1. Introduction

The definition of gestational diabetes mellitus (GDM) is any degree of glucose intolerance with onset or first recognition during pregnancy [1]. gestational diabetes mellitus (GDM) - a transitory form of diabetes induced by pregnancy - has potentially important short and long-term health consequences for both the mother and her baby [2]. gestational diabetes mellitus (GDM) is a serious pregnancy complication, in which women without previously diagnosed diabetes develop chronic hyperglycemia during gestation. In most cases, this hyperglycemia is the result of impaired glucose tolerance due to pancreatic β-cell dysfunction on a background of chronic insulin resistance [3]. The association of GDM with immediate pregnancy complications including excess fetal growth and adiposity with subsequent risk of birth trauma and with hypertensive disorders of pregnancy is well recognized. however, the associations with wide ranges of longer-term health outcomes for mother and baby, including the lifetime risks of obesity, pre-diabetes, and diabetes and cardiovascular disease have received less attention and few health systems address these important issues in a systematic way [4].

2. Methods and Material

It is a prospective study. Material for the study was recruited from the total number of pregnant women admitted to Al Baraha Hospital (Dubai, UAE) from 2008-2011 who were diagnosed with gestational diabetes. These patients were divided in two groups one who received insulin and second group who received Metformin. Data was collected from electronic records during study and followed after 10-13 years later for manifestation of the disease.

3. Results

Our prospective analysis revealed that 10 out of 15 patients with GDM from group 1 developed the disease during the first 5 years, and the remaining 5 women during the next 10 years of life. In the 2nd group, 3 out of 6 patients developed DM in the first 5 years, in the remaining 3 diabetes was diagnosed 9 years later. This proves the fact that gestational diabetes is a risk factor for developing diabetes later in life.

4. Discussion

Particular risk factors, including a history of gestational diabetes, family history of diabetes, and obesity, predispose a pregnant woman to dysglycemia [1]. In addition, nonwhite ethnicity, advanced maternal age, higher body mass index (BMI), weight gain in early adulthood, and cigarette smoking may predict increased risk of gestational diabetes [2].

For the mother, gestational diabetes is significantly associated with an increased risk of developing a postpartum disorder of glucose metabolism [5].

During the study period (2008-2011), total number of deliveries were 7853, of which 6566 (83.6%) women had spontaneous normal vaginal delivery, 1287 (16.4%) delivered by caesarean section, 170 (2.6%) had vacuum extraction and 33 (0.5%) had forceps delivery. Among these 1123 (14.3%) were diagnosed with GDM (gestational diabetes mellitus). 297 (26.4%) of them were prescribed hypoglycemic therapy (insulin or Metformin) for control of blood sugar levels during pregnancy while remaining 826 (73.6%) were managed by diet therapy only.

Material for this study was taken from 245 out of total 297 patients with GDM who took Insulin or Metformin, which were then divided into 2 groups depending on the nature of the main treatment.

Group 1 included 138 pregnant women who received insulin therapy for treatment, while Group 2 – belong to 107 pregnant women on Metformin (Glucophage) treatment. The remaining 52 out of 297 pregnant women were excluded from the study due to medication errors.

The comparisons between outcomes of treatment of GDM with insulin versus Metformin revealed that the optimal approach to normalize blood sugar levels among pregnant women with GDM makes it possible to rationally reduce the dose of insulin administered or replace it only with Metformin, which is a sparing drug of peripheral action, and also avoid cases of hypoglycemia in pregnant women. Also it avoids neonatal hypoglycemia and other undesirable complications of insulin therapy.

Of the 245 patients treated during pregnancy with GDM in 2008-2011. This study was done to see the subsequent recurrence of GDM in further pregnancies, development of type 1 or type 2 diabetes and associated complications and their current treatment regimes. Of these, 21 patients were from the 1st group who received insulin therapy for GDM in the study period (2008-2011), and 23 patients were from the 2nd group who received Metformin for GDM.

Among 21 patients of the 1st group during the study period after their birth (from 10 to 13 years), 16 women developed diabetes and most of them started Metformin for treatment. Some of them are on other group of hypoglycemic drugs. Only one women of first group is taking insulin. Among these women, there were 6 primiparas who later had more pregnancies from, in which they again developed GDM on diet or Metformin, only one of them received Insulin therapy.

One woman in this group had an early miscarriage. The remaining 15 women were multiparous, 5 of them were still pregnant and having GDM on insulin or Metformin.

The mean age of the patients in this group was 23-41 (2008-2011) and 33-54 at present (2022).

Noteworthy case: One of the pregnant women in this group was 32 years old (a native of India) in 2008 she had her 3^rd pregnancy, with previous 2 cesareans, GDM on insulin, delivered by a elective caesarean section. During her 4^th pregnancy in 2016 she had GDM on insulin and the delivery ended with a planned 4th caesarean section without complications. In 2019, she developed type 2 diabetes on Metformin. All children are healthy. The woman died in January 2021 from Covid 19 at the age of 45.

In the 2nd group of 23 women, DM developed in 6 women. And all of them are on hypoglycemic drugs, most of which (4 out of 6) are on Metformin. Of these, 12 were primiparas and subsequently had more pregnancies. They were diagnosed with GDM in all pregnancies either on diet or Metformin, except one woman who had a subsequent birth without GDM.

The age of patients in group 2 was from 24 to 37years (2008-2011) and 34-50 at the time of the study (2021).

5. Conclusions

According to NICE [6] within 5 years after undergoing GDM, 50% of women develop diabetes.

One of the conclusions from this prospective analysis can be that pregnant women with GDM treated with insulin are more likely to develop subsequent diabetes than those who received Metformin during pregnancy or on diet therapy for treatment.

Of the patients in group 1 - 71.4% developed DM in the next 10 years after pregnancy with GDM at the time of the study (2008-2011).

Respectively among the patients of group 2 - 26.0% developed DM at the time of the prospective analysis.

It can be concluded that in those women with GDM during pregnancy who took Metformin to correct blood sugar, the risk of developing DM is 2.7 times less (less) than in those pregnant women with GDM for whom correction of blood sugar required the use of insulin.

Based on the above analysis, we recommend that all pregnant women with GDM during pregnancy should strictly follow a diet and physical activity in order to control blood sugar levels without the use of insulin and limit themselves to diet and / or the use of Metformin.

We also recommend that all women who have had GDM lead an active healthy lifestyle during their subsequent pregnancies, and this is also acceptable for all women.