Management of early gestational glucose intolerance to improve pregnancy outcomes

Authors

  • Rajesh Jain Jain hospital & Research Centre
  • Sadhana Tiwari Obstetrics & Gynecology, GSVM Medical College, Kanpur, India.
  • Renu Gupta Obstetrics & Gynecology, GSVM Medical College, Kanpur, India.
  • Neena Gupta Obstetrics & Gynecology, GSVM Medical College, Kanpur, India.
  • Divya Dwivedi Obstetrics & Gynecology, GSVM Medical College, Kanpur, India.
  • Shweta Verma Obstetrics & Gynecology, GSVM Medical College, Kanpur, India.
  • Palak Taneja Obstetrics & Gynecology, GSVM Medical College, Kanpur, India.
  • V Seshiah Hony Distinguished Professor, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India.
  • Pikee Saxena Obstetrics & Gynecology, Lady Hardinge Medical college, New Delhi, India.

Keywords:

Diabetes/Metabolism, Public Health, Health Policy

Abstract

Diabetes during pregnancy detection does not mean prevention. A 2-hour postprandial blood glucose (PPBG) ≥110 mg/d at 8-10 weeks is crucial for predicting Gestational Diabetes Mellitus (GDM). Intervention should start at week 8 to prevent GDM as fetal beta cells start insulin secretion by 11th weeks. To Evaluate the efficacy of metformin in high-risk GDM pregnant women having postprandial blood glucose levels ≥110 mg/dL at 8-10 Weeks of gestation; Assess if Medical Nutrition Therapy (MNT) with or without metformin can prevent GDM in women with PPBG ≥110mg/dl at 8-10 weeks and Evaluate complications and outcomes in pregnant women and neonatal morbidities in Early Gestational Glucose Intolerance (EGGI) in intervention groups. A Prospective cohort study included pregnant women at 8 to 10 weeks of gestation, divided into two groups based on their blood sugar levels of ≥110 mg/dl. Those with higher levels ≥110 mg/dl received two different interventions: metformin MNT and MNT only. Follow-up outcomes were done until delivery. The mean PPBG levels were significantly lower in the metformin MNT group compared to the MNT group at 16 weeks (110.74 vs. 118.23), 24 weeks (109.54 vs. 117.78), and 32 weeks (112.8 vs. 118.8), with P-values ≤0.001. Additionally, the primary adverse neonatal composite outcomes were significantly higher in the MNT group (55 cases, 52.3%) compared to the metformin-MNT group (35 cases, 37.6%) with P ≤ 0.038. The MNT group also reported 20 spontaneous abortions (16%) and 12 stillbirths (9.6%), while the metformin group reported none. Neonatal morbidity was significantly lower in the metformin-MNT group (48 cases, 51.6%) compared to the MNT group (80 cases, 76.2%), with P < 0.001. These findings highlight the superior effectiveness of the MNT-metformin intervention. In conclusion, it is essential to keep maternal 2-hour PPBG levels below 110 mg/dl by the 10th week of pregnancy to prevent fetal hyperinsulinemia. Fetal beta cells typically begin secreting insulin around 11th week. Maintaining good glycemic control during pregnancy is crucial for preventing gestational diabetes and ensuring the health of the fetus.

Author Biography

Rajesh Jain, Jain hospital & Research Centre

•EX Project Manager, Diabetes Prevention Control Project, with National Health Mission supported by World Diabetes Foundation, Denmark.• Ex-Medical Officer,  SEARO, World Health Organization (WHO).•59 papers presented at international & national forums.•7 Book Chapters on Diabetes & Gestational diabetes; 3 book published.•95 publications on Diabetes, GDM, Nutrition, Hypertension & its complications in indexed journals•Collaborator Global Burden of Disease , Univ of Washington USA•Executive member for Diabetes in Pregnancy Study Group India.• Member of National Consultative Committee For GDM, MOHFW, GOI.• Awarded for Largest Global Diabetes Walk in Uttar Pradesh with National Health Mission, UP.•National Faculty & Speaker for DIPSI, RSSDI, FOGSI, Boehringer Ingelheim, Servier, Sanofi, NHM.•Reviewer for Journals Annals of Internal Medicine, DRCP(IDF), IJDDC(RSSDI), Clinical Medicine and 20 PubMed Journal•Editor in Chief, Diabetes Asia Journal  https://diabetesasia.org/journal/•Research Russian Herbal Concentrate for B cell Regeneration•Executive and Rapetour DIPSI Diabetes in Pregnancy Study Group of India•Author of the Book   ‘Avatar’  published by Penguin.•Appreciation Letters received from  Mother Teresa for Work on Destitute.•Representative for High-Level (UN) High-Level Meeting on NCD, 2018 at UN headquarter•Researchgate Global ranking >97 percentile Researchers. https://www.researchgate.net/profile/Rajesh-Jain-8/research•Adjunct Professor at Rama Medical College, Rama University, Kanpur, India since 2022•Guide and Co Guide for Medical Post-Graduate 4 students each time in Medical College.

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Published

2025-12-24

Issue

Vol. 12 No. 1 (2025)

Section

Articles

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