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17th Apr 2019

Introduction: Gestational diabetes mellitus (GDM) management consists of advice on diet and exercise, followed by pharmacotherapy if hyperglycaemia persists. Previous studies have highlighted maternal differences between treatment groups however only a few of them involved metformin-treated patients, in a UK clinical setting. This UK-based study aimed to identify relationships between maternal characteristics and GDM treatment modalities. Methods: Maternal records from Born in Bradford cohort participants receiving treatment for GDM during their singleton pregnancies were studied (N=727). Treatment groups consisted of lifestyle modifications (diet and/or exercise), pharmacotherapy (insulin and/or metformin) and combined treatment (lifestyle modifications and pharmacotherapy). Differences between groups were evaluated using Pearson’s χ2 and Fisher’s exact tests for categorical variables and Kruskal-Wallis test for continuous variables. Multinomial logistic regression examined maternal predictors of GDM treatment. Results: Mothers receiving lifestyle modifications (N=196) and combined therapy (N=209) were younger than mothers receiving pharmacotherapy (N=322). 57.4% of women treated with pharmacotherapy were obese compared to 17.7% and 24.9% of women in lifestyle modifications and combined therapy groups, respectively. Pakistani women were less likely to be treated with pharmacotherapy than lifestyle modifications (RRR 0.6(0.3-1.3)). Higher fasting glucose levels at diagnosis increased the risk of combined treatment compared to lifestyle modifications (RRR 1.9(1.3-2.6)). Conclusions: Being older and having a less healthy clinical profile increased the risk of treatment involving insulin and/or metformin for women with GDM.

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