The effect of probiotics on glycemic control and birth weight in gestational diabetes mellitus: meta-analysis

ABSTRACT Introduction Gestational diabetes is a common medical disorder in pregnancy. So long, it has been usually treated by insulin. Now it has been found that oral glibenclamide can be used instead of insulin with similar glycemic control and without any adverse maternal and fetal effect. Methods A comparative study between oral glibenclamide and insulin for the management of gestational diabetes mellitus (GDM) was conducted. It was a prospective randomized study and patients attending the antenatal clinic were screened with 75 gm oral glucose between 20 to 28 weeks and GDM was diagnosed based on WHO criteria of 2 hours blood glucose ≥140 mg/dl. Women with gestational diabetes were given medical nutritional therapy (MNT) for 2 weeks. Out of this, 60 women did not achieve the target blood glucose. The goal of treatment was maintenance of mean plasma glucose (MPG) of about 105 mg%. For this the fasting plasma glucose should be around 90 mg/dl and postprandial peaks around 120 mg/dl. Patients were randomly assigned to receive glibenclamide (group A, n = 30) or insulin (group B, n = 30). In group A, glibenclamide was given 2.5 mg orally in morning and doses were increased weekly by 2.5 mg up to a maximum of 20 mg and doses >7.5 mg were given in two divided doses. In group B, insulin 0.7 units per kilogram of body weight at admission was given subcutaneously three times daily and increased weekly as necessary. Self monitoring of blood glucose with glucometer was done. Blood glucose was also measured from the laboratory every week. Glycosylated hemoglobin (HbA1c) was measured before initiation of therapy and repeated in the third trimester before confinement. Terminations of pregnancy in both the groups were done between 37 and 38 weeks. The infant birth weight, blood glucose and serum bilirubin were also recorded in all cases. Results The present study showed that the two groups had similar glycemic status (fasting blood sugar in group A was 103.5 ± 14.62 mg/dl and postprandial blood sugar was 184.1 ± 20.46 mg/dl whereas in group B it was109.3 ± 19.63 mg/dl and 194.3 ± 18.47mg/dl) at the time of entry into the study. The two groups also showed similar levels of glycemic control just before confinement (fasting blood sugar in group A was 88.23 ± 6.55 mg/ dl and postprandial blood sugar was 122.7 ± 10.3 mg/dl whereas in group B it was 88.17 ± mg/dl and 128 ± 12.38 mg/dl) and there was no significant statistical difference in the two groups (p > 0.05). The perinatal outcomes in both the groups were also nearly same. There was no significant difference in birth weight, blood sugar level of neonates and complications between the two groups. There was no case of macrosomia in the two groups and the number of infants large for gestational age (LGA) was four in group A and two in group B. Hypoglycemia in newborn was slightly higher in the group A compared to group B (4 and 3 respectively). Conclusion From our study, it is evident that the use of oral agents is a pragmatic alternative to insulin therapy in cases of gestational diabetes because of similar glycemic control, ease of administration and better patient compliance due to noninvasive treatment. How to cite this article Mukhopadhyay P, Bag TS, Kyal A, Saha DP, Khalid N. Oral Hypoglycemic Glibenclamide: Can it be a Substitute to Insulin in the Management of Gestational Diabetes Mellitus? A Comparative Study. J South Asian Feder Obst Gynae 2012;4(1):28-31.

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The effects of vitamin D supplementation on glycemic control and maternal-neonatal outcomes in women with established gestational diabetes mellitus: A systematic review and meta-analysis

Clinical Nutrition ◽

10.1016/j.clnu.2020.12.016 ◽

2020 ◽

Author(s):

Mengmeng Wang ◽

Zhaojing Chen ◽

Yan Hu ◽

Ying Wang ◽

Yinyin Wu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Vitamin D ◽

Glycemic Control ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Meta Analysis ◽

Vitamin D Supplementation ◽

Neonatal Outcomes

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Effect of Probiotic Supplementation on Newborn Birth Weight for Mother with Gestational Diabetes Mellitus or Overweight/Obesity: A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu12113477 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3477

Author(s):

