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Obstetrics & GynaecologyMS OBG

Maternal and Foetal Outcomes in Gestational Diabetes Mellitus: Comparing Insulin vs Metformin Therapy in a Tertiary Care Centre

Dr. Kavitha Subramaniam¹, Dr. Nalini Devi¹, Dr. Rakesh Singh²

¹ Dept. of Obstetrics & Gynaecology, JIPMER, Puducherry · ² Dept. of Endocrinology

P4

FOGSI Annual Conference 2025 — Federation of Obstetric & Gynaecological Societies of India

Background
  • GDM prevalence has doubled in India over 10 years — now affects 10–14% of pregnancies in South India (FOGSI 2023)
  • NICE and ADA guidelines recommend metformin as an alternative to insulin, but Indian obstetric practice still defaults to insulin
  • Comparative safety data for maternal outcomes, birth weight, and NICU admission between the two treatments is lacking in Indian populations
Objective

To compare maternal outcomes (glycaemic control, preeclampsia, caesarean rate) and foetal outcomes (birth weight, NICU admission, neonatal hypoglycaemia) between insulin and metformin therapy in GDM.

Methods
Design:Prospective comparative cohort study
Setting:Obstetrics ward & ANC clinic, JIPMER, Puducherry
Period:January 2024 – December 2024
Sample:n = 120 (60 insulin, 60 metformin) — based on caesarean section rate difference of 15%, α = 0.05, power 80%
Statistics:Independent t-test for continuous variables, Chi-square for categorical, binary logistic regression (SPSS v27)
Key Findings
Glycaemic Controlp = 0.18 (NS)

HbA1c 6.1 vs 6.4%

Both groups similar at term

LSCS Ratep = 0.038

Insulin 48% vs Metformin 38%

Metformin group lower

NICU Admissionp = 0.041

Insulin 22% vs Metformin 13%

Less neonatal hypoglycaemia

LGA Neonatesp = 0.029

Insulin 20% vs Metformin 12%

Macrosomia less in metformin

Results

Glycaemic control was comparable between insulin and metformin (HbA1c 6.1 vs 6.4%, p = 0.18). Metformin was associated with significantly lower caesarean section rate (38% vs 48%, p = 0.038), NICU admissions (13% vs 22%, p = 0.041), LGA neonates (12% vs 20%, p = 0.029), and neonatal hypoglycaemia.

Conclusion

Metformin achieves equivalent glycaemic control as insulin in GDM with significantly better maternal and foetal outcomes — lower caesarean rate, fewer NICU admissions, and less macrosomia. Metformin should be considered first-line pharmacotherapy for GDM in Indian obstetric practice.

Take-Home Message

Metformin matches insulin for blood sugar control but cuts C-section rates by 10% and NICU admissions by nearly half.

References
  1. 1. Rowan JA et al. Metformin versus insulin for gestational diabetes (MiG trial). NEJM. 2008;358:2003
  2. 2. FOGSI GDM Task Force. Management of gestational diabetes in India. JOGI. 2024;74(1):12

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Poster 4 of 5 · Obstetrics & Gynaecology