Main Article Content

Anjum Rehman
Saher Fatima
Zeeshan Ahmed
Ambreen Rehman
Habiba Rehman


Citrus Paradise, Gestational diabetes mellitus, Metformin


Objective: Feto-maternal outcomes and Glycemic control in Metformin versus citrus paradise treated Gestational Diabetics

Methodology: This cohort study was conducted from March 2019 to February 2022 at the Department of Obstetrics & Gynecology, Lyari General Hospital Karachi.  Pregnant patients presenting in the antenatal clinic at 22-34 weeks of gestation with a singleton pregnancy were subjected to a 75gm oral glucose tolerance test (OGTT). Group 1 was started with Metformin at a dose of 500mg to a maximum dose of 2500mg daily. Group B was given 4 glasses (One glass equal to 250gram) of grapefruit juice daily for pharmacologic effects along with Metformin. Glycosylated hemoglobin (HbA1c), FBS and RBS were measured at the entry to the study and was repeated at each antenatal visit till 36 – 37 weeks of gestation. Maternal and perinatal outcomes were recorded on a predesigned proforma.

Results: In our study, most patients with primigravida 330(66%) and 380(76%) were Group A and B respectively. Fetal outcome mean 7.1±0.78 Apgar score was good in Group-B grapefruit with Metformin as compared with Group-A metformin 7.00±0.79. The mean Weight of the baby was 3±0.23 kg in group A, while 3.1±0.25 kg in group B. When maternal outcomes were tabulated there were significant differences between Group-A and B for HbA1C, FBS and RBS at term, significantly higher in Group-A.

Conclusion: There were lesser neonatal complications and better outcome observed in grapefruits along with metformin group as compared to metformin group in patients with gestational diabetes mellitus.



Abstract 159 | pdf Downloads 78


1. Landi SN, Radke S, Engel SM, Boggess K, Stürmer T, Howe AS, et al. Association of long-term child growth and developmental outcomes with metformin vs insulin treatment for gestational diabetes. JAMA Pediatr. 2019 Feb 1;173(2):160-8.
2. McIntyre HD, Moses RG. The diagnosis and management of gestational diabetes mellitus in the context of the COVID-19 pandemic. Diabetes Care. 2020 Jul 1;43(7):1433-4. https://doi.org/10.2337/dci20-0043
3. Szmuilowicz ED, Josefson JL, Metzger BE. Gestational diabetes mellitus. Endocrinol. Metab. Clin. 2019 Sep 1;48(3):479-93.
4. Riaz M, Nawaz A, Masood SN, Fawwad A, Basit A, Shera AS. Frequency of gestational diabetes mellitus using DIPSI criteria, a study from Pakistan. CEGH. 2019 Jun 1;7(2):218-21. https://doi.org/10.1016/j.cegh.2018.06.003
5. Razaq S, Masood Z, Malik A, Hameed-Ur-Rehaman NR, Jamil N. An Investigation on the Prevalanceof Gestational Diabetes Mellitus in the Pregnant Women of Province Balochistan. World J Med Sci 2015; 12: 198-203.DOI: 10.5829/idosi.wjms.2015.12.2.93229
6. Qazi A, Fahim A, Qureshi A. Gestational Diabetes Mellitus; Still a great problem. Prof Med J 2016; 23: 15-9. DOI:10.17957/TPMJ/16.3055
7. Fatima SS, Rehman R, Alam F, Madhani S, Chaudhry B, Khan TA. Gestational diabetes mellitus and the predisposing factors. JPMA. 2017;67(2):261-5.
8. Brown J, Martis R, Hughes B, Rowan J, Crowther CA. Oral anti-diabetic pharmacological therapies for the treatment of women with gestational diabetes. Cochrane Database Syst Rev. 2017;1:CD011967. https://doi.org/10.1002/14651858.CD011967.pub2
9. Poolsup N, Suksomboon N, Amin M. Efficacy and safety of oral antidiabetic drugs in comparison to insulin in treating gestational diabetes mellitus: ameta-analysis. PLoS One. 2014;9(10):e109985. https://doi.org/10.1371/journal.pone.0109985
10. Balsells M, García-Patterson A, Solà I, Roqué M, Gich I, Corcoy R. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ. 2015; 350:h102. https://doi.org/10.1136/bmj.h102
11. Committee on Practice Bulletins—Obstetrics. Am Congress of Obstetricians and Gynecologists: practice bulletin No. 180: gestational diabetes mellitus. Obstet Gynecol. 2017;130(1):e17-37.
12. McKinlay CJD, Alsweiler JM, Anstice NS.Children With Hypoglycemia and Their Later Development (CHYLD) Study Team. Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatr. 2017;171(10):972-983.
13. Grapefruit; Defeat Diabetes Foundation. https://defeatdiabetes.org/resources/healthful-eating/fruits/grapefruit/
14. Fujioka K et al.; The effects of grapefruit on weight and insulin resistance: relationship to the metabolic syndrome. J medic food.006 Mar 1;9(1):49-54.
15. Medscape. https://reference.medscape.com/drug/citrus-paradisi-pomelo-grapefruit-344597#0
16. Tadeu Volpato G, Queiroz Moraes-Souza R, Sousa Soares T, Leal-Silva T, Cristina Damasceno D. Medicinal plants for diabetes treatment during pregnancy. Curr Med Chem. 2017 Feb 1;24(4):404-10. https://doi.org/10.1371/journal.pone.0179785
17. Moradi B, Abbaszadeh S, Shahsavari S, Alizadeh M, Beyranvand F. The most useful medicinal herbs to treat diabetes. Biomed. Res. Ther. 2018 Aug 21;5(8):2538-51.
DOI : 10.15419/bmrat.v5i8.463
18. Wasim TA, Shaukat SH, Javaid LU, Mukhtar SA, Amer WA. Comparison of metformin and insulin for Management of Gestational Diabetes Mellitus: a randomized control trial. PJMHS. 2019;13:823-7.
19. Khan MK, Zill-E-Huma, O. Dangles A comprehensive review on flavanones, the major citrus polyphenols. J. Food Compos. Anal. 2014;33(1):85-104.
20. Gao Z, Gao W, Zeng L, Li P, Liu PH. Chemical structures, bioactivities and molecular mechanisms of citrus polymethoxyflavones. J Functional Foods2018;498-509.
21. Turner T, Burri B. Potential nutritional benefits of current citrus consumption Agriculture. 2013;3(1):170-187. https://doi.org/10.3390/agriculture3010170
22. Ashoush S, El-Said M, Fathi H, Abdelnaby M. Identification of metformin poor responders requiring supplemental insulin during randomization of metformin versus insulin for the control of gestational diabetes mellitus. J ObsGynecol Research. 2016; 42(6):640-7.
23. Reece SW, Parihar HS, LoBello C. Metformin in Gestational Diabetes Mellitus. Diabetes Spectr. 2014; 27(4): 289-295. doi: 10.2337/diaspect.27.4.289
24. Ainuddin J, Karim N, Hasan AA, Naqvi SA. Metformin versus insulin treatment in gestational diabetes in pregnancy in a developing country. A randomized control trial. Diabetes Res Clin Prac. 2015; 107:290-299. https://doi.org/10.1016/j.diabres.2014.10.001
25. Li G, Zhao S, Cui S, Li L, XuY. Effect comparison of metformin with insulin treatment for gestational diabetes: a meta-analysis based on RCTs. Arch GynaecolObstet .2015; 292(1):111-20. https://doi.org/10.1007/s00404-014-3566-0