Chun-Chi Wang ◽

Yu-Tang Tung ◽

Hua-Ching Chang ◽

Chang-Hsien Lin ◽

Yang-Ching Chen

Keyword(s):

Diabetes Mellitus ◽

Birth Weight ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Meta Analysis ◽

Mean Difference ◽

High Birth Weight ◽

Probiotic Supplementation ◽

Probiotic Intervention

High birth weight indicates the future risk of obesity and increased fat mass in childhood. Maternal gestational diabetes mellitus (GDM) or overweight are powerful predictors of high birth weight. Studies on probiotic supplementation during pregnancy have reported its benefits in modulating gut microbiota composition and improving glucose and lipid metabolism in pregnant women. Therefore, probiotic intervention during pregnancy was proposed to interrupt the transmission of obesity from mothers to newborns. Thus, we performed a meta-analysis to investigate the effect of probiotic intervention in pregnant women with GDM or overweight on newborn birth weight. We searched PubMed, EMBASE, Cochrane Library, and Web of Science databases up to 18 December 2019. Randomized controlled trials (RCTs) comparing pregnant women with GDM or overweight who received probiotic intervention during pregnancy with those receiving placebo were eligible for the analysis. Newborn birth weights were pooled to calculate the mean difference with a 95% confidence interval (CI). Two reviewers assessed the trial quality and extracted data independently. Seven RCTs involving 1093 participants were included in the analysis. Compared with the placebo, probiotics had little effect on newborn birth weight of pregnant women with GDM or overweight (mean difference = −10.27, 95% CI = −90.17 to 69.63, p = 0.801). The subgroup analysis revealed that probiotic intake by women with GDM decreased newborn birth weight, whereas probiotic intake by obese pregnant women increased newborn birth weight. Thus, no evidence indicates that probiotic intake by pregnant women with GDM or overweight can control newborn birth weight.

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Glycemic Control and Neonatal Outcomes in Women With Gestational Diabetes Mellitus Treated Using Glyburide, Metformin, or Insulin: A Pairwise and Network Meta-Analysis

10.21203/rs.3.rs-146509/v1 ◽

2021 ◽

Author(s):

Dan-Qing Yu ◽

Guan-Xin Xu ◽

Xin-Yuan Teng ◽

Jing-Wei Xu ◽

Liang-Fang Tang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Glycemic Control ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Meta Analysis ◽

Postprandial Blood Glucose ◽

Maternal Weight ◽

Insulin Group ◽

Standard Mean Difference ◽

Metformin Group

Abstract Aims: We aimed to assess the comparative efficiency and safety of the use of glyburide, metformin, and insulin in gestational diabetes mellitus (GDM).Methods: We searched for randomized controlled trials that compared glyburide, metformin, and insulin in GDM. Data regarding glycemic control and neonatal safety were collected and analyzed in pairwise and network meta-analyses.Results: A total of 4,683 individuals from 24 trials were included. Compared with glyburide, metformin reduced 2-hour postprandial blood glucose (2HPG) to a greater extent (standard mean difference (SMD) 0.18; 95% credible interval (CI) 0–0.36). There were significantly lower prevalences of neonatal hypoglycemia (risk difference (RD) −0.07; 95%CI−0.11–−0.03), neonatal intensive care unit (NICU) admission (RD−0.03; 95%CI−0.06–−0), and preeclampsia (RD−0.03; 95%CI−0.06–−0) in the metformin group than in the insulin group. The metformin group had significantly lower birth weight (SMD−0.25; 95%CI−0.41–−0.10) and maternal weight gain (SMD−0.61; 95%CI−0.86–−0.35) compared with the insulin group. Network meta-analysis suggested that metformin had the highest probability of successfully controlling glycemia and preventing neonatal complications.Conclusions: The present meta-analysis suggests that metformin may be as effective as insulin for glycemic control and is the most promising drug for the prevention of neonatal and maternal complications.

