Abstract
Objectives:Teenage pregnancy with gestational diabetes mellitus (GDM) offers a real challenge to the health system and needs a special care. We aimed to evaluate possible obstetrical and neonatal adverse events of different treatment protocols in adolescent GDM including lifestyle, metformin (MTF), and insulin.Methods:All teen pregnant women ≤ 19 years old visiting Baghdad Teaching Hospital throughout four years (from June 1, 2016 till May 31, 2020) diagnosed with GDM were included in this cohort study and followed-up closely throughout pregnancy and after delivery. Included adolescents were put on lifestyle alone during the first week of presentation. Adolescents who reached target glucose measurements were categorized into lifestyle group, while other adolescents were randomly allocated into MTF and insulin groups. Also, adolescent pregnant women without GDM were recruited as control group using computer randomization.Results:The GDM (110 cases) and control (121 individuals) groups had matched general features at recruitment except for diabetes family history. Also, GDM treatment groups had matched features. Glycemic readings (fasting and random) was significantly (p< 0.05) higher in insulin group having odds ratio (OR) of 1.41, and 1.57, respectively. In MTF group, significant protective OR was found in preeclampsia (OR=0.76, p< 0.05). MTF showed non-significant protective OR regarding prematurity and five minutes Apgar score>7 [(OR=0.83, p=0.24), and (OR=0.94, p=0.73), respectively], and significant protective association with large for gestational age and admission to neonatal intensive unit. Insulin had significantly higher prematurity, small for gestational age, and hypoglycemia [OR=1.89, 2.53, and 2.84, respectively].Conclusion:Metformin (MTF) showed less pregnancy and neonatal complications in adolescent GDM than insulin and lifestyle.
Highlights
Teenage or adolescent period lies within the age range of 10-19 years.[1]
Adolescents have a natural rebellion to medical treatment and doctorsinstructions which in turn may lead to more complications with higher frequencies if gestational diabetes mellitus (GDM) is added to the equation of pregnancy.[2]
Pregnancy is a potential risk of glucose intolerance, and insulin sensitivity is further decreased with progression of time till the point of non-matching between the secreted insulin and insulin resistance is reached to declare occurrence of gestational diabetes
Summary
Teenage (teen) or adolescent period lies within the age range of 10-19 years.[1]. Adolescents have a natural rebellion to medical treatment and doctorsinstructions which in turn may lead to more complications with higher frequencies if gestational diabetes mellitus (GDM) is added to the equation of pregnancy.[2]Pregnancy is a potential risk of glucose intolerance, and insulin sensitivity is further decreased with progression of time till the point of non-matching between the secreted insulin and insulin resistance is reached to declare occurrence of gestational diabetes. Teenage (teen) or adolescent period lies within the age range of 10-19 years.[1] Adolescents have a natural rebellion to medical treatment and doctorsinstructions which in turn may lead to more complications with higher frequencies if gestational diabetes mellitus (GDM) is added to the equation of pregnancy.[2]. Based on the idea of poor compliance in adolescents and supported by the expected adverse obstetric and neonatal events provoked by both gestational diabetes and young (teen) age group, we tried to conduct this prospective cohort to evaluate possible complications occurred during pregnancy, delivery, and early neonatal period in gestational diabetic adolescent women with regard to the main treatment options involving lifestyle, insulin, and metformin (MTF)
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