregnancy outcomes were recorded till recovery or discharge. Analysis of results was done using descriptive analysis on SPSS version 15. RESULTS: Thirty two patients presented with PPCM, which was a frequency of 1 per 837 deliveries. The mean age was 32 +/-3 years and the mean parity 3.66 +/- 1.5. All patients were obese with mean body weight of 71.91 +/- 12.9 kg. The most frequent diagnosis of cardiomyopathy was made in 12 (37.57) Balochi and 7 (21.87) mohajir women. Twenty (62.57) presented late in post partum period and 20 (62.58) were in NYHA class IV. Chronic hypertension 10 (31.257), long term tocotysis 6 (18.757), pre-eclampsia 6 (18.757) and multiple pregnancy were main riskfactors. Eighteen (52.527) women had spontaneous vaginal delivery, 2 had assisted vaginal delivery and 2 had twin vaginal delivery. Ten (31.257) required caesarean section. The main complication was congestive cardiac failure in 20 (62.57) patients and 3 maternal deaths occurred. There were 27 live births and 5 perinatal deaths were recorded. CONCLUSION: This study showed that peripartum cardiomyopathy is associated with high morbidity and mortality. Multiple risk factors are associated with it, the most important being advancing age, parity, obesity, chronic and gestational hypertension and long term tocolysis.