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Glycemic control and neonatal outcomes in women with gestational diabetes mellitus treated using glyburide, metformin, or insulin: a pairwise and network meta-analysis

BMC Endocrine Disorders ◽

10.1186/s12902-021-00865-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dan-Qing Yu ◽

Guan-Xin Xu ◽

Xin-Yuan Teng ◽

Jing-Wei Xu ◽

Liang-Fang Tang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Glycemic Control ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Meta Analysis ◽

Postprandial Blood Glucose ◽

Maternal Weight ◽

Insulin Group ◽

Standard Mean Difference ◽

Metformin Group

Abstract Aims We aimed to assess the comparative efficiency and safety of the use of glyburide, metformin, and insulin in gestational diabetes mellitus (GDM). Methods We searched for randomized controlled trials that compared glyburide, metformin, and insulin in GDM. Data regarding glycemic control and neonatal safety were collected and analyzed in pairwise and network meta-analyses. Results A total of 4533 individuals from 23 trials were included. Compared with glyburide, metformin reduced 2-h postprandial blood glucose (2HPG) to a greater extent (standard mean difference (SMD) 0.18; 95% credible interval (CI) 0.01, 0.34). There were significantly lower prevalence of neonatal hypoglycemia (risk difference (RD) − 0.07; 95%CI − 0.11, − 0.02) and preeclampsia (RD − 0.03; 95%CI − 0.06, 0) in the metformin group than in the insulin group. The metformin group had significantly lower birth weight (SMD − 0.17; 95%CI − 0.25, − 0.08) and maternal weight gain (SMD − 0.61; 95%CI − 0.86,− 0.35) compared with the insulin group. Network meta-analysis suggested that metformin had the highest probability of successfully controlling glycemia and preventing neonatal complications. Conclusions The present meta-analysis suggests that metformin may be as effective as insulin for glycemic control and is the most promising drug for the prevention of neonatal and maternal complications.

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The effects of vitamin and mineral supplementation on women with gestational diabetes mellitus

BMC Endocrine Disorders ◽

10.1186/s12902-021-00712-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dandan Li ◽

Zixin Cai ◽

Zhenhong Pan ◽

Yan Yang ◽

Jingjing Zhang

Keyword(s):

Oxidative Stress ◽

Diabetes Mellitus ◽

Glycemic Control ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Meta Analysis ◽

Cochrane Library ◽

Mineral Supplementation ◽

Vitamin And Mineral Supplementation ◽

And Oxidative Stress

Abstract Background The effects of vitamin and mineral supplementation on women with gestational diabetes mellitus (GDM) have not been well established. We conduct a meta-analysis to evaluate the effects of vitamin and mineral supplementation on glycemic control, inflammation and oxidative stress for women with GDM. Methods A systematic search of randomized controlled trials (RCTs) was conducted from PubMed, Embase, Web of Science and Cochrane Library up to July, 2020. Various results were pooled by using Review manager 5.3 and Stata 12.0. Mean difference (MD) with 95% confidence interval (CI) was estimated. Heterogeneity between studies was assessed by I-squared (I2) tests. Results Six hundred ninety-eight patients from 12 trials were included in our meta-analysis. Magnesium, zinc, selenium, calcium, vitamin D and E (alone or in combination) were found to significantly improve glycemic control in women with GDM compared to those receiving placebos: fasting plasma glucose (FPG) (MD = - 9.02; 95% CI: - 12.09, - 5.96; P < 0.00001), serum insulin (MD = - 4.33; 95% CI: - 5.35, - 3.32; P < 0.00001), homeostasis model assessment-insulin resistance (HOMA-IR) (MD = - 1.34; 95% CI: - 1.60, - 1.07; P < 0.00001), and homeostasis model of assessment for β cell function (HOMA-B) (MD = - 15.58; 95% CI: - 23.70, - 7.46; P = 0.0002). Vitamin and mineral supplementation was found to attenuated inflammation and oxidative stress through decreasing high-sensitivity C-reactive protein (hs-CRP) (MD = - 1.29; 95% CI: - 1.82, - 0.76; P < 0.00001), malondialdehyde (MDA) (MD = - 0.71; 95% CI: - 0.97, - 0.45; P < 0.00001), and increasing total antioxidant capacity (TAC) (MD = 45.55; 95% CI: 22.02, 69.08; P = 0.0001). Conclusions This meta-analysis shows that vitamin and mineral supplementation significantly improved glycemic control, attenuated inflammation and oxidative stress in women with GDM.

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